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739 NE 94 St (7)Date Time Type Insp'n Permit No. /i 4 0=" f `--C Name - Address I 7L59 gq Company Phone #� For Inspector: Approve Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request •Cp1"73 J 7,WE% 12 .u1A, , 1 5 7 ( , / vl ›-if MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date Ci " Time i Type Insp'n 4\ Permit No. in on / �S NameU\_y.. z? Address 939 `I Y /r Company Phone # 3oS 3 / b 7 j3 For Inspector: l 1 l I V Name & Date l Approved L( � 'gc ) /(4,c) Correction ❑ Re- Insp'n Fee ❑ -30S,yu6-,�5?-/7 MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date Time Type Insp'n / Permit No. '& (9 W t% ' L Name 1 Correction Address " 23 Re- Insp'n Fee ❑ Wn • Company Phone # For Inspector: 7 Name & Date Approve /O ` ❑ (, /? C C U ss BUILDING ELECTRICAL PLUMBING ROOF Owner of Building Architect Contractor or Builder Legal Description Address of Building Lot MIAMI SHORES VILLAGE, FLORIDA DATE ,,i PERMIT te' u e1 N° 6155 Work to be performed under this Permi Contractor's 7 License No. 7 1 JF v -1 '4 7C 1 . 4 - Subdi- vision e ^ *- Value of .. 01)- , -. I Amount of g ''...1 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. r� Signed. 1- _ r f * INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with 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 as cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. • CONTRACTOR OR BUILDER AUTHORITY .o.o, Date )./( /q2 Job Address '7 3 9 q 4 5T Legal Description M ;44.4 5Homes" `° Ecrt. 2. P[3 /0-37 / Lessee / Tenant 1 SR- $ELL F 144A)177 Owner's Address / 3 9' A). e . q 1 " Contracting Co. VON s OOC,N G I NC, Qualifier Poe gc. L. k'o e FoR_D State # CMOo$5,334unicipal # Competency # Ins.Co. O. f L4 Architect /Engineer N/A Address Bonding Company N/A Address Mortgagor N7/4 Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION RerimC'FM (=N c OF c(sr,;')G /41-1V ,° `oNP. U, r, 4 ©w ✓4 S,-a e 1 5 L- Oes- T /o Square Ft. Estimated Cost(value) ' 5 O vi 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. authorize the above -named contractor to do the work stated. Sigtiature of owner and /or Condo President Date , ?. /f Notary as to Owner and /or Condo President My Commission Expires: NOTARY PUBLIC, STATE OF FLORIDA. MY COMMISSION EXPIRES: April 1, 1995. BONDED THRU NOTARY PUBLIC UNDERWRITERS. ** * * * * * * * * FEES: PERMIT Ail d RADON C.C.F. " APPROVED: PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Fire Other Zoning Building Electrical Mechanical 1 ) 1 )1)1 Engineering ss# Phone 686 - 96 21 Furthermore, I Owner- Builder Signatur of ontrac Date: /;.. ,/i /42 N ary as to Con ractor or Owner - Builder My Commission Expires: NOTARY PUBLIC, STATE OF FLORIDA: MY COMMISSION EXPIRES: April 1, 1995. * * *BONDED NOTAr PUBLIC#JNDERWIWERS. ** NOTARY TOTAL DUE Li ti PERMIT* State of Florida County of Dade TAX FOLIO NO. ' t I " ? j 2O C— NOTICE OF COMMENCEMENJ 000 THE UNDERSIGNED hereby gives notice that Improvement will be made to certainl" real property, and In accordance with Chapter 713, Florida Statutes, the following information Is provided In this Notice of Commencement. c f c u 2. General descrlptlon of improvement: REPL4CC �X rS T,ivo ft, e . (o*' 4;1.A ro,..) rH r)i2 1 S ,5. L-o c.1-rro. 1. Description of property :(legal descrlptlon of the property, and street address I f ava i !able) A/loq f , t i _5,4004 Se dr. 2 P5 /0-37 1'. o, 20 f Z J 73 ?, 3. Owner I n f o r m a t i o n : 739 a . Name and Address: ��SEa- i+ — p ` 94 51 33c4s b . Interest I n property: OW ft) e cA. c. Name and address of fee simple titleholder (If other than owner): it-)/(4- C 4. Contractor: (name and address) Don, E, ooLti,c , pit", /333.3NW7AO& 1 Fk 33/6 6 N/4 ( '€PA k I ts Qt r& /3333 NW 74u4;- 1 ("h. ? /`c _ 33/6 IS 5. Surety: a. Name and Address b. Amount of bond $ ,AV14 6. Lender : (Name and address) /ter /4 7. Persons with the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., F l o r i d a Statutes : (Name and address) �S AFFCt NA t ' 7.3qA lFg4 7 M;,gpir,Fe. . / 8 . I n a d d i t i o n to h i m s e l f , Owner designates Poo e-- Ora e Q of p/, to receive a copy of the Lienor's Notice as provided In Section 7.13.13(1)(b), Florida Statutes.. 9. Expiration date of notice of commencement (the expiration date Is 1 year from the date of recording unless a different date Is specified) Signature of O ner Sworn to and subscribed before me t h i s / day of. 4)17 199,4.2., �� • NOTARY MAW, sum OF FLORIDA. " 'I���,y1 � fj""F- MY COMMISSION EXPIRES: April 1, If!!. Notary ub 1 i c May Comm I ss 1 oftwe ziwArtersigi POMO UNDeawarrew. STATE OF FLORIDA COUNTY OF DADE 1 HEREBY CERTIFY. that thla•le a true py of the • orl al flied In th of!ice on 10 • day of , A. D. 1 WITNESS my hand and Official Seel. N"".."*". Clerk CIrru t Court f� Miami Shores Village . NE 2nd Avenue • Phone: 305 - 795 -2204 rinted: 9/26/2002 y f Parcel # 1132060142000 Applicant: FERNANDO CRESPO Owner: CRESPO FERNANDO JOB ADDRESS: 739 NE 94 ST Contractor JOSEPH BLOCK A/C Local Phone: 954- 389 -2297 Total Fees: 1;0:00 Total Receipts: $0.00 Permit Status: Approved Permit Expiration: 3/23/2003 Construction Value: $1,700.00 Work: CHANGE OUT AIR HANDLER JHEAT PUMP AMANA BBC60A2A/CHF48TXC If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection fee is $50.00, which must be paid in advance before calling for another inspection. 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 application 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 responsibility for work done by his agents, servants or employees. Signed' Sign Electrical Permit Permit Number: EL2002 -316 Contractor's Address: 739 NE 94 ST Page 1 of 1 Legal Description: MIAMI SHORES SEC 3 PB 10 -37 LOT 20 & W28FT LOT 21 NSPECTOR) BY: 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. (Contractor or Builder) BY: BLK 67 0 PAY T Oq o F c j° SFP /6080 No 9 cq C OST A kj / q S4) 3e9 4O9j A PI. 33326 41441 SyoRe .S 41441 rty sI x and 20,/00 * * ** 0004 1 40 '4)4 ?pps ckEspo y3' ep 900004 4 12417' POI? 4 FjgST U NION Pio F OpN Ng T /O 63-643/670 PN S. A O 0,41 • 0068.5 R /pA GAliS 4•410e1477 bect ■ The Sa ',shine State . LICENSE NUMBER M362-514-72460-0 .KIMBERLEY NOB-LE MEADORS VA NE 94 ST MIAMI SHORES, FL 33138-0000 esFm4 DATE SEX NOT. REST. ENDORSE 12-20-72 F 6-09- ISSUED EXPIRES 014242 12-20-07 DUPLICATE 0040-00 ORGAN DONOR SAFE ORNER 020104 Operation of a motor vehicle constitutes consent to any sobriety test required by taw QUANTITY Thank you for your business. JOSEPH BLOCK AIR CONDITIONING INC. 16080 LA COSTA DR. FT. LAUDERDALE, FL 33326 PH# 954- 389 -2297 BILL TO FERNADO CRESPO 739 N.E. 94TH ST. MIAMI SHORES, FL 33138 305- 751 -6666 C -321- 6773 -W- 446 -9150 TO REMOVE 4 TON TRANE AIR HANDLER AND INSTALL 4 TON AMANA . BLOWER MODEL # BBC60A2A AND CASE COIL ASSY CHF48TXC AND • AUX DRAIN PAN AND SAFETY SHUT OFF CONNECTING TO EXISTING TRANE CONDENSING HEAT PUMP . PERMITS ARE EXTRA PERMIT CHARGE Sales Tax DESCRIPTION P.O. NO. TERMS Due on receipt • Total DATE 9/23/2002 • —1,78030 6.50% Invoice INVOICE # PROJECT 6082 RATE AMOUNT 1,700.00T 110.50 $1,810.50 STATE OF FLORIDA DEPARTMENT OF LABOR AND EMPLOYMENT SECURITY DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF EXEMPTION FROM FLORIDA WORKERS' COMPENSATION LAW . This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation Law. EFFECTIVE DATE EXPIRATION DATE EXEMPTED INDIVIDUAL NAME S.S. BUSINESS NAME FEIN 650477657 BUSINESS ADDRESS 16080 LA COSTA DR .' WESTON FL 33326 12/07/2001 12/07/2003 BLOCK 261 -70 -8436 • BLOCK JOSEPH AIR CONDITIONING 11 -28 -2001 NOTE: Pursuant to Chapter 440.10(1),(8),2 F.S., a sole proprietor, partner, or an officer of a corporation who elects exemption from the Florida Workers' Compensation Law may not recover benefits or compensation under Chapter 440. \c #0466535 DATE (BAT STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION S # LO2o525oo6c CONSTRUCTION INDUSTRY LICENSING BOARD SF NRR 06/25/2002 011141171 CACfl 2187 The CLASS A AIR CONDITIONING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2004 BLOCK, JOSEPH P JR JOSEPH BLOCK A/C INC 16080 LA COSTA DRIVE FT LAUDERDALE FL 33326 JEB BUSH GOVERNOR DISPLAY AS REQUIRED BY LAW STATE OF FLORIDA AC# 0466535 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CACO32387 06/25/02 011141373 CERTIFIED AIR COND CONTR BLOCK, JOSEPH P JR JOSEPH BLOCK A/C INC IS CERTIFIED under the provisions of ch.489 PS. Expiration date: AUG 31, 2004 SEQ #L02062500605 KIM..BINKLEY -SEYER SECRETARY • 2002051618001063 MIAMI -DADE COUNTY, FLORIDA MIAMI - :::::1 11 gaSg PERMIT NO: APCF - 000133,-2002/2003 (CERT) -NRS JOSEPH BLOCK A /C, INC. 16080 LA COSTA DR FT LAUDERDALE, FL 33326- PERMITTEE: Mr. Joseph P Block, Jr. JOSEPH BLOCK A /C, INC. 16080 LA COSTA DR FORT LAUDERDALE, FL 33326- STRATOSPHERIC OZONE PROTECTION ANNUAL OPERATING PERMIT . John W. Renfrow, P.E., Director ENVIRONMENTAL RESOURCES MANAGEMENT AIR QUALITY MANAGEMENT DIVISION 33 S.W. 2nd AVENUE SUITE •900 MIAMI, FLORIDA 33130 -1540 TELEPHONE: (305) 372 -6925 FAX: (305) 372 -6954 DESCRIPTION OP FACILITY /EQUIPMENT This document, issued under the provisions of Chapter 24, Miami -Dade County Environmeintal.Protection Ordinance, shall be valid from 01 -JUL -2002 through 30- JUN - 2003. 1 Goodman Recovery unit(s) model FRU22 1 Thermalflo Recovery unit(s) model 1986 The permittee is hereby authorized to purchase refrigerant(s). R -12 R -22 from DERM approved distributors, for use during the installation, servicing and repair of air conditioners,.. refrigerators, freezers and chillers. The permittee is also authorized to handle refrigerants as recovered during salvage and dismantling of these units. This facility is subject to conditions listed below and in the following pages -(if any) of this permit. SPECIFIC CONDITIONS 1. The permittee, by acceptance of this document, agrees to maintain the subject operation so as to comply with the requirements and standards of the Florida Administrative Code 62 -281, Section(s) 608/609 of the Title VI of the Clean Air Act of 1990 and 58FR28660 and 57CFR31241 in addition to the applicable Miami -Dade County regulations. ' 2. Releasing refrigerant into the atmosphere during installation, service, repair salvage, or dismantling of any appliance (including, but not limited to,..air conditioners, refrigerators, chillers & freezers) is prohibited. All refrigerants must be recovered /recycled or recovered only using USEPA approved equipment and stored in DOT approved containera.for-subsequent reclamation. Exceptions to this venting prohibition are covered under Sections) 608/609 of the Clean Air Act. 3.'F, refrigerant recovezy7reoycling equipment must be properly maintaineB7to con•Einued ' operating efficiency of at least 90% refrigerant recovery. The permittee shall demonstrate that the refrigerant recovery/recycling equipment is in good working condition when requested by a DERM inspector. 4. Equipment that is dismantled on -site must have the refrigerant recovered in acEOrdance with EPA requirements prior to disposal. After removal of the refrigerant, a sticker-shall be attached to the unit stating: i) the permittee name, address and phone number ii) the DERM permit number iii) the date of refrigerant removal. ._ 5. Records regarding the service and repair of air conditioning, refrigeration and small appliances containing refrigerants must be maintained for a period of at least two years. Such records shall include, but not be limited to the following: i) Amount and type of refrigerant(s) purchased, and date of purchase. ii) Date of repair or service, and name and address of customer whose unit was serviced. iii) Amount of refrigerant used (added to the unit), and amount of Miami -Dade County Department of Environmental Resources Management Page 1 of 2 City of Weston 2500 Weston Rd. Suite 101 Weston, FL 33331 (954) 385.2000 Name and Address of Licensee: Block, Joseph A/C. Inc. 16080 LaCosta Drive Weston, FL 33326 License Categories: A.0 Contractor A/C Contractor LICENSE NO. 2002 - 4696 This license MUST BE DISPLAYED in a conspicuous place in your business establisI ment. The City of Weston must be notified of any changes of address or ownership: • This License is NOT TRANSFERABLE and is Subject to Revocation. • 08/09/2001 Date of Issue Barbara D. Showalter, CMC City Clerk City of Weston Occupational : License License Effective:. From: 10/1/2001 To: 9/30/2002 Contact Information: Name: Joseph Block Phone: (954) 389 -2297 $150.00 TOTAL FEE: $150.00 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR • MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSION CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. . INSR LTR TYPE OF INSURANCE POLICY NUMBER EFFECTIVE DATE (MMIDDMf) POLICY EXPIRATION DATE (MM/DDIYY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY BK00763748 BK01016715 12/12/00 12/12/01 12/12/01 12/12/Q2 ' EACH OCCURRENCE $ 300,000 X FIRE DAMAGE (Any one fire) $300,000 CLAIMS MADE X OCCUR MED EXP (Any- one Aerso80) $ 10,000 PERSONAL8ADV INJURY • s 300,000 GENERAL AGGREGATE -' $ 600 r 00 GENT AGGREGATE LIMIT APPLIES PER; POLICY n JECT n LOC PRODUCTS • COMP /OP AGG E 600 000 7 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS . COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) • — BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) • GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT. $ OTHER THAN ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ 7 OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABIUTY - " • r I ORY O ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE: $ E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIA(. PROVISIONS -- ,- CERTIFICATE HOLDER N ADDITIONAL INSURED; INSURER LETTER: _ CANCELLATION MSHORE S CITY OF MIAMI SHORES BUILDING & ZONING 10050 NE 2ND AVENUE MIAMI FL 33138 I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, REPRESENTATIVES. BEFORE THE EXPIRATION 30 DAYS WRITTEN TO DO SO SHALL ITS AGENTS OR 271444.'tA.Z\Isl ) 441.%sirl f ) .. ACORD CERTIFICATE OF LIABILITY INSURANCga PRODUCER MORTON D. WEINER /AMPAC CORAL GABLES 362 MINORCA AVENUE CORAL GABLES FL 33134 Phone:305- 444 -2324 Fax:305- 444 -4980 INSURED JOSEPH BLOCK AIR CONDITIONING INC. 16080 La Costa Drive Ft. Lauderdale FL 33326 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. " INSURERS AFFORDING COVERAGE /Y DATE (MM/DDY) 11/06/01 INSURER A: U S F &G INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES ACORD 25-S (7/97) RPORATION 1988 ELECTRICAL TYPE Minimum Fee Oi'V. TYI'f: Dryer QTY. nil:. Outlet, Appliance Q"fl. 'I Service Repair )TV. A/C Central 1 -3 Ton Dryer Vents, Number of Fan Ventilation, Cost Outlet, Wall Ductwork, Cost of Service, Temporary Periodic Inspections A/C Central 4 -7 Ton 4- Fire Pump Outlet, Switch Fireplaces, Number of 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 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 I\'IECHANICAL TYPE QTY. Minimum Fee TYPE QTY. Condensate Drain TY Generator QTY. TYPE QTV. Refrigeration, Tons 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 Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel PLUMBING TYI'li A/C Condensate QTY. TYPE. Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. 'rv1'I{ 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 2 INIPORTANT 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. STATE OF, ID , CO �" Y OF IAMI -DADE STATE OF FLORIDA, COUNTY OF MIs I -DADE i 1 Signal of Owner Prin S . fir Publi date • _ - .da OFFICIAL C SEAL: O�PRY Pt/6i. ANGELA NI r , cc .,... L . r: '. • it S 1 • Si ature tracto ' • ua 1 ter �fl S e e p, v Print Name to and subscribed before me this _ day of I • i. ature of 'rtary SEAL: Pu bli e l • PRMIT APPLICATION 1 "77 " ' — '„ s ANGELA M 10* 00 CC7OGGUY -9 rav co : . , n N ' nF F - Personally known OR, Produced Identification ✓ Personally known OR, Produced Identification L/ Type of Identification Produced: 36R -51 9=7 0 Type of Identification Produced: bz 13 y4n •t/is- 94 18 0 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 r� W 4 ...us_ Telephone 1 s :3 s / ax 9 4_ ° azzi Qualifier Name Electrical _ „� � %I ::I'Ci° a Mechanical Demolish Plumbing Shell Only Fire Foundation Only Public Works Other Structural Add'l Detachment Building Official CONTRACTOR ■ Name taLc tbi� A,C ,0 cc License No. e4 c O 3 a Address 1%0 0 E, C LA- �CQ��A. r' e- &"T G 1 " � 'L '3 3 �- 6 r� W 4 ...us_ Telephone 1 s :3 s / ax 9 4_ ° azzi Qualifier Name PROPETY Ir -- Name � x.1`3 r�+ , ` Pn _ Address i 5 - CI' c �� 1 M1Pk"A % choiLEs PL. 33 13t Home Telephone .- s -1 i - f t r , Business Telephone 3 0 s q `' `'1. 6- t i 1 s Fax 3C ° J 1 i(..., TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'l Detachment Other Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi - family) ❑ CONCURRENCY (New Construction) O OTHER (Specify & Attach) $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 Zoning Review Notary ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) PERNIIT FEES $ 5 ri‘egitaC—r fr<0',. Eitcerni, (¢.005 / sq.ft.) (¢.01 /sq.ft.) PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ ISSUING OFFICIAL 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 s CIF tom' MOWN — 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 submit- ted along with this permit application. Address PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other PB N l h Apt. Folio Number Lot Block Subdivision Current Use of Property Proposed Use of Property Tenant Information PG PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Master Permit No Subsidiary Permit No. City State PERMIT APPLICATION '+'-' � WI i i•N R. 33 I Zip 5escription of Work C h A e. c lift A, I Q k fit N A Le_ A - 4etir-4- comp 1 el .6roR?A IC i-i F4- Tx C, Zoning Linear Feet Square Feet Units Floors X alue of Work 11 Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax Og o F 41,441 SHORE'S 305-79 s-220 7 2 6 FjRSr UNIO N P IRS OF Pi. AT10 6 ,1OKF 643�6j /' H�� O 04 3 0 FS PLO A104 00 68.5 R ��A 111 NORLRCTR /c 4 91 4n• �• pR /rFO c •ps ?p 4 � S po 3 2,E ep 9 00008 8 00eij back 001.1.A Printed: 9/24/2002 Ta� et Applicant: FERNANDO - Owner: CRESPO JOB ADDRESS: 739 NE 94 JOSEPH BLOCK A/C Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Local Phone: 954 - 389 -2297 Parcel # 1132060142000 Mechanical Permit Permit Number: ME2002 -135 CRESPO FERNANDO ST Contractor's Address: 739 NE 94 ST Permit Status: Approved Permit Expiration: 3/19/2003 Construction Value: $1,700.00 Work: CHANGE OUT AIR HANDLER JHEAT PUMP AMANA BBC60A2A/CHF48TXC Page 1 of 1 Legal Description: MIAMI SHORES SEC 3 PB 10 -37 LOT 20 & W28FT LOT 21 If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection fee is $50.00, which must be paid in advance before calling for another inspection. p_ A o o A,,„) S. 06 V. ao Total Fees: C. C a O Total Receipts: $0.00 BLK 67 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 application 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 responsibility for work done by Isis agents, servants or employees. Signed: (INSPECTOR) BY: 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: ELECTRICA L — mg , : Minimum Fee QTY. TYPE Dryer QTY. TYPE Outlet, Appliance Q'1'1•. "TYPI•: Service Repair QTY. A/C Central 1 -3 Ton Fan Dryer Vents, Number of Outlet, Wall Ventilation, Cost Service, Temporary Air Handler, Tons A/C Central 4 -7 Ton Piping, Flammable Liquid Fire Pump Outlet, Switch Fire Sprinkler System Signs A/C Central 8 -15 Ton Bath Fan - Vented, # Fixture - Fluorescent Pressure Vessel 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 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 NIECHANICAL TYPE Minimum Fee QTY. TYPE Condensate Drain QTY. TYPE Generator (1 •11 Refrigeration, Tons ()"1'1. 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 Solar Water Heater Air Handler, Tons Eg Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Cap - Fixture Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Pump and Abandon PLUMBING "TYPE A/C Condensate QTY. TYPE Drains, Roof QTY. TYPE 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 2 IMPORTANT NOTICES 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. J7 ,6TATE OIDA O�MIAMI -DADE /, � f ur of Owne Signatur Owner r 1M r6c 64 0 Print Name to and subscribed before me this 7 otary Publi fate FI ignature of/�V orfda 1 O.'-FlCOAL KO. 0 'tie A NGEL A ., t 3c` .... Z - �r'r ' * cot k -sc oy nuuE..3 CC786 Personally known ` CF FAO _OR,-Prtrduced ldentificatiod/ SEAL: STATE OF FLORIDA, COUNTY OF MI I -DADE ignature of •.n��ctor' ,)0SePV, Print Name m to and subscribed before me this23 day o ?r. ignature of N SEAL: Public - tate of Florida 1P (2Y P PERMIT APPLICATION Loc.t A C Personally known 0F F bR, Projace Identification Type of Identification Produced:F2s1)G . A4S " CYype of Identification Produce&DZ• E 1.) 0 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 \Name ,m s .r v, c`L Q L. L.._ I. c.. : P c_. BY Address j ;at. , L c, A Dr.. W` ltd,. FL, S33 -6 DATE Zoning Home Telephone ,- 7 S i - (0 6 6 tQ Repair Business Telephone sac s o 4 t ., c t Alteration Interior Electrical 1 Relocation of Structure Mechanical 16":. < e; . Plumbing Other Add'I Detachment Fire Public Works Structural Building Official CON: f A v - Le ,,z_ 4' „.. 1. \Name ,m s .r v, c`L Q L. L.._ I. c.. : P c_. License No. , ,). ,).3 T CA ,v, Address j ;at. , L c, A Dr.. W` ltd,. FL, S33 -6 Telephoner _ 3 9-2 0 2..co Faxers 3( °133 Qualifier Name To o se gh ` Lc .tL PROPERTY OWNER New Construction (�r� �+ p� • Name PP iti AD ' Cae d 11 O Enclosure Address 1 c �y 4 z , t i n Si \ f \ �» s ��-t- e;ig Home Telephone ,- 7 S i - (0 6 6 tQ Repair Business Telephone sac s o 4 t ., c t Alteration Interior Fax 3 S -1& l— ( 6 L 6 Demolish TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'I Detachment Other Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi - family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) $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 Zoning Review Notary ❑ PROOF OF OWNERSHIP (Attach) ❑ FIRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) LI OTHER (Specify & Attach) PERIIIT FEES $ S- o0 (X .ft.. 0.60) x/1000 $ (¢.005 /sq.ft.) (¢.01 /sq.ft.) PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) L as TOTAL $ ISSUING OFFICIAL REVIEWED AND PREPARED BY: DATE: CONDITION OFA PPRON'AL Revised July 2001 10050 N.E. 2 "D AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • : http : / /www.rniamishoresvillage.com INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. 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 submit- ted 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: 1 39 kl 4-". .5 Si- Address Apt. Folio Number Lot Block Subdivision PB PG Current Use of Property Proposed Use of Property Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other v ARCHITECT Name License No. Address Telephone Fax Master Permit No. Subsidiary Permit No. City State a scription of Work C k AN) se e PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection Zoning Square Feet Units Floors Value of Work t l 0 0 "' Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT APPLICATION Zip A 1(L. N P /S 7Le rL A2 A jC HP4RT (C Linear Feet ENGINEER Name License No. Address Telephone Fax Owner's Name and Address . ' Registered Architect and /or Engineer Name and address of licensed contractor cr 0� �IAlvll SHORES VILLAGE UILDING INSPECTION 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 os not. A copy of approved plans and specifications must be kept at building during rogress of the work. -9(' /i7 /fthi M ia 2 - Date_. ap � Z Z 19__ No. 7 lt! _ E.Street-- ( 71 — . S- i Location and legal description of lot to be built on: Lot Block Subdivision �___ _ c ��- Street and Number where work is to be done L / �' ° <__ � , / State wor to be done a p y floors) ____ — `� 0 ",^ / r �.� ose of building (b v� Ili Lit/ Date d1 — d. `lr —6) New Building Remodeling. Addition _ Repairs No. of Stories To be constructed of Kind of foundation Roof., Covering Estimated Total cost of improvements $ n A mount of Permit $ 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 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 inspecti on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontrac r b on work to be performed under 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 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 tO F 5 Disapproved Date (Signed) Read, Sworn to and Subscribed before me. Notary Public, State of Florida and for no other purpose. to me well known, Building Inspector My Commission Expires 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.