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MECHANICALIssue Date: 11/1/2006 Owner's Name: RAGNAR DALEN Permit Type: Mechanical - Residential Work Classification: Repair Job Address: 240 99 Street NE Additional Information Miami Shores Village, FL 33138- Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Expires: 01/01/2999 Contractor(s) AFFORDABLE AIR & HEAT Phone 305 - 770 - 4167 Primary Contractor Yes Tons: Classification: Residential Additional Info: 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, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. Building Department File Copy Applicant Signature Parcel #: Block: Section: Permit Status: APPROVED Permit Number: MC -10 -06 -2679 Phone: Total Square Feet: Total Valuation: Reciuired Inspections 1132060134330 Lot: PB: 0 $ 2,000.00 Final Fees Due CCF Education Surcharge Permit Fee - Additions /Alterations Scanning Fee Technology Fee Total: Amount $3.00 $1.00 $175.00 $3.00 $4.37 $186.37 Invoice Number MC - 11 - 06 - 26657 Total: Amt Due $186.37 Amt Paid NOV 0 8PA NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. REPARATION: 3 TON A/C UNIT WITH 10 KW HEAT FEB 0 6 20N Passed - Inspector Comments qii() \ \ ,A 41 l M Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid . until Inspection Date: 01/23/2007 Inspector: Perez, JanPierre Owner: DALEN, RAGNAR Job Address: 240 99 Street NE Project: <NONE> Miami Shores Village, FL 33138- Contractor: AFFORDABLE AIR & HEAT Building Department Comments Tuesday, January 23, 2007 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Block: Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: Repair Phone Number Parcel Number 1132060134330 Lot: Phone: 305- 770 -4167 Page 1 of 1 Permit Number: MC -10 -06 -2679 Invoice Number: MC -11 -06 -26657 Applicant: RAGNAR DALEN Company Name: Owner Address: Job Address: 240 99 Street NE Miami Shores Village, FL 33138- Date Wednesday, November 8, 2006 11/08/2006 Check Receipt Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 - 8972 Payment Type Check Number 3057 Amount $186.37 Change $0.00 Total Payment: $186.37 Page 1 of 1 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING ' ` `7' 7MTE j OCT ti'< 7 2006 PERMIT APPLICATION FBC 2004 Permit Type (circle): Building . Electrical Plumbing Mechanical Roofing Owner's Name (Fee Simple Titleholder); e'.',j, Owner's Address 2'I /1/4" 976 City fl / 4 l State 1 Tenant/Lessee Name Job Address (where the work is being done) Q /OF V $ l City Miami Shores Village County Miami -Dade FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name /f Fjf R,A I/ if i%Q /e'» T Contractor's Address 5 ,7 /j/, /yo 6 T City Pi j t t 1 i /i/ /` State F L Qualifier Name (jQ/j/ f/j•'er174/1" State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name (if applicable) Value of Work For this Permit $ . 5000 .. Type of Work: ❑Addition Describe Work: Miami Shores Village C ' p M�' � Building Department ❑Alteration 0 ' LINew P 1 °-� Fe / es �. I !`7 t v s Submittal Fee $ Notary $ Training/Education Fee $ 1 •0 Scanning $ 3'OQ Radon $ Bond $ Code Enforcement $ Permit Fee $ Square / Linear Footage Of Work: DPBR $ Permit No. IC C 1 — 2(.04 C 7 1 Master Permit No. Zip 3 3/ 3 ,- Phone # Double Fee $ Phone # Phone it CCF$ f` Technology Fee $ Zip 3 3/3 g- Phone # 3v y ' 7// Q zip 33//9 Repair /Replace ❑ Demolition Zoning $ Structural Review. $ Total Fee Now Due $ See Reverse side —+ 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 sit. for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this_ _ day of , 20 _, by , day of , 20 , by who is personally 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. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Print: My Commission Expires: My Commission Expires: APPLICATION APPROVED BY: (Revised 02/08/06) Plans Examiner Engineer Zoning Bonding Company's Name (if applicable) Bonding Company's Address City Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State / Zip Signature \`�\ ��� _ ; _ Signature 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 g... • that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is sub . . to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection h : occurs seven (7) days after the building permit is issued l In the absence of such posted notice, the inspection will not .e a,pro '••nd a reinspection fee will be charged AliaktAA er or Agent stTQ \ontractor The foregoing instrument was acknowledged before me this 2.3 The foregoing in ment was acknowledged before me this day of OQ4 , 200(p, by , day of ii 200(.x, by Jon F►' ; who is personally known m - . .!. o has produced who is perso �}t,l n. •- to me or who has produced . i, :1.jo i an »p .. id take an oath. NOTARY -,; : • ; y�. ° .Tip NOTARY Sign: Sign: Print: �� /j/ �-- . '8'N. 0 04 aY25 ?00• ' Print: My Commission Expires: (Certificate of Competency Holder) State Certificate or Registration No. Certificate of Competency No. APPLICATION APPROVED BY: ** * * * * * * * * * ** ********** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ***************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner ******************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ****** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * ** Chc 10/14/03 My Commission Expires: on and who did take an oath. Engineer Zoning Date I-13-9r Job Address of 4 /o Ng-- 99 T Legal Description Owner / Lessee / Tenant /11,9 RCOS LLO,v/45 Owner's Address ) 4G' /U r qg Contracting Co. -tRO .t7N(i Address 5 ZS'/UW �7A lie #yo/ l`1 //H lie Qualifier c JC7P �C�AP�2 SS# �� Phone State #0.00A.5 Municipal #D9- 035 /g%,ompetency # S (fig Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICA PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION =k(( e-I2u /Ce f SO A. Signature of o er and /or Condo President Date: Notary'as to Owner and /or Condo President My Commission.Expires: VO rrr j " ^Y • ° {; c ,.! E OF F9_C►`v!OEf Y ^,r35 B. * ':=.� . * ::3. * ** * FEES: PERMIT .34.9 ,eP a RADON APPROVED: PERMIT APPLICATION FOR MIAMI SHORES VILLAGE 1 Pk (L TON (OK.c.0 Square Ft. Estimated Cost(value) * Zoning Mechanical Plumbing Tax Folio / /3 a 06O 1..3o "43.30 Master Permit # Phone 6 c./ - 5s38' 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. Sig Date • ittei op ih AAA fl o Contractor or Notary s6R,��C�. fq �'IA er- Builder My Co>`'i� Exp6m14EA6 ._ quo t it ti is AVELINO CONSTANZO it Commission Expires * Oct. 1996 Comm. No. CC 233721 * C.C.F. Fire Other Building Electrica: 1, 7 tOF FLO!*.* NOTARY of Con ractor or Owner- Builder Engineering' * ** A TOTAL DUE 3 /. c - )IIST11119 *. 30 3:klLwitLco.PPede O 41-1. it)Z. I-4 JOB ADDRESS OWNER INFORMATION ANGiLTt.OT,/iNiettieut, Y.401gritiereNt6 . INFORMATION / / 7 Q 240 IJE.-qqs T Iv\I AtA\ . e WIZZI7S MARCos LuoriAS NAIS: .)oczcas Su APE-2_ MASIErt_ eier...TRiCJA■J ADDRESS: 525M0-274 JOB DESCRIPTION: '57112TM5151= : ' 240 NYE q q 7 PHONE NO.: &42. -- S 6 Lg SEAL,DATE.AND It S 0 ice: e1 1 s_ A -16)47424ov Jittr.41 ran.: NO, I SIGNATURE-- - )IIST11119 *. 30 3:klLwitLco.PPede O 41-1. it)Z. PERMIT NO. TAX FOLIO NO. / /-3 t)‘ 0 /.3 o y3 3 0 STATE OF FLORIDA: COUNTY OF DADE: 9 RO 1 329 1995 JAM 12 13:13 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 addres : 0 RAZ • V 4 1 m'T P13 , 7 7D f&+ 7 t 7 ice 2 (/v At)C 9? 2. Description of improvement: • .C6 L 4-, m c o ^. 7 is IA., 7 3. Owner(s) name and address: Al . r " Interest in property: Name and address of fee simple titleho er: 1 '-/7 4. Contractor's name and address: 771/9/0L: /`y � ^- ) > > i 0 ^' 3 i". • • ' / G ` l Sri t 7 S r 6-- Kr+ i , 9- /e 33 / 5. Surety:(Payment bond required by owner frpm contractor, if any) Name and address: I h Amount of bond S 6. Lender's name and address: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Fiorida Statutes. Name and address: different date is specified) Signature of owner Print Owners Name Notary Publi Print Notary's ame My Commission Expires: y ho .d and Off VIN. , ERN_ STATE ®:^ FLORODA, C015,IM 11 01 D'NDE lae,, s1? Qi. ©t ci Cr pi 6n affko on \ \\ (lc , A. D. 19 NOTICE OF COMMENCEMENT )Df l-T, i e,o a.Po S / A- ' fi• l y > •3 g CvI.frJ1 U n f 4 S,/ /tie . r71 / Z• 31 (Pi N/A /VP iv!Scol, ; ;Ji! at"Cour.Cy Ka iu 8. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and address: r/ d /f7 SD N - • r9 ✓� 9. Expiration date of this Notice of Commencement: (the expiration d to is 1 year from the date of recording unless a f 1 m f a,5 c-i-o f VP • E mP l .'f7r{•mA --TVf Sworn to and subscribed before me this // ay of 719Z1%. 3678e7 .;� 0 cp Mr COMMISSION UP. OF f'•. MAY 21 199$ if)y*% Ho� Prepared by: A1411 A^/6 £4 )/ L %)-• A AA b,' $ Address* q s o 3 S w j ;),I tr tnn Fl- 33[51-- Signature o Date: ** * APPROVED: 1 " A(.CAArt NL Zonin PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date I /1- 9 C ' Job Address °z` Aj ' 1 % 99 sT; Tax Polio /!3A D6O/ ° 1 1/33 j) Legal Description S : N e/Lr 1 vv". -t � - Owner / Lessee / Tenant C R C.0 '4= D � � � Master Permit I 2,2s Owner's Address /9S / ^1-467 / t1" /v. sue..; A F� 33/8'/ Phone 94 S' 9 9 Cont racting Co. )/ 6, e9 /e° Address WORK DESCRIPTION -1 NSlf //A T�b , o� °f er and /or Condo President &c'.tAa(. 1i)1 MARIAN J}cKSoN) NOTARY PUBLIC STATE OF FLORID COMMISSION NO. CC416725 ®�l.Y RA, c 1tl ltjN RXI�. , b �1 s®'' Mechanical Qualifier 1 1 1� 2 Y✓1 i' /-; SS# - Phone ;: 3 er 3 State # ame-v ° 4P Competency # Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBINGHANICAL) ROOFING PAVING FENCE SIGN L ,`C_ 3 ?D of / /5' ?, /g/ W v cis / Tai s� / ft`.3 ;&) / // G , i N S c4e!, Square Ft. 4 Estimated Cost(value) ' 7 S VD- 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 const uction and zoning. Furthermore, I authorize the above -named retractor to do the work stated. a EE ci) fir, ■ • w 2 LLU� ° z A CCO Emv = w U Q Signature of Contractor Date: Notary as to Own r and /or Condo President Notary == to Contractor Owner- Buyaie> My Comniss4�Y- a �� My Co. Fission Expires: a-9-5r" T r int type or stamp name of Not =orally known D3 ype a;yEi number*f I.D. p FEES: PERMIT RADON v....!'. /1' NOTARY TOTAL DUE 6p /4 * * * Fire Other Building Electrical Plumbing Engineering * * ** BUILDING ELECTRICAL ❑ PLUMBING ❑ ROOFING ❑ 0 Owner of C' Building 'x'C're Architect Contractor 14' -p or Builder _Ad Legal Lot Description CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA DATE t r 19 ,r PERMIT 7803 Contractor's License No. 71 / / Work to be performed under this Permit B1 ....sa 4r-A '1a! Subdi- vision Address of ` l ,- Value of �j I Amount of ar Building 7 e 7i� / Project $ °� / I 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 applica- tion 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 respon- sibility for work done by his agents, servants or employees. tile f Signed � � I � , INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereun in compliance th all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted t the proper authorities of Miami Shores Village. In as cepting this permit I assume responsibility for ell work done by either, myself, my agent, servant or employee. • BY AUTHORITY AY.OT STATE OF FLORIDA, } COUNTY OF DADE. ss. MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT S APPLICATION FOR ELECTRICAL PERMIT Permit No 7 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. Owner's Name and Address Ener No 240 Street .... N,...E.... 99...St. Registered Architect and /or Engineer Employing Electrician's Name ....$U,t]- .State...Ele is No 9.70 Street Aj...�pJ.r. 2'l. -Ave. Location and Legal Description Lot Block 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 Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps Underground P P Type of Installation — Conduit Tubing B.X.L Metal Moulding - ± Amount of Permit $ (Signed) Electrical 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 complied with the provisions thereof, and will require similar compliance from all contractors or subcontractors 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. (Signed) Master Electrician. 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, and 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 NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. SWITCH OUTLETS LIGHT OUTLETS PLUG RECE'P'T'S FIXTURES NO. LAMPS REFRIO. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER HEATER W. HEAT. CONN. SPACE HEAVER STRIP HEATER TOTAL CONTR. LIST CHECK ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. MOTORS O -I HP MOTORS 1.5 HP N EON TRANS. RADIO TOTAL CONTR. LIST 2KP A/C 2.00 CHECK STATE OF FLORIDA, } COUNTY OF DADE. ss. MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT S APPLICATION FOR ELECTRICAL PERMIT Permit No 7 Date Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address Ener No 240 Street .... N,...E.... 99...St. Registered Architect and /or Engineer Employing Electrician's Name ....$U,t]- .State...Ele is No 9.70 Street Aj...�pJ.r. 2'l. -Ave. Location and Legal Description Lot Block 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 Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps Underground P P Type of Installation — Conduit Tubing B.X.L Metal Moulding - ± Amount of Permit $ (Signed) Electrical 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 complied with the provisions thereof, and will require similar compliance from all contractors or subcontractors 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. (Signed) Master Electrician. 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, and 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 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. • APPLICATION FOR BUILDING PERMIT 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 specification must be kept at building during progress of the work. 16,2-5-117 4 ? Owner's Name and Address Registered Architect and /or Engineer Name and address of licensed contractor Location and legal description of lot to be built on: STATE OF FLORIDA, COUNTY OF DADE. I ss MIAMI SHORES VILLAGE Date 1J 6 Date BUILDING INSPECTION DEPARTMENT — ; L D _ i . W fe iv , . Date > 19t -t!_eP No. _G2 Street___ Block Subdivision Lot__—__ Street and Number where work is to be done ago ,� State work to be done and purpose of building (by floors).—.4.- 4-404 oors)_�l_ - 1 pp .. -- - -- 02 '1✓ , and for no other purpose. New Building_ Remodeling Addition Repairs No. of Stories To be constructed of Kind of founda 'on Roof Covering Estimated Total cost of improvements $_c2 7 S '�I (»,)__Amount of Permit $ OZ?____ Zone cubage required____.__ _ _ ___flan Cubage Distance to next nearest building _ _____Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspe tion on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcon ctors, • : .rk to be performed under this permit, as are licensed by Miami Shores Village. Remarks_____--------- -__ -_— (Signed) Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared 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. 7 Permit No 1a 3 Disapproved (Signed) _Ea `-6`- Buildi .V nspector Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires PLANNING BOARD DATE Chairman 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.