1181 NE 97 St (7)APPLICATION FOR BUILDING PERMIT
Application is hereby made for the apppproval 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.
Owner's Name and Address.-
Registered Architect and /or Engineer
Name and address of licensed contractor - ..
Location and legal description of lot to be built on:
Lot Block Sub isi n
Street and Number where work is to be done
State work to be done and purpose of building (by floors)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Date ' � ...� ..-��
No. , /,/ Street
tJJ
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of founds ion Roof Coveri g
Estimated Total cost of improvements $ Amount 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
ba sent to
I hereby sub 0 the plan and cifications for said building. otices with reference to the building and 'is construction Y
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 pection on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such sub ntrac rs, on w to be pprftl ed under this
permit, as are licensed by Miami Shores Village. v c e t/
Remarks
(Signed).'
STATE OF FLORIDA, 1
COUNTY OF DADE. J
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.
1' i , tY C
Permit No ' Date c) L d -- Read, Sworn to and Subscribed before me.
Disapproved , .� / Date
/� j � _ i //" ! . Notary Public, State of Florida
(Signed) ' ` : - %,.1...--k --4
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.
Jo
City
Is Building Historically Designated YES NO 1 -
Contractor's Company Name ,Bk; r
Contractor's Address 2 :` 6 p ' /67 , 7 1
$ Value of Work For this Permit - U�
ir
bmittal Fee $
Notary $
Scanning $
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $
1Vlldllll J1(U1GJ V U1Qj;G
(Continued on opposite side)
Miami Shores Village
Building Department
4(e
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
rical Plumbing cechanical Roofing
�oanty Miami -Dade
Permit No.
c
Master Permit No.
Phone #
Architect/Engineer's Name (if applicable) Phone #
Square Footage Of Work:
City /4� ‘6.4 1` State f (, Zip 5 /
Qualifier 4`� '' l /�' i ? /l �
Zip
Phone # � 5 /L
Type of Work: ❑Addition ['Alteration ['New ❑ Repair/Replace ❑ Demolition
Describe Work: A/ C; C-/ ( (c;
� * *,� *�� * * * * *� * * * * * *� *,'�•� * *.�� Fees *� � * * * * * * * * * *� * * * * * * * * *��
Zoning
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 commencemenjmust 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.
Owner or Agent
The foregoing instrument was acknowledged before me this-5
day of 20I5, by /147,.4 jso,&.
who is personally known to me or who has produced
i2 ri der S b c €erci'As identification and who did take an oath.
NOTARY PUBLIC,
Sign:
Print:
Chc 12/15/03
ORLANDO OUVO. JR.
COMM SSION # DD2872sc
ANIKLb Ul/Uiiuuti
02 / D �/ 90NDED THRU 1 -683 YO'i ARV i
My Commission Expires:
******************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
Signature
The foregoing instrument w s acknowledged before me thisf
day of /�� , 2 // / , by Gs
who is personally known to me or who has produced
son4 tnt a'''las identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
* * * * * * * * * * * * * * * * * * * **
My Commission Expires:
Contractor
iANY PURL STA7 ' e FLCIFi!C :d
— / / O # uw.ej7 ac
l�ina DiA S 02 J03/200t1
> n cIF, I nE- • ,r1rAJ v;
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
(Certificate of Competency Holder)
State Certificate or Registration No. ( /'�', /{ A , 399- Certificate of Competency No.
** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
13
2 ap,
Plans Examiner
Engineer
Zoning
AIR CONDITIONING EQUIPMENT
' EXACT CHANGE OUT
AFFIDAVIT FORM
' ALL INFORMATION MUST BE FILLED IN ACCURATELY.
THE FOLLOWING INFORMATION REPRESENTS THE EXISTING CONDITIONS:
ADDRESS: 1 i0 - — l
Disconnect Mounting Location information:
AHU Circuit
Breaker
AMP
Size
CU Circuit
Breaker
Circuit Breaker Panel
Notary Required
Branch Circuit
Wire Size
Branch Circuit
Wire Size
Miami Shores Village
AMP Size
Air Hander Disconnect
Alin Size
Condenser Unit Oanned
Cornpany Name Qualifier Name Qualifier
ORLANDO OLIVO, J18,
NOTARY PUBLIC - STATE OP FLORMA
COMMISSION # DD287299
EXPIRES 02103/2005
BONDED THRU 1. 888 - NOTARY'
5
04c
P.A0 72 7
Mounted on AHU unit? Yes No k
Above Base Flood Level? Yes 3c No
Clear workspace
30" wide & 36" front? Yes )C No
Mounted on C/U unit Yes No -3(
Above Base Flood Level? Yes ,. No
Clear workspace
30" wide & 36" front? Yes No
Low voltage thermostat wiring is installed
in a separate raceway from the power
iiing? Yes )( NO _
THE FOLLOWING REPRESENTS THE NEW EQUIPMENT:
NAME PLATE INFORNATION:
=ANEW AIR HANDLER UNIT NEW CONDENSER UNIT
MINIMUM CIRCUIT AMPACITY? 0 .1- MINIMUM CIRCUIT AMPACITY? __ 5
MAXIMUM OVER CURR>rNT ST A? - - - - ... _. _ . _ _ ... _ _ - . - SOP? Iv�L�XIMUM OVER CURREI�t'� SI�F? �
ELECTRIC HEATER KW SIZE? ` le_to
I as qualifying agent for the air conditioning equipment installation at the above address
location hereby attest:
The above information provided for the existing electrical conditions and the nameplate
information provided for the new equipment is accurate and truthful.
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 5/16/2005
Applicant: HELEN
Owner: EDELSON
JOB ADDRESS: 1181 NE 97
Contractor BLUE BREEZE AC
Local Phone: 305 - 865 -1220
Parcel # 1132050170020
Signed:
(INSPECTOR)
Mechanical Permit
Permit Number: MC2005 -64
EDELSON
HELEN
ST
Contractor's Address: 736 NW 107 ST
Legal Description: REV PL MIAMI SHORES SEC 8
Permit Status: APPROVED Permit Expiration: 11/7/2005 Construction Value: $5,000.00
Work: NC CHANGE OUT
Page 1 of 1
PB 43 -51 LOT 2
Fees:
FEE2005 -6195
FEE2005 -6196
FEE2005 -6197
FEE2005 -6198
FEE2005 -6199
Description
Building Fee
CCF
Training and Education Fee
Technology Fee
Scanning Fee
Total Fees:
Amount
$175.00
$3.00
$1.00
$4.38
$3.00
$186.38
Total Fees: $186.38
Total Receipts: $0.00
-115 -
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:
BLK 180 LOT
Company
Phone #
Inspection Date
Approved
Correction
Re- Insp'n Fee
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
B iding Inspection Request
Date 1 18 i
TypeInsp'n ¥ ` no t Q
Permit No. IA Q,.. Os-64
Name �i Y,2r)
Address iin1 iv c3 rsh
MIAMI SHORES VILLAGE � ` (�t
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date
Type Insp'n 1 V\VMA 1\t a
Permit No. ■(:)._st ( k
Name ,` ``,1 (\ -ek‘. / /0�
Address \V \ 1- l�
Company \J\(1/''((b( Q k( C
01-0 (e dk(k)
Phone #
Inspection Date
Approved
Correction
Re- Insp'n Fee
z_
-Cr-1)u