MECHANICAL'Inspection Number: INSP -9269
Inspection Date: 02/13/2006
Inspector: Perez, JanPierre
Owner: ROLPH, RODNEY & FRANCES
Job Address: 453 92 Street NE
Project: <NONE>
Contractor: COMMUNITY AC
Building Department Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
($75)
Miami Shores Village, FL
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspector Coin re.nts
Block: Lot:
� [)N tJ
Isuift i \u\AA9/(lx/N'
Utiipdhoiv\i Ciehmj
e a4 )
Permit Number: MC2005-54
Permit Type: Mechanical - Residential
Inspection Type: Rough
Work Classification: Addition /Alteration
Phone Number (305)762 -6756
Parcel Number 1132060140260
Phone: 305- 207 -7445
Wednesday, February 8, 2006 Page 2 of 2
Date
APPROVED:
Zoning
Mechanical
Owner's Address
Contracting Vt
WORK DESCRIPTIO
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address . 3
Legal Description Historically Designated: Yes
Owner/Lessee / Tenanf ! L p h O'? I P i 1
cT
AP II sir r IPP
Qualifier ` / � '� j l .� CPr k)a ss# , Phone O
State # CAC 9 SS O Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING
N)c-tio z-Vc-
Square Ft. Estimated Cost (value) ,( --co
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER
OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work
will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL
PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
Plumbing
No
Tax Folio
to Contractor
My Commission Expire
4 No
7 gd3)
Master Permit #
Phone
Address 2 i ZU S 02, A V
ROOFING PAVING FENCE SIGN
or o er- : ui er a
CO ;r12!; iZ 'C'N NC. ^,C/;.f,;..M
C.C.F. NOTARY BOND
— Date
FEES: PERMIT ' C RADON
Building Electrical
aa��
TOTAL DUE /D o. ,
Structural Engineer
NEW SYS[Dri
+ � � and coop load calcIIL r ans
j t ic l aas for new bral ao -or moons
tee:.
:MIAMI SHORES VILLAGE
RE QULREItifEiNTS FOR l.ECE4 `� ECAL PERNIti. S
1/42T thawing. duct wads, s= of .., _s pe: c d , Ic att of ±
hrT r t and condensiag wait ca rear of grape ty -
1\1f ' Snores Air Candra Regulations let= steed by qua.Eer. and home
T q n ? trait bed placed as the side of the a _`ems the nest
door nei cr with their name, ads, and c_ ci.4. i dm they
hzve uo abSewans tq the unit being ms fled ia. the side
+ L , Xrmateci vile of job is over S? 00.00, the Nock° of C: eacemc t
b _red. . w..d submitted. with putt arrplicadcn_
�cb de`c±ucn. as permit anofi ".1. ne--sc to iaciade
C'ECANCT OUTS
of to and sus_
♦ An le�cai permit by licensed cater rLL be outer far hook,*
Side of one owner and aw..li:Ee: rlo
Cccd n unit oast be located in rear ofpraoe ty cr whew cid unit is -
worn des dcm: iachde numb of tons and SWs
Nodal of C ence .ent recorded iz jab ove; S2,500.00
ITEM
BATH TUB
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS
CENTRAL HEATING Lp 160,I
DISHWASHER
RECEPTACLES
A/C (WIND)
DISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL) '712»3
DRINKING FOUNTAIN
SERVICE SIZE IN AMPS
DUCT WORK ;p0D
FLOOR DRAIN
SERVICE REPAIR/METER CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TOP
UNDERGROUND TANKS
LAVATORY
OVEN
ABOVE GROUND TANKS
LAUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
MOTORS 0- 1 HP
STEAM BOILERS
SHOWER
MOTORS OVER 1- 3 HP
HOT WATER BOILERS
SINK, POT /3 COMP.
MOTORS OVER 3- 5 HP
MECHANICAL VENTILATION
SINK, RESIDENCE
MOTORS OVER 5- 8 If
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTORS OVER 8- 10 HP
ELEVATORS/ESCALATORS
TEMPORARY WATER CLOSET
MOTCRS OVER 10- 25 HP
FIRE SPRINKLER SYSTEMS
URINAL
MOTORS OVER 25-100 HP
COOLING TOWERS
WATER CLOSET
MOTORS OVER 100 HP
VIOLATION
INDIRECT WASTES
A/C WINDOW
REINSPECTION
WATER SUPPLY TO:
AIR CONDITIONERS
A/C UNIT
STRIP HEATER
FIRE SPRINKLER
GENERATORS TRANSFORMERS
HEATER -NEW INST.
GENERATORS TRANSFORMERS
HEATER - REPLACE
GENERATORS TRANSFORMERS
LAWN SPRINKLER -WELL
SPECIAL PURPOSE
SWIMMING POOL
OUTLETS COMMERCIAL
WATER SERVICE
SIGN TUBES
SEWER CONNECTIONS
SIGN TRANSFORMERS
UTILITY-SEWER-
SIGN TIME CLOCK
UTILITY -WATER
FIXTLRES
SEPTIC TANK
ANTENNA
RELAY
TELEVISION OUTLETS
DRAINFIELO, 4" TILE/RES.
VIOLATION
PUMP S ABANDON SEPTIC TANK
REINSPECTION
SOAKAGE PIT CU. FT.
CATCH BASIN
DISCHARGE WELL
DOMESTIC WELL
AREA DRAIN
ROOF INLET
SOLAR WATER HEATER
FIRE STANDPIPE
POOL PIPING
-AWN SPRINKLER SYSTEM
1AS RANGE
4ETER SET (GAS)
AS PIPING
.ADDENDUM TO BUILDING PERMIT APPLICATION
(AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B.
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ELECTRICAL
MECHANICAL
0 c 751 Ar
Sec. 6 -3 Air Conditioning Regulations.
(a) All individual air conditioning units installed in walls or windows shall be securely aiichored
to the walls by approved methods. Units installed over public property, paths of egress or more
than ten (10) feet above grade shall be secured to the structure by bolts or screws to resist horizontal
wind loads. Such units cantilevering more than eight (8) inches on the exterior of a building shall
be supported by steel angle brackets secured by bolting. Bolts to masonry shall be set in lead shields
or similarly rot - resistant fastenings.
(b) The Illowing special requirements shall apply to the control and regulation of noise nuisance
from air conditioning machinery.
(1) All equipment, existing or hereafter installed, re22sdless of Location, shall be
maintained in good working order. Equipment so located that normal operating
noises create a nuisance to adjacent owners or occupants shall be provided with
soundproofing, or sound-absorbing baffels, or enclosures, as approved to insure
maintenance of a reasonable noise leveL
(c) : Violation of this section ch all be punished as is now or may hereafter be provided by law
(Ord. No. 299, Sec. 1 -3, 2- 21 -61).
(2) Air eqiipirent on outer walls, on roofs, or in the other exposed locations, which are
unduly noisy, and which causes valid complaints from adjoining property owners or
occupants may be required to be relocated, redesigned and/or enclosed in noise -
retarding materials when, in the opinion of the building official, such enclosure is
necessary or would be effective.
(
Miami Shores Village
Special consideration shall be given to the planning of all future installations to
minirniZil the noise nuisance to adjoining property owners or occupants and the
binding official chali have authority to reject or require the redesign daily system
which, in his opinion, would cause such a noise nuisance.
PERMIT APPLICATION FOR MIAMI SNORES VILLAGE
D, 9/9/98 Sob Ae3d 4 453 N.E. 92 8T. Tex Polio
IcsalDmaiptim Historically Demisted; Yes No_
Master Permit # L 2 S�� d ..
rune 757 -7194
Oonen �e / Tenumt
Owner's Martel
C erectI g tom.
LEHRER - FR sack Ic
.453 N.E. 92 STREET
R.L.A. AIR COND., INC.
Quigm RICHARD ARNETTE ss# 305- 266 -6627
•gam# CAC 022414 ] ici #
P� C'asp'in In.t Cor$ttscontinent l
Att;hiteatl giaear Addrma
Bcaadirg CorPa1Y _
Meutgagex
Permit Type (circle one); BUILDING ELECTRICAL PLUMBING CHANIC
WORK DBSCR ON EXACT REPLACEMENT OF 2 TON COND. UNIT
schism Ft
-,—._
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO 1
$O MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (=g you 1N1E:
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YCt
NOTICE OF COMMENCEMENT) .
Application is hereby made to obtain a permit to do work and installation as indicated above, a
on the attached addendum (if applicable). I certify that all work will be performed to meet t
standards of all laws regulating construction in this jurisdiction. I underata, that ee a
permits are required for ELECTRICAL. PLUMBING, SIGNS, POOLS, ROOPINC and MECHANICAL NOR. r°
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work wi
be done in compliance with all applicable laws regulating construction and onip�. Our
authorize the above -na d contractor to do the work 'stated. ` R /_,
. , .3/9 /7
Signature of own = and /or Condo President
o ky as t • Owner and /or Condo President
My Commission Expires:
** * * fe. *
PEW: PERMIT ?S
APPROV3D:
T O O T)
RADON
Zoning
Mechanic.
Other
8lectrica '
8 nsinearin��_
o2I3S -no:, H3T3 '8 D3S S1 S9f L 9CS SOC TFd 60 TT .ow 86
Addtevs 7351 N.W. 7 ST. "R" MIAMI
Address
Address
Famed Cast (veIu $970.
ROOFING MVn c FENCE SIGN
Si r ure! of Contractor or Owner
.r
Notary as ro Cont»•aat •
-*Neil • Patricia S. Haney >t
Notary Public, State of Florida ,<
Q Commission No. CC 596246 }
* pmt * ir0.° MytlommissioiExp. I2/77000 i'
. Bonded Through Fla. Notary Service & Bonding Co. a
C. C. 1. J . D ririrrrrirrrriiirAr D rrr � rrri r
NOTARY
ermare,_
PERMIT NO.
ADDRESS:
MIAMI SHORES VILLAGE
BUILDING / ZONING DEPARTMENT'
SECTION
BY
DATE
ZONING
ELECTRICAL
.
MECHANICAL
PLUMBING
FIRE
PUBLIC WORKS
STRUCTURAL
BUILDING OFFICIAL
1. Subject to compliance with ett Federal, State.
County, Vil(age lutes end tegutattons. Mtge ett
no responstb(tlty for isometry oflor resutts (tact
these Gans
2. Th1s copy of plans meat ha ayaUabts oa
buffeting site or no Inspection tall be coctdocteet.
APPLICANT 0 c e•'" �oL "H
DATE
V R, i� s u. (e
2o>I)/i✓G
• CRITIQUE SHEET
•
1 G�
JOB ADDRESS X S 3 /" ' E' / 01 5 T7 F -y-
PHONE (t 7Co - i 75 Aee f(Ter r ' Piez 4Eu
APPUCATION #
SHEET OF
MISCELLANEOUS
COMMENTS
eL
el at
X3 0, e thf
(NITIA i
4 1(.4°6 ,e ve y x-,Ete_s
ms s¢/. .�1 erve s / o4//o r e tf ocieW
'7/t 0'c / ro,z. Itef is
d es", e , - •ekt s �
/Veit/- CO,(), ///G S P r - ° x ?
4 ' • ------ 5) JD /q s etc/ a e Ceti
QT/ n" J6I
, 1 Aga
t'rq 44./- iss zcP
'ci M 7 "ef-,141/2 / 1,e eZil A
624 cre, ,d r! L f ,641' f e ct rea
/Pic t' t X ) 7 S <Vey cer' ce ck <c, retiMa )
ark/ a /se e icr cA cy s
1 Dro et . C of / sScr e i oerr
�/1-s ce-ar Ar e //ter 5 uc_Acre aver S
�/`O�� / / frl e
CZTy of STATE OF FLORIDA
AND DADE COUNTY COMPE'tY
Flood E evation
U • .D Zi1C AND DO ING 'D _
_ CGFU N. 7. 2 ^ NENUE
7I (305) 79.5-'-'04 V. (lad
=DING PMET/=MACTORS 3'J TIS1'2 .TTCN
21:1
21ON 1.
CATION (DP R) STATE REGISMATION
Copy of current OCCUPATIONAL LIC ISE - - :.m county::: munic_pai_t,
business is located.
Certificate of Insurance for LIABILITY (addressed to M._`mi Shores
Village).
Certificate of Insoiance for 'S COMP (addressed to uiami
ShoresVillage) or if exempt-
State of Florida LES Form BC -204, Construct :on Industry Notice of
Election to be Exempt
PLEASE SUBMIT EVESCI'IHIriG CAECCED OFF
_,[_ Permit Application (signed by person performing the work, licensed
contractor and the property owner, both signatures notarized).
F/ Two sets of plans /drawings signed and sewed by registered architect or
engineer. Occupancies by Group Classification must be on plans and
pei` application. All plans must incicde folio number and property
address . Amended plans, in addition to the above, must also include the
pewit number.
Structural calculations signed and sealed by architect or engineer when
applicable.
Current survey of the property.
N/ Certificate of Elevation signed and sealed by Sv-- veyor.
1 Substantial Improvements Checklist (contractor or owner)-
s
Two sets of energy calculations_
Try sets of signed & sealed Tznss Plans (Engineer).
DADE County or State of Florida Products Approvals for roof materials,
sheds, windows, exterior /garage doors, aluminum "=torts, screen_
enclosures, shutters awnings, skylights, french cars and etc.
A_arovals from MRS, DARE County Impact Fee Section, Fire Depart &
Health Department (when applicable). DERM
Warranty Deed or Other Proof of Ownership if necessary.
Structural Review fee � /00
Notice of Commencement
M. - 7 9 / - 9.- o
1 / 53 hig
Blum Building Contractors, Inc.
275 Northeast 92nd Street
Miami Shores, Florida 33138
State Certified Building Contractors
CBC 057429
(305) 756 -9321 (fax) 751 -1546
Miami Shores Village
Building Department
10050 N E 2 ° Ave.
Miami Shores, FL 33138
RE: 453 N.E. 92nd St.
Miami Shores, F133138
Legal Description: East Y2 of 18 and all 19 & 20 lots, Miami Shores, Sec 2, and PB 10 -37
CONTRACTOR'S AFFIDAVIT
This affidavit shall attest to the best of my knowledge, belief and professional judgement
the renovations to the address referenced above will be in compliance and in strict
accordance with the approved permit plans. If for some reason the renovations are not in
compliance I Robert C. Blum will remove all work performed at said property at my own
expense.
This letter is being submitted to the Village of Miami Shores building department.
Sincerely,
Blum Building Contractors, Inc.
Robert C. Blum, President
This document was acknowledged before me this 16 day of August 2000, by Robert
C. Blum who is personally known to me and who did not take an oath.
OFR Nc!1'A tY SEAL
JULIE A i:.:;' I,.
NOTARY PUBLJe FLORIDA
OOMMiSr3 ?t)N NO 0040
u1 OO MiS5;Uiv t; I' MAY 11 A i.cl I
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building
Owner's Name (Fee Simple Titleholder)
Owner's ddre s 4 3 /Vff
City ./` f iiiti 5 Al ,
C
Tenant/Lessee Name
State
Job Address (where the work is being done)
City Miami Shores Village
Is Building Historically Designated YES
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 7.95.221) Fax: (305) 756.8972
■ - is nflR°
i
Electrical
tte c(
-2 t5Y
NO
Zip
46 A(c" s 7
County Miami -Dade
Contractor's Company Name / \�
Contractor's Address 11 3
City �. ! �
Qualifier N�SE -� `'
State Certificate or Registration No.
$ Value of Work For this Permit
Type of Work: A ddition ['Alteration
Describe Work: %.. ‘,1 vvF LA.
c l : a4 f occ (et 4 i! til
Submittal Fee $
Total Fee Now Due $
(Continued on opposite side)
C/ac�%S to \ ) Certifi
Permit Fee $
Training/Education Fee $
State \�
* * * * * * * * * * * * * * * * * * * * * * * * * ** *F
Plumbing
Phone # get/ 7 S
Architect/Engineer's Name (if applicable) C •
Permit No. NCO — S4-
Mastker Permit No. o /c4 0
Phone #
Phone #
Square Footage Of Work:
['New ❑ Repair/Replace ❑ Demolition
t7 c 't' V `b - ei'
*(56********* 24*
C
one
Technology Fee $
Mechanical
CO /CC
Roofing
Zip
900 sqe-
Notary $
Scanning $ Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $ ,�
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven 7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be appp ed and a re i tio ee will be charged.
Signature
Owner or Age
The foregoing instrument was acknowledged before me this
day of 01 f1 . , 20(1 1a 5 4 ,
who is personally known to me or who has produced
Ib
NOT • PUBLIC:
Sign:
Prin
My Co mission_
As identification and who did take an oath.
chc 05/13/03
TARY PUBLIC -STATE OF FLORIDA
Hernandez
nding Co., Inc.
Signature
The foregoing instrument was acknowledged before me this
day of , 205 , by 741j,S 5 J l o A9c/O1Z -Cr ,
who is personally known to me or who has produced PP %--
as identification and who did take an oath.
Ql�i•
NOTARY PUBLIC:
********************************* * * * * * * * * * * *m* * * * * * * * * * ** * * * **
f /i
APPLICATION APPROVED BY A I
i
Contractor
Sign:
Print:
My Commission Expires:
r
o�pt►�`Y ''�- Annette Diaz
Q _C .in scion #DD439999
,i ^� ° '
Expires: UNE 12 2009
ices:
m•wmTARY,co
Plans Examiner
Engineer
Zoning
Issue Date: 1/13/2006 Expires: 12/22/2006
Owner's Name: RODNEY & FRANCES ROLPH
Permit Type: Mechanical - Residential
Work Classification: Addition /Alteration
Job Address: 453 92 Street NE
Miami Shores Village, FL
Contractor(s)
COMMUNITY AC
Phone
305 - 207 -7445
Primary Contractor
Yes
Comments:
INSTALL NEW SPLIT SYSTEM 5 TON 12 SEER INCLUDING DUCT VENTILATION
REVISION:
RUN NEW DUCTS AND VENTS TO THE 900 SQ FT ADDITION
Additional Information
Tons: 5 TON
Classification: Residential
Additional Info:
In consideration of the issuance to me of this permit, I agree to perform the work
covered hereunder in compliance with all ordinances and regulations pertaining
thereto and in strict conformity with the plans, drawings, statements or specifications
submitted to the proper authorities of Miami Shores Village. In accepting this permit I
assume responsibility for all work done by either myself, my agent, servants, or
employes. I understand that separate permits are required for ELECTRICAL,
PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING
POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that
all work will be done in compliance with all applicable laws regulating construction
and zoning. Futhermore, I authorize the above -named contractor to do the work
stated.
Fees Due Amount
CCF $3.00
Education Surcharge $1.00
Permit Fee - Additions /Alterations $175.00
Revision Fee $35.00
Scanning Fee $3.00
Technology Fee $4.38
Total: $221.38
Building Department File Copy
Applicant Signature
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit
Invoice Number
MC - 12 - 05 - 23221
Total:
EJAN 3 0 PAID
C .C,•
Permit Status: APPROVED
Permit Number: MC2005 -54
Phone: (305)762 -6756
Parcel #: 1132060140260
Block: Lot:
Section: PB:
Total Square Feet: 900
Total Valuation: $ 5,000.00
Required Inspections
Rough
Rough Duct
Ventilation
Smoke Test
Hood
Smoke Det Test
Final
Amt Due
$221.38
Amt Paid
$7 &V
NOTICE: In addition to the requirements of this permit, there may be
additional restrictions applicable to this property that may be found in the
public records of this county.
AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER
GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT
DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES.
BUILDING x _ Permit No. 1110... 65- SL\
PERMIT APPLICATION
" Master Permr L
FBC 2001 ----„,
Permit Type (circle): Building gleciricai Pkimiiing Mechanical ) Roofing
Owner's Name (Fee Simple Titleholder) Phone # d �✓ _____ (0
Owner's dress 4c3 N6 q2 , J
City ��Lj,a krA4 S res State FL-
Tenant /Lessee Name
Job Address (where the work is being done)
City Miami Shores Village
Is Building Historically Designated YES
Contractor's Company Name nn ,
Contractor's Address _ Q'S GamQ
City oV` State —
e r
Qualifier
State Certificate or Registration No. C-74605) 4
Architect /Engineer's Name (if applicable)
$ Value of Work For this Permit
Type of Work: *Addition ❑Alteration
Describe Work:
ja rteLke0A1, ()VC; -t ctAkci
* * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $
Notary $ r Training /Education Fee $
Scanning $ Radon $
Code Enforcement $
Total Fee Now Due $
(Continued on opposite side)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
A 7 Z
lig NE X1 s I
County Miami • ade
NO
**F
Structural Plan Review. $
/
Zip 3V
Phone #
. / Phone # 8.6 177g
U
Certificate of Competency No.
w
Zip 3.1/
Phone #
Square Footage Of Work:
Or
CCF $
Z ip S3/
❑ Repair /Replace ❑ Demolition
s pdetk 5 -to �� I ? e o seg cS
Technology Fee $
Zoning Bond $
9 f9Qy
CO /CC
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEM ENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attach ent. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occ irs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved a d a reinspection fee will be charged.
Signature
APPLICATION APPROVED BY:
chc 05/13/03
Signature
Owner ' Agen 1 Contr
The foregoing instrument was ackno !1- -.4. 1 before me this The foregoing instrument was acknowledged before me this �.S'J
day of , 20 , iy : , day of / rii , 20 OS, b 4;4.40 4'o % (-.
who is personally known to e or w 11 j. produced who is personally known to me or who has produced 7
As i .'id who did take an oath. 1 fc...e a 1 as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
DE LOS REYL'S
Sign: \ .s Sign:
V Ib8 .•:� ;es;
Print: Print: i • 'i 2�..' ` /► . (8 , f At •
'•min +" Florida Notary
My Commission Expires: My Commissi xp res
* * * * * * * * * * * * * * **
Plans Examiner
Engineer
Zoning
ITEM
BATH TLE
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS
CENTRAL HEATING
DISHWASHER
RECEPTACLES
A/C (WIND)
DISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN AMPS
DUCT WORK
FLOOR DRAIN
SERVICE REPAIR/METER CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TOP
UNDERGROUND TANKS
LAVATORY
OVEN
ABOVE GROUND TANKS
LAUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
MOTORS C- 1 HP
STEAM BOILERS
SHOWER
MOTORS OVER 1- 3 HP
HOT WATER BOILERS
SINK, POT /3 COMP.
MOTORS OVER 3- 5 HP
MECHANICAL VENTILATION
SINK, RESIDENCE
MOTORS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTORS OVER 8- 10 HP
ELEVATORS/ESCALATORS
TEMPORARY WATER CLOSET
MOTORS OVER 10- 25 HP
FIRE SPRINKLER SYSTEMG
URINAL
ICTORS OVER 25-100 HP
COOLING TOWERS
WATER CLOSET
I
MOTORS OVER 100 FP
VIOLATION
INDIRECT WASTES-
A/C WINDOW
REINSPECTION
WATER SUPPLY TO:
AIR CONDITIONERS
A/C UNIT
I
STRIP HEATER
FIRE SPRINKLER
I GENERATORS TRANSFORMERS
f
I
HEATER -NEW INST.
GENERATORS TRANSFORMERS
I
t (
HEATER - REPLACE
I
GENERATORS TRANSFORMERS
LAWN SPRINKLER -WELL
I
j
SPECIAL PURPOSE
SWIMfi4ING POOL
OUTLETS COMMERCIAL
WATER SERVICE
SIGN TUBES
SEWER CONNECTIONS
SIGN TRANSFORMERS
UTILITY -SEWER
SIGN TIME CLOCK
UTILITY -WATER
FIXTLRES
SEPTIC TANK
ANTENNA
RELAY
TELEVISION OUTLETS
DRAINFIELD, 4' TILE/RES.
VIOLATION
PUMP & ABANDON SEPTIC TANK
REINSPECTION
i
SOAKAGE PIT CU. FT.
1
CATCH BASIN
DISCHARGE WELL
DOMESTIC WELL
)
I
AREA DRAIN
ROOF INLET
1
i
SOLAR WATER HEATER
FIRE STANDPIPE
POOL PIPING
1
LAWN SPRINKLER SYSTEM
I
I 1
GAS RANG
METER SET (GAS)
I
GAS PIPING
' ADDENDUM TO BUILDING PERMIT APPLICATION
6
(AN APLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B.
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ELECTRICAL
MECHANICAL
/ Tess: 453 92 Street NE
Project: <NONE>
SP -3930
2/0 /2006
/JanPierre
i ROLPH, RODNEY & FRANCES
Miami Shores Village, FL
Contractor: COMMUNITY AC
Building Department Comments
Monday, February 6, 2006
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Pho : (305)795 -2204 Fax: (305)756 -8972
Permit Type: Mechanical - Residential
Inspection Type: Rough
Work Classification: Addition /Alteration
Block:
Phone Number (305)762 -6756
Parcel Number 1132060140260
Lot:
Phone: 305 - 207 -7445
Page 2 of 2
Passed
Inspector Comments
P/
.....7re
c
(14414
11((([‘/'
)
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
/ Tess: 453 92 Street NE
Project: <NONE>
SP -3930
2/0 /2006
/JanPierre
i ROLPH, RODNEY & FRANCES
Miami Shores Village, FL
Contractor: COMMUNITY AC
Building Department Comments
Monday, February 6, 2006
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Pho : (305)795 -2204 Fax: (305)756 -8972
Permit Type: Mechanical - Residential
Inspection Type: Rough
Work Classification: Addition /Alteration
Block:
Phone Number (305)762 -6756
Parcel Number 1132060140260
Lot:
Phone: 305 - 207 -7445
Page 2 of 2
Inspection Date: 04/12/2006
Inspector: Perez, JanPierre
Owner: ROLPH, RODNEY & FRANCES
Job Address: 453 92 Street NE
Project: <NONE>
Miami Shores Village, FL
Contractor: COMMUNITY AC
Building Department Comments
Tuesday, April 11, 2006
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Ph • e: (305)795 -2204 Fax: (305)756 -8972 + 4; i , it j
t
Permit Type: Mechanical - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Block:
Phone Number (305)762 -6756
Parcel Number 1132060140260
Lot:
Phone: 305 - 207 -7445
Passed
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
Page 1 of 2