MECHANICALBUILDING !
PERMIT APPLICATION
FBC 2001
Tenant/Lessee Name
$ Value of Work For this Permit
Type of Work:
Describe Work:
['Addition
Total Fee Now Due $
(Continued on opposite side)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Sho Florida 33138
Tel: (305) 795.2204 Fax: (3305)'756.8972
�a L . !l \) J
i k35
Permit No. @J Came — `3 S
Master Permit No.
Permit Type (circle): Building Electrical Plumbing
Owner's Name (Fee Simple Titleholder) ' tJ r , C u Pho
Owner's Address (' I 1 N - 5 S' f r- �-4—
Qx
Cit VIA \ CUM 1 S ` 1(1Dr CS State F L-
Zip 351
Phone #
Job Address (where the work is being done) 101 1 NE E 95 S'fr-ee.-i-
City Miami Shores Village County Miami -Dade Zip 3 (�j0
Is Building Historically Designated YES NO
Contractor's Company Name Ze (V IC,€
Contractor's Address a4 (0 0 Sw rl 5 Ave_
City m I Otin State F
Qualifier ,( (\ IS (_ AiI 5 fal
Architect/Engineer's Name (if applicable) ` 4fr Phone #
Phone #
Zip 3 5 S�
Square Footage Of Work:
['Alteration New [ Repair/Replace ['Demolition
I5A ac, Q C v o(eA
Roofing
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ , °I) Permit Fee $ /Io 4' CCF $ 3. an CO /CC
Notary $ Training/Education Fee $ I , () C Technology Fee $3,
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 approved and a reinspection fee will be charged.
Signature
NOTARY PU Jessica Ram0 NOTARY PUBLIC:
• .�
Sign: ;; •�=' ommission # DD 025225 Sign; -
9r Expires May 13, 2005
Print: . y .... O Q.� Bonded Thra .i Print.
, 04, 1 `' Atlantic Bonding Go., 146 '
My Commission Expires:
Chc 12/15/03
Signature
'RA.I'eAl
wner or Agent
The foregoing instrument was acknowledged before me this ') The foregoing instrument was acknowledged before me this '5
day of Ma-1/0 20 04 , by � e r( MCC- 0/.. cta iay of b a` , 20 , by Dill Vl ►� CrP
personally who is kno t me o ho has pro o uce.
p y c' p 1 � � io is personally known to m •� or who has produced
bL (LA a_ 0 QCs 1dentific and who did take an oath. 'dentification and who did take an oath.
Contractor
+ = ssica Ramos
5225
Expires May 1 , 2005
My Commission Expires: °��►� untie Bonding Go., Iaa
**** * * * *it * * * * * * * * * * * * * * * * * * * * * * * * **
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY: .-**> L( 1--c-G`r "� Plans Examiner
Engineer
Zoning
ITEM
BATH TUB
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS
CENTRAL HEATING /0 KW
DISHWASHER
RECEPTACLES
A/C (WIND)
DISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL) 5 Iv Al
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 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 HP
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTORS OVER 8- 10 HP
ELEVATORS/ESCALATORS
TEMPORARY WATER CLOSET
MOTORS OVER 10- 25 HP
FIRE SPRINKLER SYSTEMS
URINAL
MOTORS OVER 25-100 HP
COOLING TOWERS
WATER CLOSET
MOTORS OVER 100 If
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
DRAINFIELD, 4' TILE/RES.
VIOLATION
PUMP & 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
LAWN SPRINKLER SYSTEM
GAS RANGE
METER.SET (GAS)
GAS PIPING
4
.� t 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
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 3/9/2004
Applicant:
Owner:
JOB ADDRESS: 1071 NE 95
Contractor SERVICE EXPERTS LLC
Local Phone: 305 - 264 - 2020
Parcel # 1132060143610
Mechanical Permit
Permit Number: MC2004 -35
ST
Contractor's Address: 4600 S. W. 75 AVE.
Legal Description: MIAMI SHORES SEC 3 PB 10 -37 E1/2 OF LOT 25 & LOT 26 & 27 BLK
Fees: Description Amount
FEE2004 -2441 Building Fee $150.00
FEE2004 -2442 CCF $3.00
FEE2004 -2443 Training and Education Fee $1.00
FEE2004 -2444 Technology Fee $3.75
Total Fees: $157.75
Total Fees: $ j. j
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration: 9/1/2004 Construction Value: $4,435.00
Work: CHANGEOUT 5 TON NC SYSTEM W /10 KW HEAT LENNOX
Signed: (INSPECTOR)
Page 1 of 1
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 responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
Owner's Name and Address.
New Building
MIAMI SHORES VILLAGE
BUILDING11CTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Registered Architect and /or Engineer
Name and address of licensed contracto
Chairman
Member
Member ........
Date.
Street
Location and legal description of lot to be built on:
Lot Block division
Street and Number where work is to be done 0 �/
State work b done and purpose,ol'building (by floors) -.. ..-e1
and for no other purpose.
Remodeling Addition Repairs
No. of Stories
To be constructed of Kind of foundation J R
Estimated Total cost of improvements $ 0 " Amount of Permit $
Zone cubage required _Plan Cubage
Distance to next nearest building Size of Building Lot
k/ Covering
Maximum live load to be borne by each floor
I hereby subm' the plans • d s *cations for said 'Ming. otices withreferenc to the bu } Iding end it structi may
be sent to
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for in ection on the site of' the work such bli ; notice
or notices as are required by the Act. The undersigned agrees to employ only such sub ntractoyS, on work 1O be rfor 1 er this
permit, as are licensed by Miami Shores Village.
Remarks ( Signed
STATE OF FLORIDA,
COUNTY OF DADE. j ss
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
to me well known,
and who, being by me first duly sworn, upon oath deposes and says that he is the.
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Permit No a .f! Date It 1 7 —6 s? Read, Sworn to and Subscribed before me.
Disapproved � r i ofte
/ Notary Public, State of Florida
(Signed) .
Buildin: , nspector My Commission Expires
PLANNING BOARD DATE
Member
Member
Member
Council Approved Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
0
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
PERMIT
Owner of
Building
Architect
Contractor
or Builder
Legal Lot
11
Description Bl
N° 5758
DATE. 19
Contractor's
License No.
Work to be performed under this Permit
Subdi-
vision
Address of - Value of I Amount of
Building Project $ I Permit $ '=
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the applica-
tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked
at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this
permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants or employees.
Signed. • INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances'tmnd regulations
pertaining thereto'and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employed.
BY AUTHORITY ABBOT
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby wade for the approval of the detailed statement of the plans and specifications herewith submitted for the build -
ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, Florida. and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Date.. ' l t�
Owners Name and Address .. `
Registered Architect and /or Engineer ,.- .,.,•,- 1111,,,,- ,. .....
Name and address of licensed contractor e 1 ° _C 7E6 , 170 ''C
Location and legal description of lot to be built on:
Lot Block Subdivision • Street and Number where work is to be done... 71 � �! '
State wo tp done and ose of building (by floors C.
P g )
New Building Remodeling Addition Repairs
To be constructed of Kind of foundation R f Covering _...
u i
Estimated Total cost of improvements $ 1, a C �' Amount of Permit $. 1 .. 1
Zone cubage required plan Cubage
Distance to next nearest building. Size of Building Lot
Maximum live load to be borne..by each floor
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of labor under theFlorida Workmen's Compensation Act, being Section 5966, Compiled General Laws lorida, Permanent Supplement.
and has complied with the provisions thereof, and will require similar compliance from all contractor r sub -co • ctors employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspection on,t a st t e work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontract.rs, on o be . formed- under this
pennit, as are licensed by Miami Shores Village.
Remarks (Signed).
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
and who, being by me first duly sworn, upon oath deposes and says that he is the.
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Permit No..__._ V Date Tv � eP. c Read, Sworn to and Subscribed before me.
Disapproved Date.
Notary Public, State of Florida
(Signed)
Building nspc t r
and for no other purpose.
A /c_ eAJ
My Commission Expires
No. of Stories
to me well known,
PLANNING BOARD DATE
Chairman Member
Member Member
Member ...... — — - — - _ Member
Council Approved Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and/or workmanship.
i
Date Job Address 1 011 0 l �J�s T Tax Folio ii '7-010 li =XOI O CJ
Legal Description 1 ' /2 P., �(p ��'1 CC,K. S sGC 2..
Lessee / Tenant ‘ Z--0S-C , H . Master Permit # jt
Phone 1 € LO 51)(01
Contracting Co. -- W% ■ t)) ■. 112- C kJ Address 1 42_aro u .1t i )(le- ILA
Qualifier SS# - - Phone g1 — 1 0 ��
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Owner's
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Address 1 0 I �e..; S'r
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANIC ROOPING PAVING PENCE SIGN
WORK DESCRIPTION ►JY.t.�) 6_::ro■.' 1VA t 12 - N P - ►7L -
Square Ft. Estimated Cost(value) I(P7 7
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 c th.' all the foregoing information is accurate and that all work will
be done in com• fiance 'ith all :pplicable laws regulating construction and zoning. Furthermore, I
authorize th- above - 4 med con: actor to do the work stated.
Fa-
Signature of owner and /or Condo President a ►i'
Date:
6fJg
CikeRt,SEAL A
otary as to Owner n• rP. o
My Commission Expir ' �It (-r BARBARA ANN FUGAZZI
COMMISSION NUMBER
, 'fib a CC360191
Q MY COMMISSION EXP.
** * * * c*OF ,V° * MAFf :.. 8
FEES: PERMIT ( RADON
APPROVED:
Zoning
Mechanical
C.C.F.
*
I r
C,gt
Notary as to
My Commission
*
NOTARY .t-fv1
Fire
�+�r Building
k l , Plumbing_
LA)/
Signature of Co tracto5,0i. Owner- Builder
Date: 6 /';ay
010,St aet9m'. CIANNIVEAMu;l fie
k BARBARA ANN FUGAZZI
r COMMISSION NUMBER
' ;q r Q CC360191
MY COMMISSION EXP.
4 OF F�� MAR 29 1098
TOTAL DUE " 0' 16
qy
Other
Electrical
Engineering
PENGUIN AIR CONDITIONING, INC.
Sales - Service - Installation
14230 West Dixie Highway
NORTH MIAMI, FLORIDA 33161
Phone 893 -9055
❑ SERVICE I ❑ PICKUP PHONE / /
❑ INSTALL ❑ DELIVE C L /Yn
NAM
cat a ,
ADDRE S�
Cri-Y 4/1j) 33/3e
MAIIE MODEL
NATURE OF
SERVICE
REQUEST
QUAN. PART NO.
74144 *ou
INVOICE COPY
Technician
DESCRIPTIO
TE COMPLETED
1 SERIAL NO.
I REPAIR IN
Q HOME ❑ SHOP
5
r154cA .l. 4J 5
e s
(,Lii`•L 15 IT, w, fi�ea
A » N °,t.e - �� c
SERVICE PERFORMED -r
cd) 13[6 —6
CASH COMPLETION
OF WORK
Customer's Signature
See reverse side for uaran
PRICE
DA ORDE
DATE RO MJ y E
AP RTM@NT
DATE OF ORIG. INSTAL
n
TOTAL
MATERIAL
TECHNICAL
SERVICE
TIME
factory hereby knowledg hat equipm has been left es
❑ ESTIMATE
❑WARRANTY
❑ CONTRACT
❑ CASH
❑ CHARGE
❑ C.O.D.
TAX
AMOUN
oa 38
as being satis-
n !ood co tion.
MIAMI SHORES VILL
BUILDING DEPART
305- 795 -2204
Bui1lding Inspection Reques
Date
Type Insp'n : t `c` 1 c
Permit No. l.. 0 4 35
Name ie,qc'rc1 OCR I
Address
Company 1 6 q1)
Phone # f � � e?c f ,2
Inspection Date
Approved 4I 1t/ ❑
Correction ❑
Re-Insp'n Fee ❑