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PLUMBINGBUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Electrical Job Address (where the work is being done) City Miami Shores Village Is Building Historically Designated YES Contractor's Address a 6 99 W Ff i City / / /AL dr Qf+/ Qualifier 1bAu g h b rePAscituftt State Certificate or Registration No. Architect/Engineer's Name (if applicable) $ Value of Work For this Permit Type of Work: Describe Work: Submittal Fee $ Notary $ Scanning $ Code Enforcement $ Total Fee Now Due $ I 6 - 1 (Continued on opposite side) ['Addition ['Alteration Training/Education Fee $ Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Owner's Name (Fee Simple Titleholder) c r 7 f, Phone # 092/ Owner's Address 8177 ti6 9 7 /57e - 22/3 Y City $h19$/ 5/ /02e, State P o/L' 1j A Zip Tenant/Lessee Name .5' 77 Ai 9 7 .5' 7 County Miami -Dads NO $ocfiNfAf Ca/LRapoa/ EAlOw JEt'itiwGPhone # Contractor's Company Name 7 ? sr. 05 Phone # State •L bA Zip ao ❑New uN D E2G249 uA/t+ pRc PA./ E Permit No. f L -12:05 — Master Permit No. Certificate of Competency No. 0/95 / Phone # Square Footage Of Work: Mechanical Zip 33/3 S ❑ Repair/Replace Or AS 2/ Iii A/G. 33/3 g of- ?AR-sS" 93014 Roofing ❑ Demolition * * * * * * * * * * * * * * * * * * ** ****** Fw* * * * * * * * * * * * * ** * * * * * * * * * * * * ** Permit Fee $ CCF $ CO /CC Technology Fee $ Radon $ Zoning Bond $ 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 10 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 properly 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' Ow or Agent The foregoing instrument was acknowledged before me this day of b&kQy er, 20 ®S, by c •m tis \ARAI who is personally known to me or who has prnct nr.P,d �ri •. G•w As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: 'D /%Ja..■ Q,,vin My Commission Expires: l *** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ****** * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * APPLICATION APPROVED BY: chc 05/13/03 Contractor The foregoing instrument was acknowledged before me this 21 day ofi�P.C&4 C/r , 20 6 by n SC c (& who is_gersonall known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Cason) 1i 4,... Qc>i /►> a OFFICIAL NOTARY SEA CAROL! N h. A TE OF ORIDA COMMISSIO . NO. D 136724 MY 1..: L EXPII LY 24 y Commission Expires: 7/ e FFI Y SEAL � NOTARY STATE OF FLORID. COMMISSION NO. DD136724 Y 24 * * * * * * * * * * * * * * * * * * * * * * * Plans Examiner Engineer Zoning BUILDING ❑ ELECTRICAL ❑ PERMIT N° 14661 PLUMBING ❑ ROOFING ❑ Work to be performed under this Permit Owner of Building Architect Contractor or Builder Legal Lot II BL Description. Address of Building CONTRACTOR OR BUILDER MIAMI SHORES VELLAGE. FLORIDA Subdi- vision Value of Project $ DATE 17 195 Contractor's License No. Amt. of Permit $ This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. Signed • BY r :... INSPECTOR 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 responsibility for all work done by either, myself, my agent, servant or employee. BY AUTHORITY BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Architect Contractor or Builder Legal Lot II BI. Description Address of Building MIAMI SHORES VILLAGE, FLORIDA ❑ PERMIT N? 14675 ❑ Work to be performed under this Permit CONTRACTOR OR BUILDER Subdi- vision Value of Project $ DATE 195 Contractor's License No Amt. of Permit $ This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. Signed • BY INSPECTOR 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 responsibility for all work done by either, myself, my agent, servant or employee. BY AUTHORITY Permit No.._ Nature of Water Supply Amount of Permit $__ Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building 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 Divisior of Miami Shores Village shall be complied with, wheth r herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address J -- -- -- - b• -.-- Street Registered Architect and /or Engineer Employing Plumber's Name k Block -y � �.. _.-------------- -_ - - -. Subdiv Street and Number where work is to be performed —No. _27 9 _ ° _.L_ Street-. g State work to be performed and purpose of building (By Floors) _ New Building Remodeling —__ Addition Location and Legal Description Lot.- MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT No ... • _ ---L ` � �-- ---- - - - - -- ( Signed) Date Street. Repairs__ __ ....... .......... No of Stories Size Septic Tank __, Type of Tank___ Capacity Gals. Feet of Drain Tile _ Dist. Feet of Tank or Drain Field from Well. Well 1 L 0 _ Size of Soakage Pit Plumbing InspeLos. The undersigned applicant for this building permit does hereby certify that he understarlds,dnd accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennanent Supplement, and has com- plied 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 are required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as an licensed by Miami Shores Village. / 7 S' =� '" � � j , ' ._ Sr 7 ( Signed - _ - Master Plumber. STATE OF FLORIDA, 1 �, r (� COUNTY OF DADE. 1 Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare 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 tat therein by him stated are true. My Commission Expires Notary Public, State of Florida NOT A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or foul materi nd /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUaB URINALS CATCH BASIN FLOOR DRAIN DRINKIMG FOU NT'NS W s N. },}I ,44 # 1�� / / /1/ / x TOTAL FIXTURE! / CL TR. / / 6- / / - CHECK / Ts SEWER CONN. 7 - DRAIN ' P IELD / SOAKAGE PIT 7 GREASE TRAP SOLAR H EATER 7\s° SEPTIC TANK DEEP WILL SPRKLR. SYSTEM SWIM'G POOL CONTR. / CNBCK CHECK Permit No.._ Nature of Water Supply Amount of Permit $__ Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building 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 Divisior of Miami Shores Village shall be complied with, wheth r herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address J -- -- -- - b• -.-- Street Registered Architect and /or Engineer Employing Plumber's Name k Block -y � �.. _.-------------- -_ - - -. Subdiv Street and Number where work is to be performed —No. _27 9 _ ° _.L_ Street-. g State work to be performed and purpose of building (By Floors) _ New Building Remodeling —__ Addition Location and Legal Description Lot.- MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT No ... • _ ---L ` � �-- ---- - - - - -- ( Signed) Date Street. Repairs__ __ ....... .......... No of Stories Size Septic Tank __, Type of Tank___ Capacity Gals. Feet of Drain Tile _ Dist. Feet of Tank or Drain Field from Well. Well 1 L 0 _ Size of Soakage Pit Plumbing InspeLos. The undersigned applicant for this building permit does hereby certify that he understarlds,dnd accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennanent Supplement, and has com- plied 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 are required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as an licensed by Miami Shores Village. / 7 S' =� '" � � j , ' ._ Sr 7 ( Signed - _ - Master Plumber. STATE OF FLORIDA, 1 �, r (� COUNTY OF DADE. 1 Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare 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 tat therein by him stated are true. My Commission Expires Notary Public, State of Florida NOT A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or foul materi nd /or workmanship. Permit No. d 46 Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or othlet 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 Divisior 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 work. el Owner's Name and Address l �'a No Street Registered Architect and /or Engineer Employing Plumber's Name Amount of Permit $ Location and Legal Description Lot._ My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT New Building Remodeling_______________ ___________ Addition No. Block_ Street and Number where work is to be performed—No.... State work to be performed and purpose of building (By Floors) (Signed)_ (Signed) Size Septic Tank._ Type of Tank Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well_ Nature of Water Supply: City —Well __ Size of Soakage Pit Capacity Gals.. The undersigned applica /for this building permit does hereby certify that he and stands and accepts his obligations as an employer of labor under the Florida Workm /s Compensation Act, being Section 5388, Compiled Cener aws of Florida Pennanent Supplement, and has cr.,n- plied with the provisio I : 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 are required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this pPrrnit, as an licensed by Miami Shores Village. Repairs Date Street___ Subdivision ' Street No. of Stories Plumbing Inspector. Notary Public, State of Florida Master Plumber. STATE OF FLORIDA, ss, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare 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 tat. therein by him stated are true. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or fall materials and /or woo anauship. CLOSETS BATH TUBS SHOWERS LAVA• TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS U CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTR. LIST CHECK _ SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SwIM'G POOL CONTR. LIST CHECK 66 II Permit No. d 46 Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or othlet 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 Divisior 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 work. el Owner's Name and Address l �'a No Street Registered Architect and /or Engineer Employing Plumber's Name Amount of Permit $ Location and Legal Description Lot._ My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT New Building Remodeling_______________ ___________ Addition No. Block_ Street and Number where work is to be performed—No.... State work to be performed and purpose of building (By Floors) (Signed)_ (Signed) Size Septic Tank._ Type of Tank Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well_ Nature of Water Supply: City —Well __ Size of Soakage Pit Capacity Gals.. The undersigned applica /for this building permit does hereby certify that he and stands and accepts his obligations as an employer of labor under the Florida Workm /s Compensation Act, being Section 5388, Compiled Cener aws of Florida Pennanent Supplement, and has cr.,n- plied with the provisio I : 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 are required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this pPrrnit, as an licensed by Miami Shores Village. Repairs Date Street___ Subdivision ' Street No. of Stories Plumbing Inspector. Notary Public, State of Florida Master Plumber. STATE OF FLORIDA, ss, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare 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 tat. therein by him stated are true. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or fall materials and /or woo anauship. PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY ( TO RETAIN COPY) Date S 30 g Job Address 819 1A q Tax Folio Legal Description Master Permit # 3 1 4 Owner / Lessee / Tenant ®5€ l_ Owner's Address 519. $C" Phone Contracting Co. iJ S t�� c& 4..`p WVV i\4j \AA Qualifier CACAOS \1 . s SS# Phone 5S8 State# C 37 j[ L.) Architect /Engineer Bonding Company Mortgagor Permit Type (circle one): BUILDING ELECTRICAL WORK DESCRIPTION . e.� t Y� Signature of Owner and /or Condo President Date: Notary as to Owner and /or Condo President My Commission Expires: * . * . * * * * PERMIT FEE: APPROVED: Competency # Zoning Building Address ( o — IS W4,$ 7 1p prot Address Address Address Square Ft. Estimated Cost an °� P „ WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO 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). Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING, and MECHANICAL work. 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. Furthermore, I authorize the above -named contractor to do the work stated. Mechanical Plumbing 4 l� e of Contracto a e : S3d /P/ Z> 'L Ins. Co. 'Me VraLoAeitm MECHANICAL PAVING FENCE SIGN Notary as to Contractor or Owner- Builder My Commission Expires: NOTARY PURIIC STATE OFR.QR!®, *AY COMM.AWN EXPI S P /Qa /S. Fire Other Bonded Vim Ste:'-ibL.r- a!yas & Sweet Electrical Owner- Builder 00 1 Engineering A PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 0.— 1 31 C ‘Iob Address $ 7 S lir 77 s: Tax o1io r S T 3 Legal Description 1 G r iZ st 4) 2 3 3/k 7 3 Historically Designated: Yes No Owner/Lessee / Tenant �� PWOK Master Permit # 4 J y 94' Owner's Address 871 9 t.i 7.-7 s / ✓e 7" Phone ?o 7 � Y - ( , !; Contractin Co. G S S / A0 (S !'i c, Qualifier ..1. / et. 6 e5 State # ek O i ZCO Municipal # Architect/Engineer Bonding Company Mortgagor Address Address N CAF as to Q M Commission Expires: qD ' Pere (4t er and/or Condo President ' D FEES: PERMIT / q D "*". RADON APPROVED: Zoning Building Mechanical Plumbing Address 1800 PF /37 ST SS# - Phone 3 j SV e 00O Competency # Ins. Co. On 6 Address 'Y 7 s w 7 7 C- Electrical xi/ ECHANICAL ROOFING PAVING FENCE SIGN Permit Type (circle one): UILDING LECTRICAL WORK DESCRIPTION L) //U-C1 /1 ?DO ( �a� � cts Pool rirfn Square Ft. 3 !) Estimated Cost (value) (/) OD a WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO 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.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate an laws re lating construction and zoning. Furthermore, I authorize the above -n k stated. " I./ Signs �4• "Tr 'Builder Al Ask 1 be done in compliance with all applicable A /_./. N i as to •ntrali • r or • . HER!VM�N My •mmission Expires: Notary Public, State of ; My comm. exp. May 24, 20C Comm. No. CC819725 C.C.F. . — NOTARY 0 BOND 3 Date e TOTAL DUE T / / NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITU AT TIME OF FIRST INSPECTION PERMIT NO. STATE OF FLORIDA: } COUNTY OF DADE: • THE UNDERSIGNED hereby gives notice that improvements will be made to chain real property. and in accordance with Chapter 713. Florida Statutes, the following information is provided in this Notice of Commencement. �p 1. Legal description of property and street address: �� AJ ..�, 9 7 Si Y /rn/ • • 2. Description of improvement: 3 .Owner(s) name and address: e 6S /17 L 975 A/C Interest in property: Name and address of fee simple titleholder: 4. Contractor's name and address: ( L • •••' • c 04, • G p /J�, 1 S /yl>/l�7/ . z. ?. AT - OF FLT¢` JAp �, o. 4. ^ „ Z_aTif. t7 a” . rD�ia 5. Surety:(Payment bond required by owner horn Name and address: Amount of bond $ 6. Lender's name and address: Section 713.13(1)(b). Florida Statutes. Name and address: 9. Expiration date of /is Notice of : (lhe differentiate is specified) r / j - / TAX FOLIO NO. A-1/ be G © cQc) NIA Print Owners Name t X11 y of Owne r '/ Sworn to and subscribed before me this.Z___daY of , 6 - ,1g A%1 , .-Q /1 e ✓eJ 1 VIPtin P1 _ - KENNETH Notary Public, My comm. e Comm. r >- prepared by: Address: 998635558 1999 DEC 16 10:16 • 1 year from the date of recording unless a 7. Persons within the State of Florida designated by Ow r upon whom notices or other documents may be served as provide by Section 713.13(1)(a)7.. Florida Statutes. • Name and address: ; 8. In addition to himself, Owner designates the following person(s) to receive a copy of the Uenor's Notice as provided in RM N V � GtS30 Florida b p 'G -Cr 4, 2003 NIA-1 / �./ 3-5"'- 725 Permit No 3 6 119 Owner's Name and Address MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date - — — -_ Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building 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 work. No._,--- _____- _ _ Street 4 Registered Architect and /or En ineer - Employing Plumber's Name_- f / .... - 7 - '� --- -___.- No.- _--- - - ---- Street —_ Location and Legal Description Lot /� Bl Subdivision �y 9 24 � Street and Number where work is to be performed —Nog 1 , __q_7 State work to be performed and purpose of building (By Floors) ----------__ - New Building_ ____ ._..___ Remodeling —_ _ __ -._ Addition-_ -_ Repairs No. of Stories... ... ___ ..... . .... Street Size Septic Tank_ Feet of Drain Tile___ - •-) t. Feet of Tank or Drain Field from Well Nature of Water Supply: City—Well. ____, ______ _________._ — ____Size of Soakage Pit Amount of Permit $ r STATE OF FLORIDA, t COUNTY OF DADE. ss. Capacity Gals ( Signed Plumbing Inspector. 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 com- plied 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 are required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared 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 therein by him stated are true. My Commission Expires Notary Public, State of Florida Master Plumber. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necesssry by improper notice for inspection, or faulty materials and /or wort nanship. CLOSETS BATH TUBS SHOWERS LAVA. TORIES NKS SINKS SLOP SINKS LAUNDRY TUBE RINALS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FI %TUREB CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR H EATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL CONTR. LIO• CHI1CK Permit No 3 6 119 Owner's Name and Address MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date - — — -_ Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building 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 work. No._,--- _____- _ _ Street 4 Registered Architect and /or En ineer - Employing Plumber's Name_- f / .... - 7 - '� --- -___.- No.- _--- - - ---- Street —_ Location and Legal Description Lot /� Bl Subdivision �y 9 24 � Street and Number where work is to be performed —Nog 1 , __q_7 State work to be performed and purpose of building (By Floors) ----------__ - New Building_ ____ ._..___ Remodeling —_ _ __ -._ Addition-_ -_ Repairs No. of Stories... ... ___ ..... . .... Street Size Septic Tank_ Feet of Drain Tile___ - •-) t. Feet of Tank or Drain Field from Well Nature of Water Supply: City—Well. ____, ______ _________._ — ____Size of Soakage Pit Amount of Permit $ r STATE OF FLORIDA, t COUNTY OF DADE. ss. Capacity Gals ( Signed Plumbing Inspector. 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 com- plied 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 are required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared 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 therein by him stated are true. My Commission Expires Notary Public, State of Florida Master Plumber. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necesssry by improper notice for inspection, or faulty materials and /or wort nanship. . BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Owner's Name (Fee Simple Titleholder) Owner's Address q City N/A./1/ ) Ao /Res State Tenant/Lessee Name Job Address (where the work is being done) City Miami Shores Village / Ls Building Historically Designated YES NO Y Contractor's Company Name Pi ) eJ '•P, Contractor's Address P. 0 . 607( City P • 1 /4 N) Qualifier (e ( 5 up $ Value of Work For this Permit Type of Work: Describe Work: Total Fee Now Due $ (Continue 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 Electrical Permit No. (•'t D — 30 ' Master Permit No. Mechanical Roofing � ) Ai eRi / Phone# c '7 1# ST yob. oO DAddition DAlteration ❑New £7i '/ii' F'/ 1 Rep-y9) /q 46ct '79 .Aec- NOV 18 PAID F(.,7q zip 3 / 3S Phone # 79 ; it County Miami -Dade g c.)mhiaLl—Ne-- 5S13 State F 5 Phone # c184(- , 3 _..e.(1 Zip Zip Architect/Engineer's Name (if applicable) Phone # '3 3/3 Square Footage Of Work: :3 0075 * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** El ❑ Demolition Submittal Fee $ Permit Fee $ ('1 S . CCF $ ` - D . Notary $ S -CO Training/Education Fee $ • loo Technology Fee $ 4. 3'7 . Scanning $ .CC- -' Radon $ Bond $ 3C0 • C)O • Code Enforcement $ DIEM. 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 pennit 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 NOT Sign: Print: Owner The foregoing instrument was acknowledged before me this 1% The foregoing instrument was acknowledged before me this day of , 20 by 1t1tr►i Fee. vrl, , day of KiCA , 200_J by Spp`f1ve "PSSV f , apgas who is pers al known to me or who has produced My Commission Expires: OF F1.Os, •∎%, * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ** State Certificate or Registration No. / Certificate of Competency No. * * * * * * * * * * * * * * * * * * * * * * * * * * ** * *;,i * *; ********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED B Chc 10/14/03 tification and . ho did take an oath. gent NOTARY PUBLI Sign: Print: who is personally known to me or who has produced identification and who did take an oath. xpires: Jul 13, 2007 oaF, ptres: Jul 984 Bonded Thru 4 ,Jan Bonded n ;3, 20 07 (Certificate of Competency Holder) My Commission Expires: Plans Examiner Engineer Zoning