444 NE 96 St (13)Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
BUILDING
PERMIT APPLICATI
FBC 2001
Permit Type (circle): Building
Owner's Name (Fee Simple Titleholder)
Owner's Address
City ,1/.49,07/
Qualifier 6k74 WC) OL,/(J
State Certificate or Registration Noa/3/ 63'
Type of Work: ❑Addition ❑Alteration
Total Fee Now Due $ 1 , 2 • S 5
(Continued on opposite side)
Miami Shores Village
P O O O O P
Tel- " (305) 756.8972
OWE
�00� �j(� o z 7 • N I
Electrical
City State Zip
Tenant/Lessee Name Phone #
Job (where the work is being done) T7'9' / / — 96 5T
City Miami Shores Village County Miami -Dade
Is Building Historically Designated YES NO
Contractor's Company Name PEfpY-}' b 0 U t)2 / .S7. Phone #36:6 9 — D / 3 /
Contractor's Address / 2 Z7 /t
State
Zip_3 /7�
Architect/Engineer's Name (if applicable) Phone #
�/
0 a
$ Value of Work For this Permit r3 Square Footage Of Work: (9O•
❑New
Describe Work: , SEM.. /e/7-e./f j() 41-P. ()Q
Plumbing Mechanical Roofing
Phone #
Certificate of Competency No6/6 6 ;
IZfritei;air/Replace ❑ Demolition
77,
• * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Permit No. Ito,. (.016 —
Master Permit No. R.c_ A04-44
Zip
Submittal Fee $ Permit Fee $ Af CP e GPO' CCF $ Q. (=ID CO /CC
Notary $ S- Training/Education Fee $ 0.10 Technology Fee $ 3 •
Scanning $ 3 •• 00 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 oc s s • en (7) days after the building permit is issued In the absence of such posted notice, the
inspection einspection fee will be charged.
Owner or Agent
The foregoing instrument was acknowledged before me this , The forego irjstrument was acknowledged before me this <2 ?fl'
day of t (f�� , 20 , by Aka ( Xtd'zaal o; 04 • day of , / , 20� by
who is personally known to me or who has produced rt. QrtVO'SC(G who is personally known to me or who has produced,L• d1 •
ft a o - 633 4 " rOAs identification and who did take an oath. Qy001,(1-78376- i nufication and who did take an oath.
NOTARY P / :LI '
Sign:
!� I. AZ Sign:
MY COMMISSION # DD 483995 4 " LUIS FEHNANUtt
Bonded Thru Notary Public Undenvraers
Print: M t/Cg, / 6,1 ,
FXPIRFS• nrinhar 9f1, 2009 Print:
My Commission Expires: APRIL 4041•11.11.1•1•■■ My Commission 61Y COMMISSION # DD 348468
OF EXPIRES: November 7, 2008
APPLICATION APPROVED B
chc 05/13/03
Signature
NOTARY PUBLIC:
Contractor
************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
„GC Examiner
Engineer
Zoning
AN REPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS E.
OETAINED, TSE OWNER'S NOTARIZED SIGNATUJRE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
SOLAR WATER HEATER
FIRE STANdPIPE
POOL PIPING
LAWN SPRINKLER SYSTEM.
GAS RANGE
ME=TER SET (GAS)
GAS PID1
ADDENDUM TO BUILDING PERMIT APPLI(:A 11UN
ELECTRICAL
MECHANICAL
FEW
ATH Tl.E
UNIT
FEE
ITEM
SNITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
I DE T
L I GHIT OUTLETS
CENTRAL HEAT I N.G
ISHWASHER
I
RECEPTACLES
A/C (WINO)
ISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL)
RINKING FOUNTAIN
SERVICE SIZE IN AMPS
DUCT WORK
O C R DRAIN
SERVICE R E P A I P J T E R CHANGE
REFRIGERATION i
REASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
HTERCEPTOR
RANGE TOP
UNDERGROUND TANKS
ATCRY
OVEN
ABOVE GROUND TANKS
.AV
TRAY
WATER HEATER
U.F. PRESSURE VESSELS
.'UNDRY
1OTHES WASHER
MOTORS C- 1 HP
STEA1 BOILERS
SHOWER
MOTORS OVER 1- 3 HP
HOT WATER BOILERS I I
SINK, POT /3 COMP.
MOTORS OVER - 5 NP
M'PCHANICAL VENTILATION
SINK, RESIDENCE
MOTORS OVER 8 HP
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTORS OVER E- 10 HP
ELEVATORS/ESCALATORS
TEMPORARY WATER CLOSET
MOTORS OVER 1C- 25 HP
FIRE SPRINKLER SYSTE>.G
UR 1 NAL
MOTORS OVER 2E-100 HP
COOL I NG TOWERS
WATER CLOSET
MOTORS OVER 100 HP
VIOLATION
INDIRECT WASTES
A/C WINbW
RE I R ECT1ON 1
WATER SUPPLY T0:
AIR, COND ITIONERS
I I
A/C UNIT
I STRIP HEATER
(
I I
F IRE SPRINKLER
I GENERATORS TRANSFORMERS
HEATER -NEW INSi.
i GENERATORS TRANSFORMERS
HEATER - REPLACE
1 GENERATORS TRANSFORMERS
(
I
LAWN SPRINKLER -WELL
I J SPECIAL PURPOSE
SWIMMING POOL
OUTLETS COM+,ERCIAL
WATER SERVICE
SIGN TUBES
SEWER CONNECT IONS
' S I GN TRANSFORMERS
UTILITY -SEWER
SIGN TIME CLOCK
UTILITY -WATER
FIXTURES
SEPT IC TAN;
1 ANTENNA
1
RELAY
I TELEVISION OUTLETS
I
1
DRAINFIELD, 4' TILE/RES.
VIOLATION
PUMP L ABANDON SEPTIC TANK
RE I NSF' I ON
SOAKAGE PIT CU. FT.
CATCH BASIN
DISCHARGE WELL
1
DOMESTIC WELL
I
I
AREA CRAW'
ROOF IHL
AN REPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS E.
OETAINED, TSE OWNER'S NOTARIZED SIGNATUJRE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
SOLAR WATER HEATER
FIRE STANdPIPE
POOL PIPING
LAWN SPRINKLER SYSTEM.
GAS RANGE
ME=TER SET (GAS)
GAS PID1
ADDENDUM TO BUILDING PERMIT APPLI(:A 11UN
ELECTRICAL
MECHANICAL