PL-05-238BUILDING
PERMIT APPLICATIO
FBC 2001
Permit Type (circle): Building lectric .1 Plumbing Mechanical Roofmg
Owner's Name (Fe
e Simple Titleholder) rGervi worry p('- 56 - �� # , - 1W
Owner's Address t O L WO q
l �/
City 4' c.v+1 State '� t r Zip (. 1. 3 p 7 I� �C�
Tenant/Lessee Name Phone # 30S `" .. L -- - 13.--(6/
Job Address (where the work is being done) 1P32- I v v q(-0
City Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES NO
Contractor's Company Name An CA4.. E. f
Contractor's Address 15105 t' W 39- T1 E 43W
City �I ( t_firK State Zip `�'� j
J E Y �, � 4
Qualifier f SALO ^ \
State Certificate or Registration No. 44 C tgq-1660 t Certificate of Competency No.
Architect/Engineer's Name (if applicable)
$ Value of Work For this Permit 1 1 e l �. ' g/ Square Footage Of Work:
Type of Work: DAddition DAlteration ZNew
Describe Work: v ` GC& t t F D • C • 4
1� P ftC f�
co Gj
* * * * * * * * * * * * * * * ** < ******,*F ,me*******************
Submittal Fee $ Permit Fee $ 540 1 CCF $ I ' ' ZO CO /CC
Notary $ Training/Education F e $ 3 - 40 Technology Fee $ 1Z • "75
Scanning $ 3. W Radon $ Zoning Bond $ 3C: C)°
Code Enforcement $
Total Fee Now Due $
(Continued on opposite side)
33G.35
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Structural Plan Review. $
'Pon— 2,66'
Permit No.
Master Permit No.
Phone #
/RI Repair/Replace.. 0 Demolition
nb
1036
Bonding Company's Name (if applicable)
Bonding Company's Address
City
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 1t ,,b, agt" /�`" • Signature --Z---
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this 2(o The foregoing instrument was acknowledged before me this
day of JUkI ,20 by , day of 3ULI ,2005, by
'
who is personally known to me or who has produced who is personally known to me or who has produced
As i tification and who did take an oath. ntification and who did take an oath.
NO
Sign:
Print:
My Commission Expires`.
******* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
chc 05/13/03
State
Evelyn Rodriguez
► Commission #DD 154
:•; Expire 007,, 2808
NOTARY PUBLIC
Sign:
Print:
My Commission Expires:
Engineer
Zoning
Zip
etaft? I5
**************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
�'� g flans Examiner
G MIAMI S VILLAGE
B-& 1ILDING DEPARTMENT
305- 795 -2204 SEP 3 0 2005
Building Inspection Request
Date 2 -1 CS
Type Insp'r l cSiP124
Permit NoPL-7
Name N P`.
Address g� `
Company 4L �- P y 4-t Co'J" v-texE
NLS'FC'Tl obA
Phone # C ` 3413
Inspection Date
Approved
Correction
Re- Insp'n Fee
A A
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 7/29/2005
Applicant:
Owner:
JOB ADDRESS: 602 NE 96
Parcel # 1132060141410
Signed:
Plumbing Permit
Permit Number: PL2005 -238
ST
Page 1 of 1
Contractor ALL AMERICAN FIRE INSPECTIONS, INC Contractor's Address: 15105 NW 77TH AVE, SUITE 300
Local Phone: 305/828 -3473
Legal Description: MIAMI SHORES SEC 2 PB 10 - 37 LOTS 1 TO 10 INC BLK 61 LOT SIZE
Fees: Description Amount
FEE2005 - 10356 Building Fee $510.00
FEE2005 - 10357 CCF $10.20
FEE2005 -10358 Training and Education Fee $3.40
FEE2005 -10359 Technology Fee $12.75
FEE2005 -10360 Scanning Fee $3.00
FEE2005 -10361 Builders Bond $300.00
Total Fees: $839.35
Total Fees: $839.35
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration: 1/23/2006 Construction Value: $17,000.00
Work: REPLACING FDC AND UNDERGROUND ADDING BACK FLOW
(INSPECTOR)
410 PAID
crC 1 acts
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:
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
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
MOTCRS 0- 1 If
STEAM BOILERS
SHOWER
MOTORS OVER 1- 3 If
HOT WATER BOILERS
SINK, POT /3 COMP.
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 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
r
FIRE SPRINKLER
GENERATORS TRANSFORMERS
HEATER -NEW INST.
GENERATORS TRANSFORMERS
HEATER - REPLACE
GENERATORS TRANSFORMERS
LAWN SPRINKLER -WELL
SPECIAL PURPOSE
SWIMAING 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
PULP & 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
0 'ADDENDUM TO BUILDING PERMIT APPLICATION
(AN AP1iI,ICAION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B.
OB AINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ELECTRICAL
MECHANICAL
NOTICE OF COMMENCEMENT
• A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO. � ,�' 6,52g.TAX i NO./
f/37 -4 (41iI0
STATE OF FLORIDA:
COUNTY OF MIAMI -DADE:
4. Contractor's name and address:
6. Lender's name and address:
•
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real
property, and in accordance with Chapter 713, Florida Statutes, the following information
is provided in this Notice of Commencement.
1. Legal description of property and street/address: Chu n? h eam a S
. !V b 6 St r2Pet r 8 tit or4S r4_
atz e24-77,,,...), )2//4
Signature of Owner
Print Owner's Name if /cia t teh pri `` e ,, �'"
Sworn to and subscribed before me this "I day of
CFN 2005RM:18139
OR Bk 23645 Ps 04121 (1as)
RECORDED OB/04/2005 14:52:04
HARVEY RUVIN, CLERK OF COURT
HIAMI-DADE COUNTY? FLORIDA
LAST PAGE
3 / 3 g c./.7 `
2. Description of improvement: .tea std/ e eu. /4 I r ed/ant c; 68d4 1/0.21 ad /v
3.Owner(s) name and address: il/a. i Sh re .r Asir ir j /an shore -A
, l o o 2 .. / ( 1 E / 4 , S t rc ` - t . ,/f1 ra vH SSo r FG 33,3‘ -
Interest in property:
Name and address of fee simple titleholder:
5. Surety: (Payment bond required by owner from contractor, if an
STATE c Ucq Te
Name and address: f / l ' r HERESY CER71- fr,af rc4 r •
original fi d kt t ce NIL
‘4 ?Z i ghi i
o'
Amount of bond $
HARVEY WAR CL,E, 1 4T �i t�� c vR vtr lL 'f a 1. ri. ;s =
7. Persons within the state of Florida designated by O wner upon who Gices or of e • ocumen s may be served as
provided by Section 713.13(1Xa)7., Florida Statutes,
Name and address:
Prepared by
20 > >�ee»al���uq l ���
NV oli f
8. In addition to himself, Owners designates the following person(s) to receive a copy of the Uenor's Notice as provided
in Section 713.13(1)(b), Florida Statutes.
Name and address:
9. Expiratiorq date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a
different date is specified)
Notary Public . c!'VV4'—
. I s