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ALARMCONTRACTOR A� - { � Name ., eo_k N �s1`�Y . l ( TOR License No. �C i 0 10 Address ice LE. I zs IU _MI Atr4 i , ICL. 33 /44 Telephone spit 3 77474 Fax $q 3 /s Qualifier Name 2000 /1 S PROPERTY OWNER Name f ,,�f�y► l'., M►e� /1l� � Rhe t H- t � I Address 1 I S . E q ST N\avNA S hires ( r1- Home Telephone 305_7s-R-- (I o P Business Telephone 30 s — 5a ---) ..t S S b Fax TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'1 Attachment Other Add'I Detachment Other INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. APPLICATION Job Address: Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted along with this permit application. MI&0A - A n ofreS City • /_ y � iQ oZ 01Q 0 133 90 description of Work tr ( ' I . -A 4X.49 Ne Qq Address Apt. Folio Number Lot Block Subdivision PB PG Current Use of Property R.0 Proposed Use of Property Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax PERMIT APPLICATION Master Permit No. Subsidiary Permit NFL ' d---100 c>1 L 313V State wL Zip Zoning Linear Feet Square Feet Units Floors Value of Work 2 f) () O Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax Page 2 IN'IPORTA NOTICES 1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. AFFIDAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1 Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. STS E OF FLORIDA, COUNTY OF MIAMI -DADE U8( l/ ublic 1O, OFFICIAL NOTARY SEAL , S P 0 6 ( ANGELA M BECKER 0 • COMMISSON NUMBER 2 • r CC786697 IIY "r Q MY COM MISSION EXPIRES eOF f. ON NOV: 15,2002 Signat Signatu4l of Owner • Rhlewk Print Na e Swo Sri nd subscribed befo e me this SEAL: Personally known . 1 , Produced Identification 2 Type of Identifcation Produced '� 3 v /D� t 3 STA int Name t r PERMIT APPLICATION ORI bay, U`∎ TY OF MIAMI -DADE atur f Con actor / Qualifier worn to and subscribed before me this 'Le, -a FFICIAL• �T SEA ♦P PUe ANGELA M BECKER Q rr �� o sWSSION UMBER N CC786 MY COMMISSION H EXPIRES 9r F OF f� NOV. 15,2002_' Person: . e 'n OR,, Prod } uced Identification `) �' Type of Identification Produced: / D)-. Village of Miami Shores 10050 NE 2nd Avenue Miami Shores, FL 33138 Phone: 305 - 795 -2204 Printed: 2/12/2002 Applicant: CYNTHIA Owner: RHEAULT Contractor SECURITY MASTERS INC Local Phone: Parcel # 1132060132870 Job Address: 115 NE : 94 ST Fees: FEE2002 -852 FEE2002 -853 FE E2002 -854 Permit Status: Approved Work: SECURITY ALARM SYSTFM . If there is no permit pa fee is $50.00, which must This Permit is granted to the cc ordinances pertaining thereto and and approved by the propermuni. authorization. A further condition ordinances and regulations pertai by his agents, servants or employ Signed: ,/ 7 In consideration of the issuanct with the plans. drawings, stateme myself, my agent, servants or err c PAY TO THE ORDER OF Description Amount Building Permit Application F460.00 CCF Notary Fee Total Fees: Electrical Permit Permit Number: EL2002 -53 RHEAULT CYNTHIA Address: 1150 NE 125 ST Cellular: Legal Description: 1 53 41 6 53 42 MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 15 & W4OFT OF LOT 16 $1.20 $5.00 $66.20 Permit Expiration: 8/11/2002 Construction Value: $2,000.00 SECURITY MASTERS, INC. PHONE; 305- 893 -7766 1150 N.E. 125 STREET NORTH MIAMI, FL 33161 www.securitymasters.com /4 l A-1m f $C4 -5 0 MEMO ?l II'0055630 ':0660 L03 ? ?I: 0405 34 Page 1 of 1 COMMERCIAL BANK OF FLORIDA NORTH MIAMI OFFICE NORTH MIAMI. FLORIDA 33181 Total Fees: $86.20 Total Receipts: $0.00 2 &One 5563 63 37/660 4 D $ DOLLARS FLORIDA LGENSE The un.shiin' State q I ONALU CARL. ADAMS ,� 2125 NE 123 STREET • r - NORTH MIAMI, FL 3 31 81- 0000 1• 12 -04 -53 M 6 -02 A A352- 723 -53- 444 -0`Wt 10 -11 -90 OPERATOR "' " "rs 12 -04 -97 SAFE DRIVER 51091009694 The Sunshine State LICENSE NUMBER R430- 106-63 -507 -0 CYNTHIA FINCH RHEAULT �{ 115NE94ST MIAMI SHORES, FL 331362821 ~ 01 -0743 F 546 A BIRTH DATE SEX MGT. REST. ENDORSE. ISSUED OZ1 116 FXPIRES DUPLICATE 01 -07-03 01 -11-00 SAFE DRIVER 7(660001110263 Operation of a motor vehicle constitutes consent to Oily sobriety test required by law. t. ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. TYPE Outlet, Appliance QTY. TYPE Service Repair QTY. A/C Central 1 -3 Ton Heating Strips, each Fan Outlet, Wall Service, Temporary Paint Booth A/C Central 4 -7 Ton Fire Pump • Outlet, Switch Piping, Flammable Liquid Signs A/C Central 8 -15 Ton Fixture - Fluorescent Process/Pressure Piping Oven Space Heater (kw) A/C Central 16 -20 Ton - Pressure Vessel Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery , Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar V/ Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New MECHANICAL TYPE Minimum Fee QTY. 'TYPE Condensate Drain QTY. TYPE Generator QTY. TYPE Refrigeration, Tons QTY. A/C Central, Tons Ty. Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Pump and Abandon Bath Fan - Vented, # Fireplaces, Number of - Pressure Vessel Gas - Appliance PLUMBING TYPE A/C Condensate QTY. TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. TYPE Soakage Pit Ty. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pum I 91 isposal Interceptor Roof Inlet Water Closet HI omestic Well Laundry Tray Septic Connection Water Heater Drainbeld, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: SECTION BY DATE Zoning Electrical /Z. X Mechanical Plumbing Fire Public Works Structural Building Official Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM - (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) PERMIT FEES $3.00 per page (Scanning Fee) $ Miami Shores Village Bond Metropolitan Dade County (C.C.F.) $ Inspector State Educational Fund $ State DCA (Radon) Code Enforcement Fine Zgting Review REVIEWED AND PREPARED BY: $ $ ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) $ (sq.ft. = x/1000 x ¢.60) (¢.005 / sq.ft.) (¢.01 /sq.ft.) PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) X34 ISSUING OFFICIAL TOTAL $ --ed DATE: f CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com Date y /d `C2 Time Type Insp'n i 4c y 4 / L �- Permit No.Z / ,:Z t ,5 Name RI 4u -1 t Address hedr e 57Y 5, Company ( S!'', ..�� t4ef rag Phone # 3,5 ' t. 77 6 For Inspector: qvd- ®2 Name & ate Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request 1132°6-0/3.470 o CONTRACTOR ,o Name _ 1 k. A A i IQ, I leA 2h ea ik 4 Name see,u. (� lt( N\ *' ( r--- - L Home Telephone 5 7 s - i -- I O License No. e i 0 /c Fax Address i5 N.E. 62.5 G [ Ra_ tPsk-mi a FL 35 I4 o/ Repair Telephone $ef 3 7��0 / Fax $q 3 e f� ^ 07 Qualifier Name 2OAJ 5 Demolish PROPERTY OWNER ,o Name _ 1 k. A A i IQ, I leA 2h ea ik 4 Address ' ‘S NE, -"lt_t, si — Nk ' SInore5 ( r--- - L Home Telephone 5 7 s - i -- I O Business Telephone Sin 5_ 5a S o s o Fax TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'l Attachment Other Add'l Detachment Other o°o ® SNORE !fy! Rao' N ,IN'TRUCTI NS - The following steps'inust+tic tal.crr,to obQain aype�rmtt frcom the t Shores' tllag = 4.. 3 Step I. Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted along with this permit application. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. APPLICATION Job Address: as 6/14 sr Address Apt. / 130 , / ( ) (e 0 1 3 description of Work j 2 L k r ( v 7 Folio Number Lot Block Subdivision PB PG Zoning Linear Feet Current Use of Property ,OS . Square Feet Units Floors Proposed Use of Property )<Value of Work 2 1 O D 0 Bldg Value Tenant Information Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Master Permit No. Subsidiary Permit NoV/ ' oZd d o2 ` 3 Mivv� t Sa o re<S PL 33138 City State at , rvv Zip • PERMIT APPLICATION ENGINEER Name License No. Address Telephone Fax Page 2 c r PERMIT APPLICATION INI POR'I'ANT NOTICES 1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUII'MENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. AFFIDAVIT - Please read ca refully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1S Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. atur f Coin ractor / Qualifier oil A-DAi'd int Name A worn ti and subscribed before me this day ST E OF FLORIDA, COUNTY OF MIAMI -DADE WZ.Z S wo SEAL: A i g nai 4 er in,4, (a. A . RhebtAA. f 4 Print NarN e nd subscribed befo e me this u . of f_ • _ _IA a, LO, Sign re of 'ftary Public ~P .Y r FFICIAAL NOTARY SFAS � 0.Y Ug ANGELA Pfl N BECKER NUMB @W �o ¢ CC786697 ! MY COMMISS tpRFS 'O f 9 NOV. 15,20 J� Produced Identification 2 Type of Identification Produced: rIJG ' - V /0 . ( -C/2 . 0 Personally known - • • STA • • ORI Ur' Y OF MIAMI -DADE S' Signal e Nola Y Fi � i ` — P P Ud AN GELA B SEA O~ ,- z' �� nuwuea * l, Q CC786697 • Q C9Y coMC�lss!O E7(p1 � fL °6 FdO�/ 15,2002 Person own OR, Produced Identificati on Type of Identification Produced: S Village of Miami Shores 10050 NE 2nd Avenue Miami Shores, FL 33138 Phone: 305- 795 -2204 Printed: 2/12/2002 Applicant: CYNTHIA Owner: RHEAULT Contractor SECURITY MASTERS INC Local Phone: Parcel # 1132060132870 Job Address: 115 NE Fees: FEE2002 -852 FEE2002 -853 FEE2002 -854 Permit Status: Approved Work: SECURITY ALARM SYSTFM . If there is no permit pa fee is $50.00, which must This Permit is granted to the cc ordinances pertaining thereto and and approved by the proper muni. authorization. A further condition ordinances and regulations pertai by his agents, servants or employ Signed: In consideration of the issuance with the plans. drawings, stateme myself, my agent, servants or err Signed:c�Zi'�f �y 94 ST Description Amount Building Permit Application Fee60.00 CCF Notary Fee Total Fees: Permit Expiration: PAY TO THE ORDER OF Electrical Permit Permit Number: EL2002 -53 Address: 1150 NE 125 ST Cellular: 8/11/2002 RHEAULT CYNTHIA Legal Description: 1 53 41 6 53 42 MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 15 & W4OFT OF LOT 16 $1.20 $5.00 $66.20 Construction Value: SECURITY MASTERS, INC. PHONE; 305 - 893 -7766 1150 N.E. 125 STREET NORTH MIAMI, FL 33161 www.securitymasters.com /4, Alm t $61- 0 t -4-&-C-1 $2,000.00 MEMO ?sue/"= r 7 0 '00556311' 1:0660 X03771: 11 '40534 Page 1 of 1 COMMERCIAL BANK OF FLORIDA NORTH MIAMI OFFICE NORTH MIAMI, FLORIDA 33161 2 X O" Total Fees: $86.20 Total Receipts: $0.00 5563 63 137/660 4 Qom/ °P /00 OLLARS • • - • • •■14.1 F I-0 RIDA DRIVER starf• 1, 1 is 10NALD CARL ADAMS 125 NE 123 STREET • NORTH MIAMI, FL 33181-0000 12-04-53 M 6-02 A A352-723-53-444-0 OPERATOR • SAFE DRIVER 1,01,S 10-11-90 12-04-97 09694 The Sunshine State UCENSE NUMBER R430-106-63-507-0 CYNTHIA FINCH RHEAULT 115 NE 945T MIAMI SHORES, FL 331352621 BIRTH DATE SEX 14GT, REST, ENDORSE. 01-0743 F 5-06A ISSUED I '<FIRES DUPLICATE 024796 01-07-03 01-11-00 SAFE DRIVER X560001110263 Operation of a motor vehicle constitutes consent to any sobriety test required by law. ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer 1 , QT1'. 1 i'I'VPI3 Outlet, Appliance QTY. 'I PE , Service Repair Q{1'1'. A/C Central 1 -3 Ton Fan Outlet, Wall Service, Temporary A/C Central 4 -7 Ton Fire Pump • Outlet, Switch Signs A/C Central 8 -15 Ton Fixture - Fluorescent Oven Space Heater (kw) A/C Central 16-20 Ton Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar V' Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New 'MECHANICAL TYPE Minimum Fee QTY. TYPE. Condensate Drain QTY. TYPE Generator Q'TY. TYPE Refrigeration, Tons Q'F A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Supply, AC Well Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Temporary Toilet PLUMBING TYPE A/C Condensate QTY. 'TYPE Drains, Roof I QTY. I 1 'I'YI'E Miscellaneous Fixture QTY. TYPE , Soakage Pit QTY. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 3 • PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: SECTION BY DATE Zoning Electrical '-?, rZY' Mechanical Plumbing Fire Public Works Structural Building Official Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) LI FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) PERMIT FEES $3.00 per page (Scanning Fee) Miami Shores Village Bond Metropolitan Dade County (C.C.F.) $ Inspector State Educational Fund State DCA (Radon) Code Enforcement Fine Z ing Review ISSUING OFFIC ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) $ (¢.005 / sq.ft.) $ (¢.01 /sq.ft.) Se 06 PERMIT APPLICATION (sq.ft. = x/1000 x t.60) ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2"° AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date t'-/ ` 12 Time Type Insp'n 4g41/a61 Permit No. 40 D Z X 53 Name��,s / � Address �> /// ? /4 s J Company Phone # For Inspector: "/l- le Name & Approved Correction ❑ /""��z�� Re- Insp'n Fee ❑ 11,32 D4.°0 /. •02870