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1270 NE 98 St (7)Dat Type Insp'n Permit No. Nam Address Comp, y Phone # Approved Correction Re- Insp'n Fee MIAMI SHORES VILLA E BUILDING DEPARTM NT 305- 795 -2204 Building Inspection Reque Inspection Date , ( f \ 7 RECEIVED MAY 1 9 2004 BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Electrical ( Plumbing ) eebau cal 2 Owner's Name (Fee Simple Titleholder) t ' L1i st Phone # Owner- -s Address 1 V1 0 N.) City i Gt i 5I-NOYC.S State (, - Tenant/Lessee Dame Job Address (Where the work is being done) ZIC 1. 6 cla City Miami Shores Village County Miami -Dade Zlp 3 Is Building Historically Designated YES NO, City NA CL rYN (Continued on opposite side) Miami Shores Village Building Department 30050 N.E.2nd Avenue, Miami Shores, Flotida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Contractor's Company Name 1i Can Ck t 1vn1 Contractor's Address (oCl Total Fee Now Due $__s State t. Qualifiert, 0 J- Permit loo. N. n . Master Permit No #` 4-6711 Phone Zip 5513e Phone # 5e: 404 z 634642Z 1 Architect/Engineer's Name (if applicable) Phone # !J"Q' $ Value of Work For this Permit O Square Footage Of 'ork: Type of Work: ['Addition ,Alteration ❑New 0 Repair/Replace ❑ O Describe Work: I G L C 1 _ i - -i S r i A d disk j r e . ( oc +G K-(-t re S C +.Jlm , ei ►Z-t Cr; (ouut nd rz 1 -bn rI tL , d i-5h LAD S lne..0 ,tee t occX - 4 rep 1 ac e LA-Dc t — erg tnect-( 4 50 * * * * * * * * * * * * * * * * * * * * * * * * * ** *Fees * * * * * * ** * * * * * *** Submittal Fee $ Permit Fee $ ''2.'/ © CCF $ . ,3` U COICC Notary $ Training/Education Fee $ r 4 - Technology Fee $ d Scanning $ Radon $ Zoning Bond Code Enforcement $ 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 AMR 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 RES%JLT 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. Signatur VY� Signature � . Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this I day of , 20 _ , by , day of 200 by i i'Yei; ti ' 04) o me or who has produced As identification and who did take an oath. w as identification and who did take an oath. who is personally known to me or who has produced APPLICATION APPROVED BY. Chc 12/15/03 NOTARY PUBLIC: NOTARY PUB Sign: S• P • jilicHAI . p t;/ :1UH 0,1.3 ti Print: ' nt��"� My Commission Expires: My Commission ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** (Certificate of Competency Holder) State Certificate or Registration No. Certificate of Competency No. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ** * * ** * * * * * * * * * * * * * * * * * ** ************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Engineer Zoning ITEM BATH TUB : UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER ;7 RECEPTACLES A/C (WIND) DISPOSAL - i 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 4 WATER HEATER i U.F. PRESSURE VESSELS CLOTHES WASHER I 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 '.. 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 If COOLING TOWERS WATER CLOSET MOTORS OVER 100 HP VIOLATION INDIRECT WASTES -' ABC WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS HEATER -NEW INST. GENERATORS TRANSFORMERS I 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 FIXTLRES 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 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 Icz )-1A4zegjpEf= ELECTRICAL MECHANICAL Miami Shores Village 10050 NE 2nd Avenue Plumbing Permit Phone: 305 - 795 -2204 Permit Number: PL2004 -148 Printed: 5/21/2004 Applicant: LUCIE ROGENSDORF Owner: ROGENSDORF LUCIE JOB ADDRESS: 1270 NE 98 ST Contractor KENDALL PLUMBING CO. INC. Contractor's Address: 6910 S. W. 75 TERRACE Local Phone: 305 - 662 -8863 Parcel # 1132050090310 Page 1 of 1 Legal Description: 5 53 42 EARLETON SHORES PB 43 -80 LOT 3 LESS E12.5FT & E5OFT LOT 4 Fees: Description Amount FEE2004 -5183 Building Fee $270.00 FEE2004 -5184 CCF $1.80 FEE2004 -5185 Training and Education Fee $0.60 FEE2004 -5186 Technology Fee $6.75 Total Fees: $279.15 Total Fees: $279,� Total Receipts: C1 /b7 Permit Status: APPROVED Permit Expiration: 11/15/2004 Construction Value: $3,000.00 Work: REPLACE KITCHEN SINK AND DW, RELICATE ICE MAKER, ADD ISLAND SINK, REPALCE LAUONDRY ROOM FIXTURES; JUN 1 5 PAID Signed: (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 responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: MIAMI SHORES VILLAGE ( 9/ BUILDING DEPARTMENT . 305- 795 -2204 D66 uilding Inspection Request g \o Type sp'n Permit No. Name ' Address Company Phone # Inspection Date Correction Re- Insp'n Fee ❑ Type Insp'n Permit No. Name 6P ou on- MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date 2 edLitilA, Address ID-7O N E 9 YJ Company c5cl -e- ✓ ' Phone # - Inspection Date Approved Correction Re-Insp'n Fee BUILDING PERMIT APPLICATION FBC 2001 Miami Shores Village Building Department 10050 N;E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Plumbing 'Lc=0Wp 4 Permit No. Master Permit No. RECEIVED JUN ,1 8 2004 Permit Type (circle): Building Electrica Mechanical Roos Owner's Name (Fee Simple Titleholder) ' hone # Owner's Address N5 4 City 11`4ka'nr\ 1 'ha State F+Q Zip Tenant/Lessee Name Phone # Job Address (where the work is being done) 1070 N E c9s City Miami Shores Village Is Building Historically Designated YES State Certificate or Registration No. $ Value of Work For this Permit n� Scanning $ Radon $ Total Fee Now Due $ 140.0 (Continued on opposite side) 12600 19(s so o County _ Mia€ i -Dade NO Contractor's Company Name Phone # Contractor's Address 4 NE I a cit NI O �Y11At'tll State F Qualifier so r R1 Zip Zip Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # Square Footage Of Work: 0 Repair/Replace 0 Demolition Type of Work: ❑Addition 0Alteration :New Describe Work: • -- tZ ux3\UI' — ADb CF LINE FUV W'TE- 14E * * * * * * * * * * * * * * * * * * * * * * * ** e * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** 1• Submittal Fee $ Permit Fee $ 6 XY CCF $ CH /CC Notary $ Training/Education Fee $ Technology Pee $ Zoning Bond $ Code Enforcement $ Structural Pan Review. $ REr " 14 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 82500, 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 `i t ' "� l caner or Agent The foregooi g was acknowledged before me this 1 LP day of �2 - who is�rsonally known to > d As is , '• ation a ° o4 1 take an oath. Sign: Print: My Commission Expires: ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED B/ Chc 05/13/03 Signature ,, & . _ k ..') Contractor The foregoinginstrrument was acknowledged before day of -.,2,Pd , by ` e„ otliiit h Print: s .%*) q ° ° My Commissieir o m: " '' ho has produced ho did take an oath. ire ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ******************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** 6 - 2_ t f cy Plans Examiner Engineer Zoning Yo r yao y 4P/'S 01:;";‘.e• , Suburban Pro 2491 N.E. 130th pane Oth Street N. titiam;, FL 33161 305 891 -8393 Qualifier ✓a� Job Address / 70 64/c Longest Run Total BTU's �� 0.10' • e95222" 1 - - X - X - X X 92'27'40 2 CR.:MC:£=5.54 ' 108.50' ■ Tr-E EAST 52 FEET or Lor 4 old- "itri Oes / 25 ZO Z..14 7. r C0VCRET - er a . LOTJ La'S . „ PE REST 1260 FrE7 108.50' 1E30' -X X —X_X 25.3 -- N 90'07'40' Eri" 52.7 - .30.09' . - - ' ABBREVIATION$,; • • - • : sVoCaStDEVALIC CBS4CONCRETE BLOCK STRUCTuRE, CLFICKWILDIKFENCE.PL4FROPERTY UNE. DuE•DRADis;GE EJ.SEM Eta iP IRON P E. ,t2 S R n e E. 13Q.j1 -t -FL. 3.3151 3 () 5 - S93: 8 3 93 LEGAL? LOT 3, 25 FEET EOF IN BLOCK .3 IN 1 BOOK'Ai, .PAGE 80 0 LOCATION SKETCH SCALE: NTS 11 41; • g270 qq.»45,- M I Ani PoRt 1-7e. N.E. 13th " //9 X; is A VENUE r 1- SURVEY FOR: PAM REGENSDORF, 1270 N.E. 98TH ST., MIAMI SHORES, LESS THE EAST 12 1/2 FEET THEREOF AND LOT. OF EARLEION SHORES,.ACCORDING-TOrT F THE PUBLIC RECORDS OF DADE COUki,:FLORP Parcel # 1132050090310 Electrical Permit Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Permit Number: EL2004 -139 Printed: 6/9/2004 Applicant: LUCIE ROGENSDORF Owner: ROGENSDORF LUCIE JOB ADDRESS: 1270 NE 98 ST Contractor METRO ELECTRIC SERVICE INC Contractor's Address: 15050 NE 20 AVE Local Phone: 305 - 945 -1991 Permit Status: APPLIED Permit Expiration: 11/16/2004 Construction Value: $2,800.00 Work: INSTALL LIGHTS AND RECEPTACLES FOR KITCHEN AND RELOCATE OTHER OUTLETS Page 1 of 1 SUN i 6 PAID Legal Description: 5 53 42 EARLETON SHORES PB 43 -80 LOT 3 LESS E12.5FT & E5OFT LOT 4 Fees: Description Amount FEE2004 -5888 Building Fee $100.00 FEE2004 -5889 CCF $1.80 FEE2004 -5890 Training and Education Fee $0.60 FEE2004 -5891 Technology Fee $2.50 Total Fees: $104.90 Total Fees: $144.9g ,c Total Receipts: $0.00 Signed: (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 responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: BUIL PE FBC 2001 Architect/Engineer's Name (if applicab $ Value of Work For this Permit Type of Work: ❑Addition Describe Work's X RSk X Ctiva nQ O CAlz attk0,/ Miami Shores Village Building Department 0050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.5972 Job Address (where the work is being done) teri 0 Ai Lc- fee\ ( City Miami Shores Villaee County Miami -Dade Is Building Historically Designated YES NO [)Alteration D New Submittal Fee l) .. 0 0 Permit Fee $ 04 Notary $ Training/Education Fee $ , 4 Scanning $ Radon $ Zoning Perm lt N aster Permit No. / B. ? -;.O0 Permit Type (circle): Building Electric , Plumbing Me aniical RQe4g R' Owner's Name (Fee Simple Titleholder) if ' (i� ' "LI CE{ �+ � !� P oae # Owner's Address 1 .1 0 r\ C. I , f v+� rywi (f 1, 2/) City YAAAT V\,k 443\95 State L Zip Tenant/Lessee Name Phone # VI c Contractor's Company Name d 1 ''+"r * _ S Phone # C as Contractor's Address /...5 4/ 0 4,41–P City /V /1 t l4 iv) f ' State pc-. Qualifier l) 0 0 4 c-A5 S'q ire Zip .3 Phone # C..J S._ Zip Square Footage Ot' Wyk: R * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * ** * * * * * * * * * i *** ** *9F*** ** ** Code Enforcement $ Structural Plan Review. Total Fee Now Due $ (Continued on opposite side) plate 0 Demolition CCF $ l Co/CC Technology Fee $ Bond $ 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. NOTARY PUBLIC: . NOTARY PUBLIC: Sign: Sign: Print: i e di.,, K /"i�c.�$ d - • hl�,V I� A • Print: My Commission Expires: APPLICATION APPROVED BY: Chc 12/15/03 o has prod i - d Signature Signature tr-k 2/�. --- Owner or Agent Contractor The foregoing instrument was acknowledged before me this f The foregoi g instrument was acknowledged before me this day of C , 2COf, by , day of ly known to me o wllo roduced who i ersotlally known As identif ca ' r d who did i e an oath. as ide ,200y , by COMMISSION f$ D 111Ziv.i 1\11 � - ijL: :_. EXPIRES 07/08/2006 My Commission Expires: ;nTAh �uc Yr �- ,1 . 0:• 1.a >. 3 0\DED YHRU 1- 888- NOTARY7 GD;:D::iSS!OZ is OU122 i :::3 i3 nit: nu) ii-1U 1. P8!r- ROi•ArY'∎ (Certificate of Competency Holder) State Certificate or Registration No. 6 ( ,p) 3 PJ Certificate of Competency No. Plans Examiner Engineer Zoning ITEM BATH TUB UNIT FEE ITEM SWITCH OUTLETS UNIT $ FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS / 2. CENTRAL HEATING DISHWASHER RECEPTACLES A/C (WIND) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING "FOUNTAIN SERVICE SIZE IN MPS 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 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 FIRE SPRINKLER GENERATORS TRANSFORMERS 'HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIW ING 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 1 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 PLUMBING 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.) ELECTRICAL MECHANICAL Parcel # 1132050090310 Signed: (INSPECTOR) Building Permit Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Permit Number: BP2004-617 Printed: 6/9/2004 Applicant: LUCIE ROGENSDORF Owner: ROGENSDORF LUCIE JOB ADDRESS: 1270 NE 98 ST Permit Status: APPROVED Permit Expiration: 11/3/2004 Construction Value: $13,500.00 Work: KIT REMODELING Page 1 of 1 Contractor NANCE CONSTRUCTORS, INC. Contractor's Address: 8362 PINES BLVD. SUITE 312 Local Phone: Legal Description: 5 53 42 EARLETON SHORES PB 43 -80 LOT 3 LESS E12.5FT & E5OFT LOT 4 Fees: Description Amount FEE2004 -5896 Structural Fee $100.00 FEE2004 -5897 Building Fee $405.00 FEE2004 -5898 CCF $8.40 FEE2004 -5899 Notary Fee $5.00 FEE2004 -5900 Training and Education Fee $2.80 FEE2004 -5901 Technology Fee $10.12 Total Fees: $531.32 Total Fees: $551.2 _e c Total Receipts: AF 1, 3 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: ).Sa7 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION SP PERMIT NO. 9OO q - 1 TAX FOUO NO. STATE OF FLORIDA: COUNTY OF MIAMI -DADE: 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: t Q10 t) E. Re) STV Mk 6\10440 PI 33(.35 2. Description of improvement: It 4) 9.t.VY' O oe- • 9'. E4iiration different d 23.01.52 WAGE 4 8/02 3. Owner(s) name and address: % -L K2.. -e 1a 10 N Ct rv%IPr S" 0-4' L/S t`t 33i30 Interest in property: L 0 7 " Name and address of fee simple titleholder: S tr''Y'► L. 4. Contractor's name and address: /VAIJ oz, is ucx-ty 5. Surety: (Payment bond required by Name and address: Amount of bond $ 6. Lender's name and address: a.. 7. Persons within the state of Florida designated by Owner upon whom not es or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name and address: 0"-' g^emeS ' S a o '-t 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. .1 Name and address Af /A ,0c'E' at/LC rife - lee ego, Z A we s- B� v1) „i/i5r ' 0/Z P'eir4 . �1 5 L 33 Liz z of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a STATE OF FLORIDA, COUNTY OF DADE HEREBY CERTIFY that this is a true Qppy of the owner from contraMaffr this office on 15 V d, y of NITAVESS my hand and 1ARVEY IUVIN, CFN 2004-R04-77039' OR Bk 22394 Ps 4001; (lps) RECORDED 06/15/2004 14:22:49 HARVEY RUVIN► CLERK OF COURT MIAMI -DADE COUNTY, FLORIDA LAST PAGE I Seal. and County Courts D.C. 1111 1111III1 III1111111 1111111111111 Signature of Owner Print Owner's Name �s Oti ger Prepared by Sworn to and subscribed before me t, i L. d f , 200 Notary Public Print Notary's Nam My commission =pires: Joan P Kahn • j • My Commute 00041 s /' Mkpires Seplembu20, 2006 Address: Miami Shores Village Building Department Permit No. Job Name BUILDING CRITIQUE SHEET 1) /PA46/y9 w 4 - i/btI. -c7q2_- - 7) 1Z. 10050 N. .2nd Avenue S ` �� ` Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 •4.0/1, 11,l 11 ' MIAM ADE BUILDING CODE COMPLIANCE OFFICE (BCCO) PRODUCT CONTROL DIVISION NOTICE OF ACCEPTANCE (NOA MIAMI -DADE COUNTY, FLORIDA O-DADE FLAGLER BUILDING FLAGLER STREET, SUITE 1603 MIAMI, FLORIDA 33130 -1563 (305) 375 -2901 FAX (305) 375 -2908 ECE vED Jeld -Wen, Inc. 201 Evans Road ( ." i4 0 1 2004 SCOPE: Rantoul, II 61866 This NOA is being issued under the applicable rules and regulations governing the use of construction materials. The documentation submitted has been reviewed by Miami -Dade County Product Control Division and accepted by the Board of Rules and Appeals (BORA) to be used in Miami Dade County and other areas where allowed by the Authority Having Jurisdiction (AHJ). This NOA shall not be valid after the expiration date stated below. The Miami -Dade County Product Control Division In Miami Dade County) and/or the AHJ (in areas other than Miami Dade County) reserve the right to have this product or material tested for quality assurance purposes. If this product or material fails to perform in the accepted manner, the manufacturer will incur the expense of such testing and the AHJ may immediately revoke, modify, or suspend the use of such product or material within their jurisdiction. BORA reserves the right to revoke this acceptance, if it is determined by Miami -Dade County Product Control Division that this product or material fails to meet the requirements of the applicable building code. This product is approved as described herein, and has been designed to comply with the Florida Building Code, including the High Velocity Hurricane Zone DESCRIPTION: "French View" Aluminum Clad Wood Door Sidelites APPROVAL DOCUMENT: Drawing No. W03 -86, titled "'French View' Alum Clad Wood Door Sidelites ", sheets 1 through 5 of 5, prepared by A1- Farooq Corporation, signed and sealed by Humayoun Farooq, P.E., dated 09/22/03, bearing the Miami -Dade County Product Control Approval stamp with the Notice of Acceptance number and approval date by the Miami -Dade County Product Control Division. MISSILE IMPACT RATING: Large and Small Missile Impact Resistant • LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and following statement: "Miami -Dade County Product Control Approved ", unless otherwise noted herein.. RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no change in the applicable building code negatively affecting the performance of this product. TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in the materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of any product, for sales, advertising or any other purposes shall automatically terminate this NOA. Failure to comply with any section of this NOA shall be cause for termination and removal of NOA. ADVERTISEMENT: The NOA number preceded by the words Miami -Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, then it shall be done in its entirety. INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at the request of the Building Official. This NOA consists of this page 1 and evidence page E-1, as well as approval document mentioned above. The submitted documentation was reviewed by Theodore Berman, P.E. AY- NOA No 03- 1016.03 Expiration Date: February 19,2009v Approval Date: February 19, 2004 Page 1 Jeld -Wen. Inc. NOTICE OF ACCEPTANCE: EVIDENCE SUBMITTED A. DRAWINGS 1. Manufacturer's die drawings and sections 2. Drawing No. W03 -86, titled "'French View' Alum Clad Wood Door Sidelites ", sheets 1 through 5 of 5, prepared by AI- Farooq Corporation, signed and sealed by Huniayoun Farooq, P.E. B. TESTS 1. Test reports on: 1) Large Missile Impact Test per FBC, TAS 201 -94 2) Cyclic Wind Pressure Loading per FBC, TAS 203 -94 3) Air Infiltration Test, per FBC, TAS 202 -94 4) Uniform Static Air Pressure Test, Loading per FBC TAS 202 -94 5) Water Resistance Test, per FBC, TAS 202 -94 along with installation diagram of a French View Aluminum Clad Wood Door Sidelites, prepared by Stork® Twin City Testing, Test Report No. TCTCW103001, dated 08/07/03, signed and sealed by John Lee, P.E. C. CALCULATIONS 1. Anchor Calculations, ASTM- E1300 -98, and Structural Analysis, prepared by A1- Farooq Corporation, dated October 13, 2003, signed and sealed by Humayoun Farooq, P.E. D. QUALITY ASSURANCE 1. Miami Dade Building Code Compliance Office (BCCO). E. MATERIAL CERTIFICATIONS 1. Notice of Acceptance No. 01- 0205.02 issued to Solutia Inc. for their "Saflex /Keepsafe Maximum" dated 05/17/01, expiring on 05/21/06 F. STATEMENTS 1. Statement letter of conformance, dated October 15, 2003, signed and sealed by Humayoun Farooq, P.E. 2. Statement letter of no financial interest, dated October 15, 2003, signed and sealed by Humayoun Farooq, P.E. G. OTHER 1. Letter from the consultant stating that the product is in compliance with the Florida Building Code (FBC). E -1 Theodore Berman, P.E. Theodore Berman, Product Control Division NOA No 03- 1016.03 Expiration Date: February 19,2009 Approval Date: February 19, 2004 DESIGN LOAD CAPACITY - PSP moan H JOHT FT". DOEUTE WOIH MAIL 3/r OVI3IIL alag OR. (4) os. ( -) 2/0 2/0 66.0 66.0 2/0 2/6 KO 06.0 6/6 3/0 66.0 66.0 36 -3/4' 3/2 66.0 060 3 / 8 61.2 62.6 2/0 66.0 06.0 2/0 66.0 16.0 6/11 3/0 150 66.0 3/2 650 650 3/6 67.7 67.7 2/0 050 66.0 2/1 650 650 DA 3/0 60.0 66.0 3/2 65.0 050 NOMINAL IOW FAME NDOM NOMINAL NON FMK MAN I/O yr 2/0 24„3/4' 6/11 62-1/2' 2/0 30 -3/4' W/0 65 -1/2' 3/0 36 ■3/4' 3/2 36 -3/4' 3 / 8 42 -3/4• HZIGHTS1 WIDTHBit 'PRIMAL WOW ALMS CLAD WOOD DOOR 91DEL[TE& SIDELRES ()LAZED WITH LAMMNATED GLASS RATED FOR LAME MISSILE IMPACT AND REQUIRE NO MUTTERS. THESE PRODUCTS CAN SE INSTALLED AS SINOLE UNITS OR SIDE BY SIDE COMBINATIONS OF TWO OR MORE UNITS. ALSO IN COMOINATION WITH M6AMI - DADS COUNTY APPROVED PRODUCTS USING APPROVED MULLIONS IN BETWEEN. DESIGN LOAD RATING FOR SDEUTES TO BE AS PER CHARTS SHOWN ABOVE THIS PRODUCT IS DESIGNED TO COMPLY WITH THE MOH VELOCITY HURRICANE ZONE OF AE 2001 FLORIDA BUROMG COOS. W000 BUCKS BY OTHERS. MUST BE ANCHORED PROPERLY TO TRANSFER LOADS 70 THE STRUCTURE. ANCHORS SHALL BE AS LISTED SPACED AS SHOWN ON DETAILS. ANCHOR EMBEDMENT TO BASE 4A7ERAL SHALL BE BEYOND WALL DRESSING OR STUCCO. ANCHGI11N 0 OR LOADING CONDITIONS NOT SHOWN IN THESE DETAILS ARE NOT PART OF 111S APPROVAL. 30 3/4' Wtt. SWIM WIDTH A 1/2' MAX. MEL 110114 TYPICAL in/venom A3/4'WIL WWTE INOM OCT 11 2003 O� 440 drawing no W03 -86 shut 1 of fllI 110. S 3 4 6 O 7 O 0 10 1 1 12 13 14 16 10 17 10 11 20 21 05 23 14-11 1/0004 *0-07 YD -06/00 tIF0044 *6014 *011010 10-24 *0-25 10-02 *0056 CA-17 *DOGS *170017 *001M CC -106 *0002 00■100 .40030 0.1005 01370 12103 2 AS R10D. 1/ LEAF 1/ LEAF 1/ LEAF AS RCOO. 2 2 2 1/ LW 1/ LEAF AS 116117. AS RDOD. AS N TYPICAL ANCHORS; BEE ELI. Fat swatio 1/4• TAPCAA6 J14 SLLS IRO APPROVED MLWONS (NO SHIM SPACE) DaQOrn011 FRAIL NEM ►RNE tY• MAW AMP WPM Ora SILL Tt0ES$OLD OM 114E3HOLD OAK SLL T141 MED CU 101 RM. 00FLOY RAL SLL SUPPORT BLOCK 05 M3 loop (2277 0) 101 .NW TIM STOPS WAD L2C*0*00 4461 4116211011 TOP NIL CLAMP 0071011 ML CIAD000 FIXED SRC CLADDING 167R0*1 1AL RFATIKRSOIr CARRKA PNEE CAP MTh SEAL NANO FN PNEL 1441110 INANE R'S0RwOla FOAM TIP WOOD BUCKS NOT BY JELD —WEN. MUST SUSTAIN LOADS IMPOSED BY GLOM SYSTEM AND TRANSFER THEM TO THE euII.DRJO STRUCTURE INTO 2!!Y WOOD BUCKS OR WOOD STRUCTURE 1 -1/2 MIN. PENETRATION INTO WOOD THRU 1BY W000 BUCKS INTO MASONRY OR CONC. 1-1/4" NIN. EMBED INTO MASONRY OR CONC. DMlECTLY INTO MASONRY OR CONC. 1-1/4" MIN. EMBED WO MASONRY OR CONC. SR414NT; FRAME AND PANEL. CORNERS AND INSTALLATION SCREWS AT SILL SEALED WITH SCNNEE—MOREHEAD SM6400 SEALANT: • Cain CAL 4 70 1141407 705000 N. � CAS 64417 OC1 1 62003 Ou1S111AL ROOD 0003 -76 ROOD Rood REIM PVC W000 WOOD HOOD HOOD 8000 PIC ROOD ROOD 5003 -16 0003 -T0 0003 -18 0003.16 000.3 -76 PVC PN0 RID -MS tu1r./1ur ayrs1lAttis JELD -SIN MARDI .KID -1241 4110-101 JELD -1111 JCD -MdJ J4LD •1101 ANWSLOY AMEIMILIK • drawing 60. W03 -88 (•I1••L 207 SL tan Ow fadawiwa room nwr:J1 I7 ht l 161003 k 4 drawing no. WO3 -86 (Ant 30 5 ) TYPICAL WOOD - PONDEROSA PINE' PANEL TAP GARNER USE JET WEIR 200 NOT MELT POUR BY '3M' WM DOWELS PANEL BOTTAY CORNER lin OIL MINNOW F41000 RA [r IMP nrY 1 6 2oa3 1 d BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): ( Electrical Plumbing vicee /tie "94fiferez. Owner's Name (Fee Simple Titleholder) _ _ s #�ett2 Owner's Address / Z70 Ahd, ...1:77 "eT City ,t *A4✓/ • S cIL4eS Tenant/Lessee Name $ Value of Work For this Permit CP /5,:00 Type of Work: ❑Addition erasion DNew Describe Work: ?, -'/TCAxe04. • t�std 416 c.g. Permit Fee $ 7 �' Submittal Fee $ . (Continued on opposite side) State Ai. Total Fee Now Due $ L (1 1 I Miami Shores Village ui g Department 10050 N.E.2nd Avenue, .Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 it Permit No. Master Permit No. Phan RE I MAY 071 i Zip 33/3 Photo C ) ?Z- 71/ Job Addreas (where the work is being done) .1 Z 70 ,d: ' 8 ' r City Miami Shores Village County Miami -Dade Zip 33/58 Is Building Historically Designated YES NO 1- Contractor's Company Name tA9 r !4,Gf . Ply # 64 940 q Z 7Z. Contractor's Address 896Z , "AJes ,3 /& .S,vir a 3/ City ,�.ar8r14 -.;rie r ` State Zip ,11 © Qualifier Ce.5 q,,a. •...'a ri' i+JR or d Architect/Engineer's Name (if applicable) edoile hilf . as," 2.4 Pho ¢8 11- 74 _, Square Footage Of Work: a +O`erF CC>P $ 2 . li 4 coicc Notary S -sy n -o Training/Education Fee $ po Technology Pee $ / 1 # 1 ..,._ Scanning $ Radon $ Zoning Bo re Code Enforcement $ 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, SIGNrS, 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 :11 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 inspectio hich occurs se ' n (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not b L'1 pro . a 'd a- ` %i�rection fee will be charged Signature dged . efore me thi day of M 209 by .. PA Q, who i?perrsonally known to me)or who has produced The foreg As identification and who did take an oath. NOT, ' Y .'UBLIC: c • Sign: �' ►. • Print: 1 loci My Commission Expires: Owner or Agent strument was acknowl NOTARY PUBLIC: MARIA FERRER , 1. D 190747 Sign: ' ! �u pi` _ EXPIRES: March 26, 2007 Print: 'tor Flo Bonded Thru Budget Notary Services Contractor The foregoing instrument was acknowledged before me this day of L ,2 My Commission Expires/. who is ersonally known to me or who has produced as identification and who did take an oath. Bonded Thru Atlantic Bonding Co., Inc. * * * * * * * * * * * * * * * * * * ** (Certificate of Competency Holder) State Certificate or Registration No. Certificate of Competency No. ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: Chc 12/15/03 s' lans Examiner gineer Zoning Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. d �- - to / 7 Job Name /(4 de r /27" 'tie. S STRUCTURAL CRITIQUE SHEET 3/13/° n/3 Ned s ,dui Appr'va4 nec4, ri/e4c,61 P'c rs _it/eed rei0,6 r j aloe/ c. ear/, side d/ r��,rrlr poor.. is k h wikidaw 4f s ik ext - - �"e�c�teyJ ar new ? new h4 Prod 4 n.L ,4i' ic..a/rat9. 11 exa -H / e Seuyt� 5/3e a-s e_�eii3 �. M d re i of e5, e5, ma-s e rt r /'e9 • s 13_ o ckALL-V 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. e4 - 6 / 7 Job Name MBA /1i5 f .cr 1270 Ne 9B S/ STRUCTURAL CRITIQUE SHEET 64/04 0C SO .1-( /7 froda /4' Y' V l$ l`reo 4 DDd j k &I/7 107 ; doais /flu �l io� 5 1 / ?v? eis. Date Type Insp'n Permit No. Name Address Company Phone # Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection equest oy oS-- C -- Inspection Date ' 1')._ \I I 0 1 MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date /' Type lnsp' n A N,IL_ cg 4"s Permit No. ?L 7" 3 Name Address h 90 Ale Company Phone # Inspection Date Approved Correction Re- Insp'n Fee (. 9 44 zs1-2_ MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Buildin Inspection Request Date / / Type Insp'n r / - Permit No. FL Oil Name Q-�- Address /g70 Xe 9 �' / Company Phone # - 9i/g- Inspection Date /// Approved Correction Re -Insp' n Fee MIAMI SHORES VILLAGE BUILDING DEPARTME T 305- 795 -2204 Building Inspection Request Date7/ Z Type Insp'n iiiPl C �J �t �J /� Permit No. P 1 V -1 '3 �� ,Cj Name ealf2iilaC Address 1 ZOO Nit ",C 5 + Company CO (i,& m \ Phone # l I 3 t 3 Inspection Date Approved Correction Re- Insp'n Fee Describe Work: Total Fee Now Due $ BUILDING PERMIT APPLICATION FBC 2001 Owner's Address l7O City 1^f\ txtml 0Q•State PL . Contractor's Company Name Contractor's Address l4'U ISO Cit i\to1 Pi� r State i�K Qualifier -.ION) R lds Submittal Fee $ Permit FEE $ /2 Notary $ Scanning $ Code Enforcement $ (Continued on opposite side) * * * * * * * * * * * * * * ** Radon $ 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 Pin mbin Mechanical Roofing Owner's Name (Fee Simple Titleholder) ixt 4 0 OR. Phone # Tenant/Lessee Name rr Phone # Job Address (where the work is being done) °S 8 � City Miami Shores Village County Miami -Dade Zip Is Building Historically Designated `D'E'S NO cubunktin 'qt-I State Certificate or Registration No. Architect/Engineer's Name (if applicable) Phone # $ Value of Work For this Permit Square Footage 'Of Work: Type of Work: ❑Addition ❑Alte atitt2E U 5 Certificate of Competency No, ❑New Zip Structural Plan Review. $ R E Permit No. Master Permit No. PL 9.00 4- Phone # Zip ❑ Repair/Replace -- RSV! X 1'0 ! - 1.0 .. 4 0 Ui1„F - r * ** * F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** CCF $ Training/Education.Fee $ Technology Fee $ a CO /CC ❑ Demolition Zoning Bond $ 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. Chc 05/13/03 } Signa . a i Signature 7' ' Contractor Nu► rr The foregoing instrument was acknowledged before a this The foregoing instrumerlt��1 ; r ged before me this day of Gi�' , 20 04, by L tx%OCE� 0L- , day of �� '� , Owner or Agent who is rson s known to me NOTARY PUBLIC: APPLICATION APPROVED BY: hd.has produced As identification and who did take an oath. • i e tifidatjn and who did take an oath. NOTARY PUBLIC: S:: '/. Sign //, ho has produced ei/ Sign: ;0s Print: o Q ^ Q 0 My Commission Expires: ' „ � N O O �n N a � * * * * * * * * * * * * * * * * * * * * * *is . * * * * *. ** ************************************ * * * * * * * * ** * * * * * * * * * * * * * * * * * * * ** • * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *. * * * ** */ ********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** r '4.4 Print: My Commission Expires: C Plans Examiner Engineer Zoning :�uuur - b I;rou 'Qualifier 1491 N. E. 130:11 Stre'.t t. N. Miami, FL 33161 30 3 -v31 93 /e/ E Job At /J 7c) rv L o ::Lest Kun C.tilt BTU's A a 4 s _ 1--X X X • - „,--,, - - - 1. . _ __-_,,_.; -___---_-_____-- - ..,..,,_ _. ___ --'_? -- o Z ----- 4-1 o ›- --. --- .... N. o 'NJ ..._. , . L ......._ .... 90127'40* t r Z.3. 4' 108.50' A---- ----- A --- \ i Pt) s• „ "i - P."; EP cz, p, ^1-c c", 16.60' 61..eAa r COVCREIE LOT 3 LE15 flE ViEST 12.60 F�7 r-E EAST .59 FEET ,e0, Or LOT 4 '''` • - Sc Nk -' \ -- 108.50' 1830' N to CZ) - • - - - - _ - „ - 59'5220' .L • : • 0 a • _ . • A BB REVIATIONS• _ ec qLOCK sTRucTuRE. CLF=CHUN LINK FENCE. FL=FROPERI'Y LINE, IDUE.D RAMAGE UTILITY EASEM ENT IP= :RON PIP E. _ •_ . _ _ - ::,est Run BTU's z.‘4 Propane F 3313 5 - 3:9 1 39 LOCATION SKETCH SCALE: NTS (0 LI) jr)70 qg.i-)45 – — 179/Afil tRogeS. N.E. 1.51h 4 .000 arLd I AVENUE SURVEY FOR: PAUL REGENS3ORF, 1270 N.E. 98TH ST., MIAMI SHORES, TY.GAL7D7SCRTPTTON: LOT 3, LESS THE EAST 12 1/2 FEET THEREOF AND LOT. 25 FEET THEREOF TN BLOCK 3 OF EARLEION SHORES,•ACCORDT NG TO THE PLAT IN PLAT B001(.43, PAGE 80 OF T PUBLIC RECORDS OF DADE COUNTY,..FLORT - • •• Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 1 /6/2004 Applicant: LUCIE Owner: ROGENSDORF JOB ADDRESS: 1270 NE 98 Contractor Local Phone: 305 - 891 -9353 Parcel # 1132050090310 Plumbing Permit Permit Number: PL2004 -3 ROGENSDORF LUCIE ST SUBURBAN PROPANE DBAACME GAS Contractor's Address: 1491 NE 130 STREET Signed: (INSPECTOR) Page 1 of 1 Legal Description: 5 53 42 EARLETON SHORES PB 43 -80 LOT 3 LESS E12.5FT & E5OFT LOT 4 Fees: FEE2004 -95 FEE2004 -96 FEE2004 -97 FEE2004 -98 FEE2004 -99 Description Building Fee CCF Training and Education Fee Technology Fee Scanning Fee Total Fees: Amount $120.00 $0.60 $0.20 $3.00 $3.00 $126.80 Total Fees: $12266a.88S Total Receipts: Su.00 717.0 Permit Status: APPROVED Permit Expiration: 7/3/2004 Construction Value: $300.00 Work: SET 1 TANK RUN LINE AND CONNECT STONE JAN 2 1 PAIR 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: BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Electrical Owner's Name (Fee Simple Titleholder) Luc e Owner's Address 1 ` i 0 City mi • Di gy epSPe PL Tenant/Lessee Name Phone # Job Address (where t h e work is being d o n e ) 1 ' 70 NE. S City Miami Shores Village Is Building Historically Designated YES NO Contractor's Company Name Contractor's Address 14 , ) ' 0 City No m∎Q.r State FR Q ualifier Architect/Engineer's Name (if applicable) Phone # $ Value of Work For this Permit Type of Work: ❑Addition Describe Work: (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 cu u 0r ❑Alteration 11 Submittal Fee $,30 .CO Permit Fee $ 126 * Training/Education Fee $ * * * * * * * * * * * * ** Plumbing County Miami -Dade Zip ew Zip (+) X00# -- ANK ) 2a1 LIB tko G77+\1N ECG' 4.1 * * * * ** * * ** *F * * * * * * * * ** Notary $ Scanning $ S. 00 Radon $ Code Enforcement $ Structural Plan Review. $ Total Fee Now Due Permit No. w1L ' - 3 Master Permit No. M_ethanical Q Roofing Phone # ? L] API Phone # 905 Zip Square Footage Of Work: 0 Rep /Replace 0 Demolition CCF $ Technology Pee $ Bond $ 1-- S �' 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 nspec , • will be charged who did w1 me whgr - nit iatunkskid who did take an oath. Signature C _ • 1,1 ,, CA -Q CONnotion4gent The foregoing instrument wA'ac day of who 4spersonally:ktroVvn t'd or VvIto has pro uced who is p NOTARY PUBLIC e Sign: Print: My Commission Expires: **** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED B Chc 10/14/03 The foregoing inAn , day of LC _ 2O e an oath. (Certificate of Competency Holder) State Certificate or Registration No. LP5 C My Commission Expires: Certificate of Competency No. ' ged before me this ✓" produced NOTARY PUBLIC: Sign: rA _ Print: ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Engineer Zoning 4 . 6 6" S <<ttie ton of e lf 3. r)( fiG54011 llb o06 Suburban P .c, • am* O rn 895220" h n — 20.4' 108.50' 60.550' L, r CONCRETE •a. 17E EAST 50fEET OF LOT 4 ti LOT 3 LEIS I . TILE WEST 1260 FEET II X 108.50' k ty ..•, z 0 25.20' 2 In 0 90'77'40 ti • b ABBREVIATIONS: Jr SW(= SIDEWALK. CBS = CONCRETE BLOCK STRUCTURE, CLF =CHAIN LINK FENCE. PL= PROPERTY LINE, DUE = DRAINAGE UTILITY EASEM ENT. IP =IRON PIPE, 0 a a l 'L: r. b. c1 n' P- r Q p, a l: t. e -F . 33,151 -3 .)71 - 3393 co "3: Fitt' '`a 1 ,Q70 NE Gg'71-,;Sr ."v:J ts.,:l �JJ . �wAm s o, :43/3F 1.. -, 3st Run .,7® - i te..i BTU's //goo* , % -) LOCATION SKETCH C,�- _..E: NTS N.E. 13th AVENUE SURVEY FOR: PAUL REGENSDORF, 1270 N.E. 98TH ST., MIAMI SHORES, LEGAL LESCRTPTTON: LOT 3, LESS THE EAST 12 1/2 FEET THEREOF AND LOT 25 FEET THEREOF IN BLOCK 3 OF E=_RLETON SHORES, ACCORDING TO THE PLAT IN PLAT BOOK 43, _-PAGE 80 OF THE PUBLIC RECORDS OF DADE COUNTY, FLORIL `\� L. . N N.1 am* O rn 895220" h n — 20.4' 108.50' 60.550' L, r CONCRETE •a. 17E EAST 50fEET OF LOT 4 ti LOT 3 LEIS I . TILE WEST 1260 FEET II X 108.50' k ty ..•, z 0 25.20' 2 In 0 90'77'40 ti • b ABBREVIATIONS: Jr SW(= SIDEWALK. CBS = CONCRETE BLOCK STRUCTURE, CLF =CHAIN LINK FENCE. PL= PROPERTY LINE, DUE = DRAINAGE UTILITY EASEM ENT. IP =IRON PIPE, 0 a a l 'L: r. b. c1 n' P- r Q p, a l: t. e -F . 33,151 -3 .)71 - 3393 co "3: Fitt' '`a 1 ,Q70 NE Gg'71-,;Sr ."v:J ts.,:l �JJ . �wAm s o, :43/3F 1.. -, 3st Run .,7® - i te..i BTU's //goo* , % -) LOCATION SKETCH C,�- _..E: NTS N.E. 13th AVENUE SURVEY FOR: PAUL REGENSDORF, 1270 N.E. 98TH ST., MIAMI SHORES, LEGAL LESCRTPTTON: LOT 3, LESS THE EAST 12 1/2 FEET THEREOF AND LOT 25 FEET THEREOF IN BLOCK 3 OF E=_RLETON SHORES, ACCORDING TO THE PLAT IN PLAT BOOK 43, _-PAGE 80 OF THE PUBLIC RECORDS OF DADE COUNTY, FLORIL BUILDING PERMIT APPLICATION FBC 2001 Electrical Plumbing Mechanical Roofing Permit Type (circle }; Building Lao ... : e en, i , i'� Phone # r) 8 7� l I Owner's Name (Fee Simple Titleholder) Owner's Address 1a N `5"1 S cam' tiltAYY1i a e- - - Zip City Yr'(11.G2r( Tenant/Lessee Name Y oics Building Department 10050 N.E.2nd'Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.81 Job Address (where the work is being done) City lviiami Shore -Villa e County Miami-Dade Is Building Historically Designated YES Nri Contractor's Company Name Contractor's Address i " -9 1 tJ rl City No meal State F } Qualifier Phone # Architect/Engineer's Name (if app licable ) $ Value of Work For this Permit Type of Work: °Addition Describe Work: 0 Alteration Phone Zip er' 1" SAN Structural Plan Review. $ (Continued on opposite side) 2004 Square Footage 0f Work: lew - Q Repair/Replace 0 Demolition riun. U L. Permit Fee $ I /t 0 CCF $ SubmitfaL. Fee $ . . Training/Education Fee $ Technology Fee $ Notary ..$" , -_ - Scanning $ Radon $ Bond $ Code Enforcement $ TO THE ORDER OF UNION BANK Where Your Business Is Big Busloess". 954 -916 -4444 www.unionbk.aom /J FOR Y t 2 oa y `3 R0 $rrarl1 euha n reddocum rn t. See back for detail 5. THE PERMIT PROFESSIONALS P.O. BOX 8205 CORAL SPRINGS, FL 33075 PHONE # 305- 345 -9593 uiarltdi #1505tz;- _. er) "0052230 1:06700 ?7031: 00 L L01404011° 01-9, 1-04 DATE 5223 63-770/670 $ 10 ham A RS Permit No Registered Architect and /or ineer ..... ____��_______ _ Employing Plumber's N ! _ Location and Legal Description Lot Size Septic Tank - -- Feet of Drain Tile STATE OF FLORIDA, COUNTY OF DADE. 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 mplied with, whether herein specified or not. A copy of approved plans and specifications must be kept at a building during progress of work r Owner's Name and Address_ __ -- ...... No._ / 4 ? L) o._ Street. age_ E v il e ck Subdivision Street and Number where work is to be performed —No Street State work to be performed and purpose of building (By Floors)_____ New Building ___ ___ Remodeling___ — Addition Repairs No. of Stories_ ___Type of Tank__ Capacity Gals._ _____Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City — Well.-__________ ____ ..... ________........... ___ ___._Size of Soakage Pit Amount of Permit $— O ` The undersigned applicant for this building permit does hereby certify that he understands and accepts his.obliga under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida 'ermane plied with the provisions thereof, and will require similar compliance from all contractors or sub -con ' : tors employed performed under this permit; and will post or cause to be posted' for inspe• 'on on the site •f work such public required by the Act. The undersigned agrees to employ only such su - contractors, . to be perfo licensed by Miami Shores Village. My Commission Expires Notary Public, State of Florida Street_ �F' r ,(._T ° /• Plumbing Inspector. as an employer of labor upplement, and has corn - by him in the work t ce or n • tices as ennit 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. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made-necessary by improper notice for inspection, or faulty materials and /or worlmtanship. CLOUTS BATH TUBS SHOWERS LAVA- TORIES SINKS SS SLOP SINKS LAUNDRY TUBE U URINALS CATCH BASIN FLOOR DRAIN DRINKING FOU NT NS TOTAL FIXTURES Comm. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL CONTR. LIST f' —_— CHICK Permit No Registered Architect and /or ineer ..... ____��_______ _ Employing Plumber's N ! _ Location and Legal Description Lot Size Septic Tank - -- Feet of Drain Tile STATE OF FLORIDA, COUNTY OF DADE. 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 mplied with, whether herein specified or not. A copy of approved plans and specifications must be kept at a building during progress of work r Owner's Name and Address_ __ -- ...... No._ / 4 ? L) o._ Street. age_ E v il e ck Subdivision Street and Number where work is to be performed —No Street State work to be performed and purpose of building (By Floors)_____ New Building ___ ___ Remodeling___ — Addition Repairs No. of Stories_ ___Type of Tank__ Capacity Gals._ _____Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City — Well.-__________ ____ ..... ________........... ___ ___._Size of Soakage Pit Amount of Permit $— O ` The undersigned applicant for this building permit does hereby certify that he understands and accepts his.obliga under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida 'ermane plied with the provisions thereof, and will require similar compliance from all contractors or sub -con ' : tors employed performed under this permit; and will post or cause to be posted' for inspe• 'on on the site •f work such public required by the Act. The undersigned agrees to employ only such su - contractors, . to be perfo licensed by Miami Shores Village. My Commission Expires Notary Public, State of Florida Street_ �F' r ,(._T ° /• Plumbing Inspector. as an employer of labor upplement, and has corn - by him in the work t ce or n • tices as ennit 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. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made-necessary by improper notice for inspection, or faulty materials and /or worlmtanship. t# ern y B 1 ING ELECTRICAL PLUMBING RROOFING Owner of ,�+�+ t �l Building • + ri *4 9 r .r,4.11 =d. Architect Contractor or Builder MIAMI SMOREL:VILLAK • PERMIT N 742 0 0 Wok to be periorinet d ei Legal Lot Description I BL Address of Building #- ll.,r. This permit is granted to the contractor or butler tion herefor in strict compliance with all ordilteespt`tsg plans, drawings, statements or specifications that may have b at any time if the work is not done in compliance with such or 1 permit is granted is the understanding that the sentrafiktr er Under 7 3 eted regulations pertaining to the work covered hereby whether. eiiTONI on t PIan sibility for work done by his agents, servants er k O Yess. Signed: In consideration of the issuance to me th9s, Brit agree - to perform the wort, pertaining thereto and in strict conformity with the pktn , fls it or spe coping this permit I assume responsibility for 01 work done by either, myself, my agent, CONTRACTOR OR BUILDER BY AUTHORITY R1.0T oc,` Permit No 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. Owner's Name and Address Registered Architect and /or Engineer_:__ _____________ Employing Plumber's Name MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING ;T,:k.iwirr New Building _._ Remodeling_____ ___ Addition_ .v Amount of Permit $- - - - -- --- Date No. 7 d Street , e (Signed)- ( Signed)... is3 ( 4 _ f t / 7 treet Location and Legal Descriptio> j ot______ ........ ___________- _—yBlock_ Subdivision Street and Number where work is to be performed —No i 1 ' 1 d '")_1 1 Street ge �� , State work to be performed and purpose of building (By Floors) _ _ Repairs My Commission Expires Notary Public, State of Florida 7 - -A No. of Stories / Size Septic Tank_______________________ _ Type of Tank_ Capacity Gals. Feet of Drain Tile ________Dist. Feet of Tank or Drain Field from Well Nature of Water Suppl Well._______— _ — Size of Soakage Pit Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his ...ligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pe nanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub- contracto . 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. Master Plumber. STATE OF FLORIDA, t u. COUNTY OF DADE. j 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. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOUTS f BATH TUn5 S LAVA- TORIES S INKS SLOP SINKS LAUNDRY TUBS U URINALS CATCH BASIN FLOOR DRAIN DRINKI NG FOUNT' NS Lr_Je ^'�'�/"'- TOTAL FIXTURES CONTR. LIFT 3 / A 1- / _I__ / - - -- CHICK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP BOSOM HEATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL -- Cowrie. LIST / / CHECK oc,` Permit No 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. Owner's Name and Address Registered Architect and /or Engineer_:__ _____________ Employing Plumber's Name MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING ;T,:k.iwirr New Building _._ Remodeling_____ ___ Addition_ .v Amount of Permit $- - - - -- --- Date No. 7 d Street , e (Signed)- ( Signed)... is3 ( 4 _ f t / 7 treet Location and Legal Descriptio> j ot______ ........ ___________- _—yBlock_ Subdivision Street and Number where work is to be performed —No i 1 ' 1 d '")_1 1 Street ge �� , State work to be performed and purpose of building (By Floors) _ _ Repairs My Commission Expires Notary Public, State of Florida 7 - -A No. of Stories / Size Septic Tank_______________________ _ Type of Tank_ Capacity Gals. Feet of Drain Tile ________Dist. Feet of Tank or Drain Field from Well Nature of Water Suppl Well._______— _ — Size of Soakage Pit Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his ...ligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pe nanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub- contracto . 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. Master Plumber. STATE OF FLORIDA, t u. COUNTY OF DADE. j 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. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty materials and /or workmanship. BUILDING ELECTRICAL ?DING Owner of Building Address of Building This permit berefor in strict co drawings, statements or sp time if the work is not dose ie granted is the understandidg pertaining to the work covered here done by his agents, servants or e In consideration of the is pertaining thereto and in strict conf In accepting this permit I assume r 0 ROOF 0 MIAMI SHORES VILLAGE. FLORIPA 0 CONTRACTOR OR BUILDER gY Avreatti PERMIT ? 9061 Architect Contractor or Builder Legal Description d performed seer