558 NE 96 St (5)RECOV!( jj
Pr• 2 6 2003
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electrical
Tenant/Lessee Name
Miami Shores Village
Building Department
Plumbing
Owner's Name (Fee Simple Titleholder) 71 )4 I T) J 1 T(C " �1� Phone # S- 7 7 � - S o
Owner's Address S58
City M 1 ULA \ VIaL State Zip )
Phone #
4 l �
Job Address (where the work is being done) S � Z`5 S
City Miami Shores Village County Miami -Dade Zip .-, J
Is Building Historically Designated YES NO f/
Contractor's Company Name ( Ni&Z(-1 N-c Phone #
Contractor's Address /Z,SY D JE
City A41,444. / , IOC State Zip /‘,(,.
Qualifier 44 4��-
Architect/Engineer's Name (if applicable) Phone #
Architect/Engineer's Address
City State Zip
$ Value of Work For this Pezmit 0 $ �. Square Footage Of Work:
Number of: Bays Stories Families Bedrooms Baths
Type of Work: ['Addition DAlteration ew ❑ Repair/Replace [Demolition
Describe Work: 4i /m4 It/14 7 81 GA 51-41 N4 /1.14C H1 NL/ )1 -0 EX LS %dt-k
34 7,L0/ -1
* * * * * * * * * * * * * ** * * * * * * * * * * * * *F * * **** * * * * * * * * * * * * * *,► * * * *mot ** Pa )O $ •
County Escrow Fee $ Permit Fee $ 1 Notary $ l L. 1 1
Education/Training Fee $ Tech $ Scanning $ Radon $
Code Enforcement $ Bond $ Struct. $
Minus Plans Check Fee $ Total Fee Now Due $ (Continued on opposite side)
Permit No. P I DcJ -2(0
Master Permit No. ePO3_7
Mechanical Roofing
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
9�-)- zip - <l9iv
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 occurs seven (7) days after the building permit is issued. In the absenc,:f such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
chc7n /03
Signature
Owner or Agent Contr• or
The foregoing instrument was acknowledged before me this The foregoing instrument was • .� owledged before me this
day of , 20 _, by day of. Q,1kt - , 20 3 by Ra el �erner��e 2
who is personally known to me or who has produced ' C who is personally known to m)r s p
As identification and who did take an oath.
NOTARY PUBLIC:
Sign: Sign:
Print: ,
Print:
• �R f�
My Commission Expires: My Commission Expires 11'"°‘ p
` ia■ ;i MY COMMISSION # � T tP H2ES es 9
•
(Certificate of Competency Holder) February 2. 2004
• RF N!P` BONDED THRU TROY FAIN INSURANCE INC
State Certificate or Registration No. c_/ 053 r
Certificate of Competency No.
NOTARY PUPt
d who did take an oath.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ** * ** *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY �,
Plans Examiner
Engineer
Zoning
PIRES
FeI uary 2, 2004
.VNR� THIN !NUT FAIN INSUKANU, INC.
ITEM
BATH TUB
UNIT
_1
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS
CENTRAL HEATING
DISHWASHER
RECEPTACLES
A/C (WIN))
DISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN A PS
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 HP
MECHANICAL VENTILATION
SINK, RESIDENCE
g
MOTORS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTORS OVER 8- 10 If
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 CLOCK
UTILITY -WATER
FIXTURES
SEPTIC TANK
ANTENNA
RELAY
TELEVISION OUTLETS
DRAINFIELD, 4' TILE/RES.
_
VIOLATION
PUMP & ABANDON SEPTIC TANK
REINSPECTION
SOAKAGE PIT CU. FT.
CATCH BASIN
OISCHARGE WELL
DOMESTIC WELL
AREA DRAIN
•
T00F INLET
SOLAR WATER HEATER
IRE STANDPIPE
'00L PIPING
•
_AWN SPRINKLER SYSTEM
SAS RANGE
II
AATER SET (GAS)
;AS PIPING
O.ENDUM 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
MECHANICAL