MECHANICAL7_5(A
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
345.795 -2204
Btu tug Inspection Request
Date,
Type Insp'n I11 � N ChoC i Co 1
Permit No. e, 04 f 'a
Name OP
Address Cr C 114"
Company ( 5 5
Phone #
Inspection Date ClJ (I!J
Approved
Correction
Re- Insp'n Fee
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Miami Shores Village
Building Department
MECHANICAL CRITIQUE SHEET
1000 N.E.2nd Avenue
Miami Shares, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Permit No. ?oL>3^ -f 1
Job Name (s ,&C 9 5
X e6 it./ti
0 3 6. Crle, y /
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby uinde for the approval of the detailed statement or 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.
/O
9 77.., . — _.
_
tie ! � Date.
Owner's Name and Address . ti e...A/ 0 `V �J�� ... _ No.. C ..s..» Str eetL�
Registered Architect and /or Engineer . .,.•..,....,.,.n.,...•...,., s,.••..
C e - _.. f ..1.>� /Lip — .S �-- R� /2 . I.. . x:33 I6e
Name and address of licensed contactor ..._.
Location and legal description of lot to be built on:
Lot Block
Street and Number where work is to be done
to be done and purpose of buildi g (by floor )... .
4
STATE OF FLORIDA,
COUNTY OF DADE. is•
Subdivision......
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To 'be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements S1.0 00 I 00 Amount of Permit S.....�..a .s db
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 inspection on the site of the work such public notice
or notices as arc required by the Act. The undersigned agrees to employ only s ntractors, on work to be performed under this
pcnnit, as are licensed by Miami Shores Village.
Remarks__ ... (Signed)
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
Permit No. 11 S
Disapproved 1 1/4 . ,\. _.:... Date .._........_........._.._
(Signed)
Building Inspector
Chairman
Member
Member .. _....._......_..._.�...._....._
Council Approved Date
NOTE: A charge of $1.00 will be made for
the Planning Board.
A re- inspection fee of $1.00 will be charged
materials anti /or workmanship.
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
thcrcin by him stated ar true.
Date ' — 10 ' J Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
MyCommission Expires — _ ......_......� ..� _ _ .
PLANNING BOARD DATE
Member
Member
Member ...._ ..._
Disapproved Date
making corrections or changes to this application after approval has been obtained tarn
when such re- inspection is made necessary by improper notice for inspection or faulty
BUILDING
PERMIT APPLICATION
FBC 2001
Owner's Name (Fee Simple Titleholder)
Tenant/Lessee Name
Job Address (where the work is being done)
City Miami Shores Village
NO
Contractor's Company Name
Is Building Historically Designated
Contractor's Address
City
Qualifier
$ Value of Work For this Permit
Type of Work: ElAdditio
,11.. gait 1 a/
Describe Work:
Submittal Fee $
Notary $
Scanning $
Code Enforcement $
Radon $
Total Fee Now Due $
(Continued on opposite side)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Permit Type (circle): Building Electrical Plumbing
f &/JMft
(5 -.6-
YES
16 O1ock
lb�t� r1) 6 11\1/
State
bc
❑Alteration
G SS
County Miami -Dade
❑New
Training/Education Fee $
Zoning
Structural Plan Review. $
Phone #
Permit No.
Master Permit No.
Phone #
Owner's Address
City 11 State 41,,, Zip
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Permit Fee $ I 00 V
J
Zip
Phone # 5S�
7
Zip / t
State Certificate or Registration No. Certificate of Competency No. 9‘,, it4 op /0.2.. 1
Architect/Engineer's Name (if applicable) Phone #
Square Footage Of Work:
Repair/Replace ❑ Demolition
CCF$
Technology Fee $
, J,
� H, � �
Bond $
CO /CC
l8�
Roofing
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 absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
Owner or Agent
The foregoing instrument was acknowledged before me this
day of , 20 _, by day of
who is personally known to me or who has produced who is personally
As identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUB ..
Sign: Sign: AMA,' _ ,' ∎ •
Print: Print: �j� on #DD2319R4
�
My Commission Expires: My C� nmissi� Exp) .� BondedThru
************************************************************************* ' +1 +� Rtlahtic **** lne.
APPLICATION APPROVED BY:
Chc 05/13/03
Contractor
The foregoing instrument was acknowledged before me thi
, by
to me or who has p
identification and
f'
oduced
Zoning
10 did take an oath.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * * *,, * * * * * * * * * * * * * * **
g w Plans Examiner
Engineer
ITEM
BATH TUB
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS
CENTRAL HEATING
DISHWASHER
RECEPTACLES
A/C (WIND)
DISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN AMPS
DUCT WORK o1 /1/
.S'
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 FP
STEAM BOILERS
SHOWER
MOTORS OVER 1- 3 HP
HOT WATER BOILERS
SINK, POT /3 C0IF.
MOTORS OVER 3- 5 HP
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 FP
COOLING TOWERS
WATER CLOSET
MOTORS OVER 100 If
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
SW I W I NG POOL
OUTLETS NERC I AL
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
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
MECHANICAL