1269 NE 99 St (2)ti
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electrical Plumbing
Owner's Name (Fee Simple Titleholder) ('Drf ./44' N4OoEf Phone #
Owner's Address /02 Ca 9 A/6 99 S7, r
City/49M/ o oec-s State FG
Tenant/Lessee Name
Job Address (where the work is being done) /02 Co 9 Ai. E • 99 5T
City Miami Shores Village County Miami -Dade Zip .33/3 8
Is Building Historically Designated YES NO )
Contractor's Company Name J * C Ale doiwiryav ,V C�7
Contractor's Address 671 8 D.9aAse / �7
City //QC/, y G voz• State AZ-
Qualifier eAlg el-cs , '/ DO6 L;G
County Escrow Fee $
Education/Training Fee $
Code Enforcement $
Miami Shores Village
Building Department
Bond $
Permit Fee $
Tech $
S
- 2 003 ^ �
Permit No
Master Permit No.
Zip 33 /38
Phone #
Phone #
Zip
.33a.. 3
Notary $
Scanning $ Radon $
Struct. $
A li
eh.
2014
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Roofing
(' a j 762
�9sy� 983 /God
Phone #
Architect/Engineer's Name (if applicable)
Architect/Engineer's Address
City State Zip
$ Value of Work For this Permit 85 Square Footage Of Work:
Number of: Bays Stories Families Bedrooms Baths
Type of Work: ❑Addition DAlteration ❑New ❑ Repair/Replace ' ❑ Demolition
Describe Work:
i -- Gt) / /
c 7200,e C EP c
* * * * * * * * * * * * * * * * * * * * * * * * * ** *Fee Calculation -Misc Permits * * * * * * * * * * * * * * * * * ** * * * * ** * * **
Minus Plans Check Fee $ Fee Totals $ ct oo .Y (Continued on opposite side)
L CJ $30x0 i733//'
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) d after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved n > a reins • ecti :'e will be charged.
�
'-_ Signature /4,41/
Owner or Agent " Contractor
The foregoing instrument was acknowledged b or-'me this g The foregoing instrument was acknowledged before me this 9
day of , 20 03, by , day of 20 03, by
who is ersona ly known to me or who has produced who is personally known to me or who has produced
• •• ® . As identification and who did take an oath. ii` as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC: , 9
Sign: -66& - C . °9d. L
Print: Deborah G. 1-11 /1
Chc6 /18/03
YeteictcLeie
Sign:
Print:
° " ' 0 ° 08b01'26t1 �i Co Tm u VE OF uA My Commission Expi �w',� ° °� xiF
My . �j C".onum aion # OC . PC
EXPIRES » t" *+ ** *ct
M
�flho''° %bonded 5` r'l
(Certificate of Competency Holder)
AEisT4ic Bonding Co., l'e!c.
State Certificate or Registration No. Certificate of Competency No.
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
-6. <)
Zoning
7, J'. ®> Plans Examiner
TEM
;ATH TU
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS Jo a
UNIT
l
FEE
;MET
LIGHT OUTLETS
lk'
CENTRAL HEATING
HSI-MASHER
RECEPTACLES
A/C (WIND)
ISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL) 0 ?
�
RINKING FOUNTAIN
SERVICE SIZE IN AJ'S
DUCT WORK
LOOK DRAIN
SERVICE REPAIR/METER CHANGE
REFRIGERATION
:REASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
NTERCEPTCR
RANGE TOP
UNDERGROUND TANKS
AVATORY
OVEN
ABOVE (MOUND TANKS
AUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
:LOTHES WASHER
MOTORS 0- 1 HP
STEAM BOILERS
.HOWER
MOTORS OVER 1- 3 HP
HOT WATER BOILERS
;INK, POT /3 COMP.
MOTORS OVER 3- 5 HP
MECHANICAL VENTILATION
;INK, RESIDENCE
MOTORS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
INK, SLOP
MOTORS OVER 8- 10 1P
ELEVATORS/ESCALATORS
EWORARY WATER CLOSET
MOTORS OVER 10- 25 HP
FIRE SPRINKLER SYSTEMS
RINAL
MOTORS OVER 25-100 HP
COOLING TOWERS
;TER CLOSET
MOTORS OVER 100 HP
VIOLATION
NDIRECT WASTES
A/C WINDOW
REINSPECTION
ATER 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
CUTLETS COMMERCIAL
_
HATER SERVICE
�-
SIGN TLBES
:WER CONNECTIONS
SIGN TRANSFORMERS
TILITY -SEWER
SIGN TIME CLOCK
iILITY -WATER
FIXTLRES
:PTIC TANK
ANTENNA
:LAY
TELEVISION OUTLETS
IAINFIELD, 4' TILE/RES.
VIOLATION
AR E ABANDON SEPTIC TANK
REINSPECTION
)AKAGE PIT CU. FT.
JOH BASIN
SCHARGE WELL
MESTIC WELL
IEA DRAIN
OF INLET
JLAR WATER HEATER
RE STANDPIPE
OL PIPING
•
WN SPRINKLER SYSTEM
S RANGE
TER SET (GAS)
S PIPING
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
ADDENDUM TO BUILDING PERMIT APPLICATION
ELECTRICAL
MECHANICAL
EXECUTED By:
TO:
• DOCUMENT COVER PAGE
DOCUMENT
TITLE: N oT r pc C o ,7., /)9P Aye 6 8A
(Warranty Dad, Mortgage, Affidavit, etc)
Irief Legal Description: (if Applicable)
CFN 201
OR Bk 21434 Pss;2448 - 2449; (2ass
RECORDED 07/17/20O3 12:32:22
HARVEY RUVIN% CLERK OF COURT
MIAMI -DADE COUNTY? FLORIDA
1111111111111111111111111111111111111111111111111111111
PERMIT NO. 1O02 -20
State of Florida)
County of Dade)
General description of improvements
Owner/ Title Holder's name
different from job address
Contractor's name
and address S
Surety's name
and address
Bond number
Lender's name
and address
(Print Owner's name)
Sworn to and subscribed before me on this 1
My commission expires: __
'''''' LESLIE RACKL
rA '' MY COMMISSION 1 DD 005946
EXPIRES: March , iret ' Bonded TTIw Nolan/ Public 4 U n�i wtMn
Notice: THIS FORM IS TO BE RECORDED AT
44 WEST FLAGER (8 FLOOR)
OR LASTKPAGE° PG 2 4 �
BUILDING DEPARTMENT
NOTICE OF COMNIENCErNIENT
FOLIO NO. 1/3.2.4S Q0V 2
/29 THE UNDERSIGNED hereby gives notice that improvements will be made to the real property located at
,.v 99S7 in /�'7,J9, SI�S,�At and
in accordance with Chapter 713 of Florida Statutes, the following information is provided:
Legal description of property: Lots)
Block / of
0
and address, if
Expiration date
Person within the State of Florida, designated by Owner to receive service of notions or other documents as
provided by Section 713.13 (1) (a) 7 of Florida Statutes:
Name
Address
Person, in addition to owner, designated to receive a copy of Lienor's Notice as provide in Section 713.13 (1) (b) of
Florida Statutes:
Name
Address
Unless a different date is specified, the expiration date of this Notice of Commenc ment shall be one (1) year from
date of recording.
F
day of
m
(Signature of Owner)
Notary Public
STATE OF FLORIDA, COUNTY OR DADE
/ HEREBY C RTIFY t • at this rs a tf p of the
origins / fa his f / . 'n —
SYITNESS
HARV €Y
8
Dec -99
MIAMI SHORES LLAGE
BUILDING INSPECTION P RTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approyal of the detailed statement of 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.
Date- - -`-Q I 'Z ( O . ,19 r
Owner's Name and Address rn r v +'' d r No) - fa ( f Street t a 9 9 V
Registered Architect and /or Engineer (a - I a p p
Name and address of licensed contractor A �^ �-?s�' -*9` , 4{Zi 0 "Po:u Q bt. C w d a 1=k3
Location and legal description of lot to be built on:.
Lot Block Subdivision
Street and Number where work is to be done (Z Co 7 E q ,
State work to be done and purpo a of uilding (by floors) _,_
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 $ Amount of Permit $
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 nd specifications or said building. j ll notices 'tth reference to the building and its construction may
be sent to 4-7-4 ° - 19-`�` , : l eQ� -�-Ct �z. ,.
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 5968, Compiled General Laws of Florida, Pennanent 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 d 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 subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)._
STATE OF FLORIDA,
COUNTY OF DADE. ss
Date__
—K
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
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 c efully e - .- oregoing application, and that he did sign the same, and that all facts
therein by him stated are true. _
Permit No I( 4 Date
Read, Sworn to and Subscribed before me.
Disapproved
(Signed)
Building Inspector ` My Com on Expires
Notary Public, State of Florida
to me well known,
PLANN BOARD DATE
Chainnan Member
Member Member
Member Member
Council Approved Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
Application is hereby made for the approval of the detailed statement of 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.
Owner's Name and Address Richard Lund N, 1269 Street NE 99 St.
Registered Architect and /or Engineer
Name and address of licensed contractor Miami Heating & Ventilating Co., 2515 SW B St., Miami, Fla.
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done 1269 NE 99 St.
State work to be done and purpose of building (by flo Duo -Therm #335E, 60,000 BTU oil wall . f irn,
ga / on 611 wall tank
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 $ 550.00 .___Amount of Permit $ 5.
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 Miami Heating & Ventilating Co.
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 ins ection 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 ontractors, on work to j) performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed).
STATE OF FLORIDA,
COUNTY OF DADE. j ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared -
-- - - - - -- - - - -- 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 stat9d are true.
Permit No
Disapproved
( Signed)
7°
APPLICATION FOR BUILDING PERMIT
Building Ins
MIAMI SHORES VILLAGE
Date
Dat
BUILDING INSPECTION DEPARTMENT
or
Chairman
Member
Member
Council Approved Date
NOTE: A charge of $1.00 will be made for making corrections
the Planning Board.
A re- inspection fee of $1.00 will be charged
materials and /or workmanship.
Date October 29 19 63
PLANNING BOARD DATE
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
Member
Member
Member -- – – – Disapproved
or changes to this application after approval
no
Date
has been obtained from
when such re- inspection is made necessary by improper notice for inspection or faulty
BUILDING El
ELECTRICAL Fl PERMIT o
PLUMBING ❑ N. 9092
ROOFING ❑
Architect
Contractor
or Builder
Legal
Description.
Address of
Building
Lot
MIAMI SHORES VILLAGE. FLORIDA
❑ Work to be performed under this Permit
Owner of
Building
CONTRACTOR OR BUILDER
BL
t
Subdi-
vision
sq. Ft
Value of
Froject $
DATE � �= 1957.
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