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940 NE 99 St (9)MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 B ilding Inspection Request Date77 - n Type Insp' n i \O rr Permit No. E1 4. 1c 1D- D- Name PDST Address leaoz5 ct" l Company C CcCi1 Cn aC Phone # Inspection Date 119-9 Approved Correction Re -Insp' n Fee Tenant/Lessee Name Type of Work: ['Addition Describe Work: ,t td BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Owner's Name (Fee Simple Titleholder) Owner's Address 120F /t) •e ST City MI 4-171 f ,shore -5 State fic . Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 3313 Tel: (305) 795.2204 Fax: (305) 756.8972 Contractor's Company Name .Ih e t )1 /1'A) ii, [ ` I _ Contractor's Address ` ;SC? v �i2 ��- City I I W U',;(20 0 State % t— Qualifier — r; ICd G Permit No. � Master Permit No. Job Address (where the work is being done) 1 2-0 g ig 1 t City Miami Shores Village County Miami -Dade Zip :)')1 32 Is Building Historically Designated YES NO sL. Architect/Engineer's Name (if applicable) Phone # $ Value of Work For this Permit )� 7 Square Footage Of Work: ❑yEgrat New Zip 331 Phone # Code Enforcement $ Structural Plan Review. $ Total Fee Now Due $ f 07 , ( 7) (Continued on opposite side) Plumbing Mechanical Roofing Phone # 3o s 44 - Ye o . T Phone # -7 9. 3 t g lU Zip 3, ❑ Repair/Replace ❑ Demolition 4 . , * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ /®6 '' d0 CCF $ — 0 CO /CC Notary $ ' Training/Education Fee $ , O Technology Fee $ Scanning $ , D d Radon $ Zoning Bond $ • RE JUL 1 4 V11,1 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 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_' s ection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not roved aA reinspection fee will be charged. Signature NOTARY PUBLI Sign: Print: Chc 12/15/03 Owner or gent ]) The foregoing instrumenrcas acknowledged before m thisQ da of it Le 20 I , by K e Ttt .W . ' f oS J 1 who is Person y known to me i r APPLICATION APPROVED BY' My Commission Expires: / ***** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** 7 Signature (Certificate of Competency Holder) State Certificate or Registration No. �� 7( c ***************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Contractor The foregoing instrument was acknowledged before me this, �. day of ) t,. / L{ , 206 t� , by /i. /01 "... ,per.onallv known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: t 4.:,:LL1f M. BROWN Pn r M NE Com Exp.'SJI� t. No. DO 001028 M Commission E . es:' Certificate of Competency No. Zoning ********************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Yom`V'y Plans Examiner Engineer ITEM BATH TUB UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES A/C (WIND) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMP 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 (ROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 HP STEAM BOILERS SHOWER MOTORS QVER 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 • i 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 PUP & 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 (AN APPLICATION.FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ADDENDUM TO BUILDING PERMIT APPLICATION ELECTRICAL MECHANICAL