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1200 NE 97 St (10)• Miami Shores Village BUILDING PERMIT APPLICATION FBC 2001 Owner's Name (Fee Simple Titleholder) Owner's Address r ) ( e- Cit ) 1 `.J State Tenant/Lessee Name Contractor's Company Name ' }`t 1)} t".l s :} ) i •' i" f t: ' 4 Phone # Contractor's Address n } 1 t 2 t.!;, ' 1 r City i \0 '∎ State Zip Qualifier ) C b d , . e, i )) (t, I ) $ Value of Work For this Permit (( (� � Total Fee Now Due $ (Continued on opposite side) Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Zip Phone # Permit No. ,' --- Master Permit No. Permit Type (circle): Building Electrical Plumbing (*'Mechanical Roofing Phone # p " .. /. :3 Job Address (where the work is being done) f "� !\- t v 1 City Miami Shores Village County Miami -Dade Zip Is Building Historically Designated YES NO - • Architect/Engineer's Name (if applicable) Phone # Square Footage Of Work: Type of Work: ❑Addition ❑Alteration ['New [,Repair/Replace [II Demolition Describe Work: ► ' i') yy I (C. 4 Y) A j ( \1 t t L , F <Z 1 *** * * * * * * * * * * *** * * * *** * * * * ** F ees * * * * * * * * * * * * ** * * * *** ** * * * * * * ** Submittal Fee $ , ermit Fee $ 0 CCF $ CO /CC Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ Zoning Bond $ Code Enforcement $ Structural Plan Review. $ Bonding Company's Name (if applicable) Bonding Company's Address 4 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 Signature � / ,4"1-01 Owner or Agent f/ Contractor The foreg ing instrument was acknowledged before me this: The foregoing instrument was cknowledged before me this � p day of (.I6'i V�) , 2(C4, by ' %� i 71� � 1: � �� , day of di6i , by JO/') 114'i,4/tZ ii , who is personally known to me or who has produced L �-is personally kiiowie. or who has produced ( 1C`Virt - 2 i identification and who did take an oath. NOTARY Sign: Print: My Commission Exl3ff&: Chc 12/15/03 APPLICATION APPROVED BY: t a 22 r,r Key Ban tedThruuuucrsti : b i Serv.ces as identification and who did take an oath. Sign: .i .l ►�,�%` .i. - .,,� % 7 Print: fop?,; I ua �✓ "f� -/r:. c,' 2rdedlnrutsucyctt. 1 Cog m My Comission E ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** (Certificate of Competency Holder) State Certificate or Registration No. Certificate of Competency No. ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Engineer Zoning 1 ITEM BATH 11.8 UNIT • FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT 1' BIDET LIGHT OUTLETS CENTRAL HEATING e 4 I DISHWASHER RECEPTACLES At (WIN)) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) 4 : 0 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 IP 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 HP VIOLATION INDIRECT WASTES- . , A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS • A/C UNIT STRIP HEATER • FIRE SPRINKLER GENERATORS TRANSFORMERS • HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER - REPLACE GENERATORS TRANSFORMERS - LAWN SPRINKLER -WELL SPECIAL PURPOSE • SWIMMING POOL OUTLETS COMMERCIAL WATER SERVICE SIGN TUBES • SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY-SEWER SIGN TIME COCK UTILITYTWATER FIXT1&S SEPTIC TANK ' ANTENNA RELAY TELEVISION OUTLETS GRAINFIELD, 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 ' 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 MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -220 Building Inspection Request Date 3 Type Insp'n T OCA Permit No. C ~ — \ -1 Name Mots t.5-en Address Company Phone # Inspection Date Approved 3)2-00 C ,, Z4. Correction Re- Insp'n Fee ❑ MIAMI SHORES VILLAGE BUILDING DEPARTMEN 305 -795 -2204 Building Inspection Reques Date Type Insp'n Permit No. Name Address Company Phone # Inspection Date Approved Correction Re- Insp'n Fee tY20 0-r gco cY n s �- ,n (CA c \CfOV- ci OM 21(8,04 ;ra RfivZ ".Z021s3t3nda>=v. ..oleaa>Za.Zir ssr sl.-._4,19 . >rr>St.mmlmt.mlnarimii:Imal.75. 1aneipm - o rp_ eis3a smivlosrtu_0 3931. >y 1.Z.9.Zx.Za W 1g 515 NE. 190TH STREET g MIAMI. FL 33179 jo Z tli Pli R � S? N 63-1473.870 (305) 940 -0777 Dae PZ I Pay tothe(` liof S�Oi 0 t la/ �1G�� ` © � � III order • / ll Ii i ii A __-- a� 1 !� �.____._ Dollar W it 2100 E. H +� �. BEACH BOULEVARD ;q, V � ALE, FL 33009 , 1 4 4 1 For '! C.<' Q tk - / / /p1 � , I P: rii it "004480 � so6?0 14 7 38': LO 2 1480 111' ifl. vt .SammiwnSal �,empor r.y.„rii„, „,rinaa i, ....x r...oxiir..c.owea ..aaCTagi i sZ'u ��ifi[ii 7�. Z��aPY. ixTrvL _ :Lc.twx..w'La,,c,o.Z4i!moii i v acii�i2... .,... i r.v .,. Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Permit Number: MC2004 -17 Printed: 1 /29/2004 Applicant: KENNETH HARRIS Owner: HARRIS KENNETH JOB ADDRESS: 1200 NE 97 ST Contractor AFFORDABLE AIR & HEAT Local Phone: 305 - 940 -0777 Parcel # 1132050090620 Mechanica Permit Contractor's Address: 515 N. E. 190 St. Page 1 of 1 Legal Description: EARLETON SHORES PB 43 -80 W12.50FT OF LOT 20 & ALL OF LOT 21 Fees: Description Amount FEE2004 -939 Building Fee $100.00 FEE2004 -940 CCF $1.20 FEE2004 -941 Technology Fee $2.50 FEE2004 -942 Training and Education Fee $0.40 Total Fees: $104.10 Total Fees: $104.1% Total Receipts: w.00 Permit Status: Work: REPLACE 4 TON AIR COND WITH 8 KWHEAT Permit Expiration: 7/26/2004 Construction Value: $2,000.00 Signed: (INSPECTOR) (L'" JAM 3 0 RAID 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: • IJlL; EN 1NSPEC:T EO ' ? PAE �Ca9�Id' Application is hereby made for the apprm a1 of th" deL sled statemen of the plans and specifications herewith submitted for the build- ing or o h. - structure her r described This 1-1 hcalie is made in compliance and con o'm ty wth the Building Ordinance of Mia Ii Shores Village, h .or da, and all pro isions of tin Laws c f the State of f lurid. all o d nances of Mi m Shores Village and all rules and regu'a`ion, of the Building Div.: I of .1 im Silo. ill.age 1 '1 a -o, ipl.ed with, whether herein specified or not. A copy of apprm td plans and specificati m must be kei at bur dog durin, progress of the work. Owner' • Name and Address_. .. : ' Registered Architect and /or Engineer Name nd address of licensed contractor _ , ,,,ti- Location and legal description of lot to be built on: pea: ed i1A A EH®M 1 NPLL :ti?` Gt Lot __ .. Block.. _ - Subdivision_ ..... .... .... Street and Number where work is to be done. /1_ ' % -___ ! . i�� Date__ ��� No . Street_ ... ._._ State work to be done anta purpose of building (by floors)____. . . I , and for no other purpose. New Building. __ - Remodeling _ .__ _ . Addition.. . _ . ... __ . Repairs. _ No. of Stories To be constructed of ._ . _ Kind of foundation ._ . Roa Cov 'ring . - 7 ) . ..,� Estimated " ,tal cost of improvements $ . c,% -_' ) « %_ ! _ Amount c` Permit $.- . . ' Zone ^ubage required _.. .Plan Cubage__ ____ ____ _ _ ___ __ __ Distance to next nearest building. .. __Size of Building Lot Maximum live load to be borne by each floor . . .. . hereby submit all the plans and specLi,•ations for said building. All notices with reference to the building and its construction may be sent to - - - -- -- - - -- - - - - - -- - -- - -- The undo signed appli ant for th s budding pc -mit does hereby certify i'Iat he underta-,ds and accepts his ..bligations as an en:plm rr of I. bor under he Florida Workmen's Compensation Act bong S .Con .:" 33 Co: n led Gcn al Laws of Florida P r anon S ; I, 1.ent. and h s cnmpl ed will he prov' -ions thereof, and will require s molar co» Ian e from :ul contractors or sub contractor, cinplo -ed by Lim in the wo k to be p rf med under th s pern it and ill post or taus. to be r f' r inspection on the site of the work a -h public not e or ctices as are requir d by the Act. The u. '1. r Il?n d agrees to employ only such ibcontr ctors, on work - to be perform , der this pern•'t as are licensee by M am. Shores \ it %e. ' - . ■ Remarks (S'.; a :d ) A '\ ../' .. < <C 1 . a: 'S. 1 . STATE OF 1'1010 - DA, " j1 �;, ` COUNTY OF DADE. ' ss. Before me, the undersigned authority, a notary public, duly authori"ed to adm.nister oaths ..n take acknowledgments, per- nnall: •p- and who, being by me first d lv sworn, upon oath depoees and says that he is the .. __....__ of th aboti. de c 'bed :struction t. . 1, has care Lally read the foregoing application, and that he did sign the same, and it a'. I 'acts therein by him stated are tr ie. . q -, Permit No._ ____ _ -- 4' (2 i` _ . Date_ �. Disapproved _ _ ____ ____ _____' ,. Date __ J ;_ (Signed) - -- - -- - - --' BIrrmlding fnsp ctor Read, Sworn to and Subscribed before me. Notary Public State of Florida My Commis-ion Ex res 19 . to me wel! known, ( PLANNING BOARD DATE Chairman Member Member __. ... Member M ember .. - - - -- - _. __ Mew,he,. . Council Approved ._ Date Di :a'.- r. .....1 Date NOTE: A charge of $1.00 will be made for making corrections c- •-1 Inges to this application ft.'r ,c.1 pro%al 1, s 1 . n .',t i .,ed from the Planr ng Board A re- inspection fee of $1.00 will be charged when such re- inspection is m, rt,es.ar! by improper notice h r in.p t- ,,. or t u ty materials and /or workmanship.