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MECHANICALOwner's Name and Addrc ;Estimate Total cost of improvements $ .e7 STATE OF FLORIDA, COUNTY OF DADE. ss. MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement or me 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 tlic Laws of the State of Florida. all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Villa shall be complied with, whether herein specified or not. A copy of approved ;plans and specifications must be kept at building during grew 00 he ork. / ... ,/y ..d MI= .. Registered Architect and /or Engineer.. ,y Name and address of licensed contractor.... L . 4 ry� . ......... t Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done .... -C'i . _ .... __ _...._,�,.....__..�. Stet ork to be done and purpose of building (by floors) _......_...._ .. and for no other purpose. New Building Remodeling Addition Repairi No. of Stories _ To be constructed of Kind of fousrdatipn......,'� Roof Covering Amount of Permit :Zone cubage required plan Cubage :Distance .to next nearest building Size of Building Lot :Maximum live load to be borne by each floor I hereby submit all the plans 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 persnit dots 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, Pennanrnt 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 inspection on the of the work such public notice or notices as arc required by the Act. The undersigned agrees to employ only such subcontractors, on rk to be perfo under this :permit, as are licensed by Miami Shores Village. Remarks (Signed) ate... peared - -- / - ° , !c2 ,.,t VII If 1, • fA Before me, the undersigned authority. a notary public, duly authorized to administer oatha and take acknowledgments. personally ap- to me well knows, 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.. Permit No. - 21 Date P 9,.O Read, Sworn to and Subscribed before me. Disapproved 1 Date — - Notary Public, State of Florida (Signed) \\' s ui ing Inspector My Commiuion 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 fee of 51.00 will be charged when such re- inspection is made necessary by Improper notice for inspection � faulty materials and /or workmanship. Owner's Name and Address Application is hereby urnde for the approval of the detailed statement in me 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 Divisinn of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. A Registered Architect and /or Engineer Name and address of licensed contracto ,f4 Location and legal description of lot to be built on: MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT PLICATION FOR BUILDING PERMIT Ltittd../ kola, Building Inspector Z19.4.40- Lot Block Subdivision ...._...... Street and Number where work is to be done......a Disapproved ► , • fir.:. Date (Signed) Date .� ..� ... ..__. • . .. � Street,d6:1� 9Z3 t i N .f / 55�tt°°CC.. p. StItaywork o be done and purpose of building (b floora)., and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements S2ohg�.e Amount of Permit S. Zone cubage required .Plan Cubage Distance .to next nearest building.. Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to.. 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 w ith the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and'will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this pcnnit, as are licensed by Miami Shores Village. Remarks _. (Signed) STATE OF FLORIDA, 1 . COUNTY OF DADE. j ss' Before me, the undersigned authority. a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared and who, being by me first duly sworn, upon oath deposes and says that he is the. of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true.. Permit No. 2 I 3 Date . 1 "' �.�.:.� D 0 Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires to me well known, PLANNING BOARD DATE Chairman 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 tirc Plannir.g Board. A re.in.peetion ice of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspectitm or faulty materials anti /or workmanship. • PERMIT APPLICATION I . FOR MIAMI SHORES VILLAGE Date 10'20 Cf R q O Job Address � E� �{ Tax Folio Legal Description SI le —a :( t1 ( ( 1 C54....Historically Designated: Yes No Master Permit # 'i'3 6 7 Phone '�J �-t — Q J- (4. Owner/Lessee / Tenant ► ` l (O YUU al-n( R ite C)Y ) Ch t Owner's Address Boa qt0 - Contracting Co. C A-I cCrinci l fio or) Address & k I (v Ci■ St Qualifier t j • C, t(� State # CP Oa 1 4" Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING ECHANIC : ROOFING PAVING FENCE SIGN WORK DESCRIPTION Municipal # 12 c, 5 �� Sr �� e(ec-ft -z_ ( - ;4 Square Ft. Estimated Cost (value) SS# a (0(- IS - 'Phone an -(08v-(c1.3gL4 Competenc #04-gR02- 3 Ins. Co. tll ' 0(C I lb 3.%0 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 cons ction and zo • g. Furthermore, I authorize the above -named contractor to do the work stated. G �- - • vim, - /1 ignature downer and/or Condo Presid . t Date Notary as to Owner and/or Condo Presid , My Commission Expires: a Fr.KaA J. LO e € � ' «: s r �x,V:SsIO a cc438959 y 14, 1999 U\ FEES: PERMIT °/ RADON t Date 2— cep9A- Signature of Contractor or Owner - Builder Date ) ()*" Notary as to Contractor or Owner - Builder My Commission Expires: a' „ Pa LTLA J. L1 ' Nis( C.VAISSION n cc438969 DORM e:y�..y 14, 1999 arm D P,131 TROY no litSURANC2E, TOTAL DUE Date B C.C.F. ➢ we NOTARY BOND APPROVED: Zoning Building Electrical Mechanical � (°m" Plumbing Engineering ITEM BATH TL8 UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING a lear..%- nd4. s 7Tw DISHWASHER RECEPTACLES A/C (WIND) DISPOSAL SERVICE TEAPORARY SERVICE SIZE IN AMPS A/C (CENTRAL) -2___,A, DUCT WORK V DRINKING FOUNTAIN FLOOR DRAIN SERVICE REPAIR/1IETER 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 MOTCRS OVER 1- 3 HP HOT WATER BOILERS SINK, POT /3 COMP. MOTCRS OVER 3- 5 HP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 NIP 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 TRANSFORMERS ' HEATER -NEW INST. „, GENERATORS TRANSFORMERS 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 FIXTURES . SEPTIC TANK -___ ANTENNA • RELAY TELEVISION OUTLETS ORAINFIELO, 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 PIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) ELECTRICAL MECHANICAL