1156 NE 101 St (10)Irtspebtior Nurrnter: IS P46499
Inspection Date: 03/08/2006
Inspector: Levrack, James
Owner: GOMEZ, RODOLFO AND SUSANA
Job Address: 1156 101 ST we
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
Tuesday, March 7, 2006
Miami Shores Village, FL
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
P one: (305)795 -2204 Fax: (305)756 -8972
Block:
Permit
lum
Lot:
P L' -1- 06.146
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number (305)898 -8841
Parcel Number 1132050190250
Page 1 of 2
1 e 1 ,
, .
II
Comments
Passed
; J
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Irtspebtior Nurrnter: IS P46499
Inspection Date: 03/08/2006
Inspector: Levrack, James
Owner: GOMEZ, RODOLFO AND SUSANA
Job Address: 1156 101 ST we
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
Tuesday, March 7, 2006
Miami Shores Village, FL
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
P one: (305)795 -2204 Fax: (305)756 -8972
Block:
Permit
lum
Lot:
P L' -1- 06.146
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number (305)898 -8841
Parcel Number 1132050190250
Page 1 of 2
i spectoroumbe INtF4499
ermit wuber: PL 1-06 =146
Inspection Date: 03/08/2006
Inspector: Levrack, James
Owner: GOMEZ, RODOLFO AND SUSANA
Job Address: 1156 101 ST
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
Tuesday, March 7, 2006
Miami Shores Village, FL
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Block:
Phone Number (305)898 -8841
Parcel Number 1132050190250
Lot:
Page 2 of 2
In
Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled until
re- inspection fee is paid.
i spectoroumbe INtF4499
ermit wuber: PL 1-06 =146
Inspection Date: 03/08/2006
Inspector: Levrack, James
Owner: GOMEZ, RODOLFO AND SUSANA
Job Address: 1156 101 ST
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
Tuesday, March 7, 2006
Miami Shores Village, FL
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Block:
Phone Number (305)898 -8841
Parcel Number 1132050190250
Lot:
Page 2 of 2
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle) Electric , n Plumbing Mechanical Roofing
Name (Fee Simple Titleholder) DU Sand C Dry, L Phone # 305-29 g
Owner's Address 1) Sj (, NE
City /Vl1 a ✓►7i t.f S tate
Tenant/Lessee Name
Architect/Engineer's Name (if applicable)
Submittal Fee $
Total Fee Now Due $
(Continued on opposite side)
152— 3D
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: !,. �.'_ _ -a. ;�� 56.8972
/ 0 / SiY- c -e_"f—
$ Value of Work For this Permit - / 000 ,
Zip
Contractor's Company Name Phone #
Contractor's Address
State Certificate or Registration No. Certificate of Competency No.
Type of Work: ['Addition ['Alteration [New ) Repair/Replace
e la , b . -
sh
pan e o A A-S Tele- 64Tt+. •
Permit No
aster Permit No.
333
Phone #
Job Address (where the work is being done) / f sL0 /V E / a / s S'- f- ►---e_e -f-
Cit Miami Shores Village County Miami -Dade Zip 33) 3 X
Is Building Historically Designated YES NO 1/
City State Zip
Qualifier
Phone #
Square Footage Of Work: 3 U
n! ❑ Demolition
Describe Work: Rem vi n -£.1/I,s47 v j L s' 0 wed Po a Y ' Pho ln/e/r p c ri
14
0
cud
v Permit Fee $ �� / CI CCF $ O. (Or) CO/CC
Notary $ 5 - H OC Training/Education Fee $ Zcj Technology Fee $ 3 • 0
Scanning $ a CO 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 AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: 1 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.
Signature
Owner o
The fore oing instrument was owledged before 4e t�is /8 .
day o ,2 tT
who is personally known to me or who has produced
1 13
NOTA
Sign:
Print:
My Com
chc 05/13/03
UBLI
As identification and who did take an oath.
* * * * *. * * * * * * * * **
APPLICATION APPROVED BY:
NOTARY PUBLIC -ST
Yo
Contractor
The foregoing instrument was acknowledged before me this
�/
t ►Eayof ,20by
who is personally known to me or who has produced
PL0PJt *OTARY PUBLIC:
rnandez
5
9
Signature
as identification and who did take an oath.
Sign:
Print:
My Commission Expires:
******************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
* ** *** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
9 o? Plans Examiner
Engineer
Zoning
(AN A£PLICATION 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
ITEM
BATH TU3
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIOET
LIGHT OUTLETS
CENTRAL HEATING
DISHWASHER
RECEPTACLES
A/C (WIND)
DISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL)
DRINKIIC FOUNTAIN
SERVICE SIZE IN AMPS
DUCT WORK
FLOOR DRAIN
SERVICE REPAIR/METER CHANGE
REFRIGERATION
GREASE TRW
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 C- 1 HP
STEAM BOILERS
SHOWER
MOTORS OVER 1- 3 FP
HOT WATER BOILERS
SINK, POT /3 COMP.
MIDTORS OVER 3- 5 HP
MECHANICAL VENTILATION
SINK, RESIDENCE
MOTORS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTORS OVER 8- 10 If
ELEVATORS/ESCALATORS
TEMPORARY WATER CLOSET
MOTORS OVER 10- 25 HP
F IRE SPRINKLER SYSTEMS
URINAL
MOTORS OVER 25-100 FP
COOLING TOWERS
WATER CLOSET
MOTORS OVER 100 NP
VIOLATION
I It) IRECT WASTES
I
A/C WINOOYi
RE1NSP.ECTION
WATER SUPPLY TO:
I
AIR CONDITIONERS
1
A/C UNIT
I
STRIP HEATER
FIRE SPRINKLER
I
GENERATORS TRANSFORMERS
HEATER -NEW INST.
GENERATORS ' TRANSFORMERS
I
HEATER - REPLACE
I
GENERATORS TRANSFORMERS
LAWN SPRINKLER -WELL
1
SPECIAL PURPOSE
SWIMMING POOL
OUTLETS COMAERCIAL
WATER SERVICE
S IGN TUBES
SEWER CONNECT IONS
,
•SIGN TRANSFORMERS
UTILITY -SEWER
SIGN TIME CLOCK
UTILITY -WATER
FIXTLRES
-- .
SEPTIC TANK
ANTE RNA
RELAY
TELEVISION OUTLETS
DRAINFIELD, 4' TILE/RES.
VIOLATION
PUMP & ABANDON SEPTIC TANK
REINSPECT ION
SOAKAGE PIT J. FT.
CATCH BASIN
D I SOHARGE WELL
DOMESTIC WELL
AREA DRAI
I
ROOF INLET
SOLAR WATER HEATER
r "IRE STANDP IPE
POOL PIPING
LAWN SPRINKLER SYSTEI
GAS RANEE
I
I !
I
METER, SET (GAS)
I
GAS PIP1}T
}
I
I
(AN A£PLICATION 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
InspectionNumber I
Project: <NONE>
Inspection Date: 02/28/2006
Inspector: Levrack, James
P10682
Owner: GOMEZ, RODOLFO AND SUSANA
Job Address: 1156 101 ST NE
Miami Shores Village, FL
Contractor: HOME OWNER
Building Department Comments
Monday, February 27, 2006
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Pho e: (305)795 -2204 Fax: (305)756 -897
1
Permit Number: PL -1-06 -146
Permit Type: Plumbing - Residential
Inspection Type: Rough
Work Classificati n: Addition /Alteration
110W `eot
Phone Number (305)898 -8841
Block:
1- 06
Lot:
Parcel Number 1132050190250
Page 2 of 2
Passed
In s
C mments
.
i
•
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
InspectionNumber I
Project: <NONE>
Inspection Date: 02/28/2006
Inspector: Levrack, James
P10682
Owner: GOMEZ, RODOLFO AND SUSANA
Job Address: 1156 101 ST NE
Miami Shores Village, FL
Contractor: HOME OWNER
Building Department Comments
Monday, February 27, 2006
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Pho e: (305)795 -2204 Fax: (305)756 -897
1
Permit Number: PL -1-06 -146
Permit Type: Plumbing - Residential
Inspection Type: Rough
Work Classificati n: Addition /Alteration
110W `eot
Phone Number (305)898 -8841
Block:
1- 06
Lot:
Parcel Number 1132050190250
Page 2 of 2
Issue Date: 1/23/2006
Owner's Name: RODOLFO AND SUSANA GOMEZ
Permit Type: Plumbing - Residential
Work Classification: Addition /Alteration
Job Address: 1156 101 ST
Additional Information
Miami Shores Village, FL
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit
Expires: 01/18/2007
Contractor(s)
HOME OWNER
Phone Primary Contractor
Yes
Comments:
REMOVING EXISTING SHOWER FLOOR AND SHOWER PAN AND REPLACING
SHOWER PAN AND SHOWER FLOOR WITH NEW PAN AND TILE
Type of Work:
Additional Info:
Classification: Residential
Type of Piping:
Bond Return :
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.
Fees Due
CCF
Education Surcharge
Notary Fee
Permit Fee - Additions /Alterations
Scanning Fee
Technology Fee
Total:
Amount
$0.60
$0.20
$5.00
$140.00
$3.00
$3.50
$152.30
Building Department File Copy
Applicant Signature
Parcel #:
Block:
Section:
Total Square Feet:
Total Valuation:
Required Inspections
Permit Status: APPROVED
Permit Number: PL -1 -06 -146
Phone: (305)898 -8841
1132050190250
Lot:
PB:
30
$ 1,000.00
Underground Rough
Water Main
Top Out
Main Drain
Lavatory
Water Service
Re Pipe
Heater
Final
Invoice Number
PL - 1 - 06 - 23563
Total:
JAN 2 4 PAID
Amt Due
$152.30
Amt Paid
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.
I nspection Nu
Inspection Date: 03/08/2006
Inspector: Grande, Claudio
Owner: GOMEZ, RODOLFO AND SUSANA
Job Address: 1156 101 Street NE
Miami Shores Village, FL
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
Tuesday, March 7, 2006
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Block:
i rmlt Number; RC -1-06 -145
Permit Type: Residential Construction
Inspection Type: Final
Work Classification: Alteration
Phone Number (305)898 -8841
Parcel Number 1132050190250
Lot:
Page 2of2
Passed
v
Inspector Comments
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
I nspection Nu
Inspection Date: 03/08/2006
Inspector: Grande, Claudio
Owner: GOMEZ, RODOLFO AND SUSANA
Job Address: 1156 101 Street NE
Miami Shores Village, FL
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
Tuesday, March 7, 2006
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Block:
i rmlt Number; RC -1-06 -145
Permit Type: Residential Construction
Inspection Type: Final
Work Classification: Alteration
Phone Number (305)898 -8841
Parcel Number 1132050190250
Lot:
Page 2of2
•
BUILDING
PERMIT APPLICATI
FBC 2001
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Horida 33138
Te p, _ � �. {{ 4 �� _Eax :_( 05) 756.8972
EI
Permit Type (circle): Building Electr' al Plumbing Mechanical Q Roofing
Owner's Name (Fee Simple Titleholder) Susarl-� C 0►�► Phone # 305 -8 I . p g 1 -)
Owner's Address / 1 SLp N e 1 0 I - Sfr -c r_ t
Ct
City M 1 rY11 S'I O VeJ State FLOP I CJ ek Zip 33) 3y
Tenant/Lessee Name Phone #
Job Address (where the work is being done) / / S (p /4 C / 0 / S'
City Miami Shores Village County Miamy -Dade Zip 33 ► 3 y
Is Building Historically Designated YES NO
Contractor's Company Name
Contractor's Address
Architect/Engineer's Name (if applicable)
City State Zip
Qualifier
State Certificate or Registration No. Certificate of Competency No.
$ Value of Work For this Permit 4 1 00 v
Type of Work: ['Addition ['Alteration ['New Repair/Replace Demolition
Describe Work: h (Pre tn.) SHOW-R2 AN 6/J d 1, i A)
(1A— -C e
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $$ Permit Fee $ 1 CCF $ D. (OO CO /CC
Notary $ -5. 0( Training/Education Fee $ C) . 2.0 Technology Fee $ 2 J
Scanning $3. OD Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $
(Continued on opposite side)
Phone #
Phone #
Master Permit No.
Permit No. .E„Cc 1
Square Footage Of Work: 30
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.
Contractor
The foregoing instrument was acknowledged before me this 18 The foregoing instrument was acknowledged before me this
day ofJ A N , 20O b}561SAW147T day of , 20 by
who is personally known to me or who has produced who is personally known to me or who has produced
1 D As identification and who did take an oath. as identification and who did take an oath.
NOTA ' NOTARY PUBLIC -STATE OF FLHOWARY PUBLIC:
Sign: y Hernandez Sign:
or • ' n:
6455 g
Print: _ „ = f���'
� .r r ` , il 2 2009 Print:
My Commill.1.11111M My Commission Expires:
ded - "ZitiMrirm(onding Co., Inc.
APPLICATION APPROVED BY:
Chc 05/13/03
Y P BLIC:
** I * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
Signature
* * ** * *** ******************************************************************** * ** * ** **** * * ** ** ** * * * *,t * ** ** **
0 Plans Examiner
Engineer
Zoning
5
OWNER BUILDER DISCLOSURE STATEMENT
I �titSGc ✓tG� q_tyy-k e � being the legal property owner, for the property
Located at: Hsu L / J / 0/
Legally described as
Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the
State of Florida, F.S. 489.103(7),4nd I have read and understand the following disclosure.
Statement, which entitles me to 3rork as my own contractor, I further understand that I as the owner
must appear in person to complete all applications.
State law requires construction to be done by licensed contractors. You have applied for a permit under an
exemption to that law. The exemption allows you, as the owner of your property, to act as your own contractor
even though you do not have a license. You must supervise the construction yourself. You may build or
improve a one - family or two-family residence or a farm out - building. You may also build or improve a
commercial building at a cost of 525,000.00 or less. The building must be for your own use and occupancy. It
may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the
construction is completed, the law will presume that you built it for sale or lease, which is a violation of this
exemption. You may not hire an unlicensed person as your contractor. It is your responsibility to make sure
that people employed by you have licenses required by state law and by county or municipal licensing
ordinances. Any person working on your building who is not Icensed must work under your supervision
and must be employed by you, which means that you must deduct F.I.C.A. and with- holding tax and
provide workers' compensation for that employee, all as prescribed by law. Your construction must comply
with all applicable laws, ordinances, building codes and zoning regulations.
Proof of ownership provided ( ) initial of reviewing clerk. Tlie foregoing instrument
Was acknowledged before me this le day ofi4 ; 20 CD Co
1 . L /\ -who is personally known to me or who has
Produced • ' 0
Owner
VILLAGE OF MIAMI SHORES
BUILDING DEPARTMENT
DISCLOSURE STATEMENT
as identification and who did take an oath.
RIDA
andez
mission # DD476455
Expires: SEP. 27, 2009
Bonded Thru Atlantic Bonding Co., Inc.
Issue Date: 1/23/2006 Expires: 01/18/2007
Owner's Name: RODOLFO AND SUSANA GOMEZ
Permit Type: Residential Construction
Work Classification: Alteration
Job Address: 1156 101 Street NE
Miami Shores Village, FL
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit
Contractor(s) Phone Primary Contractor
HOME OWNER
Yes
Comments:
REPLACING SHOWER PAN AND TILE IN SHOWER MASTER BATH
Additional Information
Type of Construction:
Stories:
Front Setback:
Left Setback:
Bedrooms:
Plans Submitted:
Certificate Date: 1/18/2006
Occupancy:
Exterior:
Rear Setback:
Right Setback:
Bathrooms:
Certificate Status:
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.
Fees Due
CCF
Education Surcharge
Notary Fee
Permit Fee - Additions /Alterations
Scanning Fee
Technology Fee
Total:
Amount
$0.60
$0.20
$5.00
$100.00
$3.00
$2.50
$111.30
Building Department File Copy
Applicant Signature
Parcel #:
Block:
Section:
PB:
Total Square Feet:
Total Valuation:
Required Inspections
Permit Status: APPROVED
Permit Number: RC -1 -06 -145
Phone: (305)898 -8841
1132050190250
Lot:
30
$ 1,000.00
Slab
Termite Letter
Fill Cells Columns
Tie Beam
Window and Door Buck
Window Door Attachment
Framing
Insulation
Drywall Screw
Ceiling Grid
Final PE Certification
Shutter Attachment
Shutter Final
Invoice Number
RC -1 -06 -23562
Total:
JAN 2 4PAID
Amt Due
$111.30
Amt Paid
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.
Permit No.
STATE OF FLORIDA,
COUNTY OF DADE.
Amount of Permit $ 1)
Owner's Name and Address___/ O !/t►• 8 /9 Al i
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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.
Registered Architect and /or Engineer
Employing Plumber's Name No
Location and Legal Description LotLO >• 2 - — Block
Street
Subdivision L• j ore
Street and Number where work is to be performed —No //St Street • E / O /
State work to be performed and purpose of building (By Floors) ___ G. _ L � 14/4/ tri°E /4/4 4L E/e
New Building Remodeling Addition
Size Septic Tank Type of Tank Capacity Gals
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well T Size of Soakage Pit
( Signed )�
No/ /' '
/Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understbnds and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General aws of Florida Permanent Supplement, and has com-
plied 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 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 )/ 0A/PCPRC• :
Date_
Repairs No. of Stories
Street / /
My Commission Expires Notary Public, State of Florida
`T 4daster Plumber.
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.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
H EATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
.LIST
CHECK
Permit No.
STATE OF FLORIDA,
COUNTY OF DADE.
Amount of Permit $ 1)
Owner's Name and Address___/ O !/t►• 8 /9 Al i
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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.
Registered Architect and /or Engineer
Employing Plumber's Name No
Location and Legal Description LotLO >• 2 - — Block
Street
Subdivision L• j ore
Street and Number where work is to be performed —No //St Street • E / O /
State work to be performed and purpose of building (By Floors) ___ G. _ L � 14/4/ tri°E /4/4 4L E/e
New Building Remodeling Addition
Size Septic Tank Type of Tank Capacity Gals
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well T Size of Soakage Pit
( Signed )�
No/ /' '
/Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understbnds and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General aws of Florida Permanent Supplement, and has com-
plied 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 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 )/ 0A/PCPRC• :
Date_
Repairs No. of Stories
Street / /
My Commission Expires Notary Public, State of Florida
`T 4daster Plumber.
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 $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
,/,,S /9)v
Application is jlereby made for the approval of the detailed statement of the plans and specifications herewit ubmitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Permit No
Owner's Name and Addres
Registered Architect and /or . neer '
Feet of Drain Tile
Nature of Water Suppl
STATE OF FLORIDA, 1
COUNTY OF DADE.
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Employing Plumber's Nam ___ No ?,� Street__
Location and Legal Description Lot _ Block �_7 Subdivision____ft2�z?„___'
Street and Number where work is to be performed —No +Z�_ �3 Street__ 1_1/ •
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition \ReKus No. of Stories
Size Septic Tank$_____5_0 Type of Tank Capacity Gals
Dist. Feet of Tank or Drain Field from Well
ell Size of Soakage Pit
Amount of Permit $____) 1` 7 - -- ( Signed
(Signed)
No. Street
ng Inspector.
The undersigned applicant for this building permit does hereby certify that he u per• ands and accepts his obligatioryg s an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled Gen r. Laws of Florida Permanent Supplement, and has com-
plied 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 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.
Date
My Commission Expires Notary Public, State of Florida
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 $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
B ATH
T UBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDR
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
/
2
2
--1--
/
- --
CHECK
\
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
4919111PMIr
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL
1�/,
,.
CONTR.
LIBT
? _
2
CHECK
,/,,S /9)v
Application is jlereby made for the approval of the detailed statement of the plans and specifications herewit ubmitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Permit No
Owner's Name and Addres
Registered Architect and /or . neer '
Feet of Drain Tile
Nature of Water Suppl
STATE OF FLORIDA, 1
COUNTY OF DADE.
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Employing Plumber's Nam ___ No ?,� Street__
Location and Legal Description Lot _ Block �_7 Subdivision____ft2�z?„___'
Street and Number where work is to be performed —No +Z�_ �3 Street__ 1_1/ •
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition \ReKus No. of Stories
Size Septic Tank$_____5_0 Type of Tank Capacity Gals
Dist. Feet of Tank or Drain Field from Well
ell Size of Soakage Pit
Amount of Permit $____) 1` 7 - -- ( Signed
(Signed)
No. Street
ng Inspector.
The undersigned applicant for this building permit does hereby certify that he u per• ands and accepts his obligatioryg s an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled Gen r. Laws of Florida Permanent Supplement, and has com-
plied 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 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.
Date
My Commission Expires Notary Public, State of Florida
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
PLUMBING
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
DATE '
PERMIT N° 9197
Work to be performed under this Permit
Owner of
Building
Bl.
Subdi-
vision
Value of
Project $
195 ;
Contractor's
License No
Amt. of
Permit
1
BY AUTHORITY
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees. /
Signed: + BY
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and 'regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
aN�►
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
Legal
Description
Address of /
Building 1
Lot
MIAMI SHORES VILLAGE, FLORIDA
DATE y c. +,
1 /
Contractor's
License No
PERMIT N° 9653
Work to be performed under this Permit
� i
/.. / \ .-/
Architect
Contractor ,' / f",,✓
or Builder - ,,,
Bl.
Signed:
In consideration of the issuance to me of this permit I agree to pert()
pertaining thereto and in strict conformity with the plans, drawings, stateme
In accepting this permitassume respo`�'�ibility for all work done by either'
l i
CONTRACTOR OR BUILDER
;�
Subdi-
vision
Value of
Project $
Amt. of
Permit $
e <• c
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for thorough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or d .. ings or in the statements o specifications and that he assumes responsibility for work
done by his agents, servants or employees.
BY
INSPECTOR
m the work covered hereunder in compliance with all ordinances
or specifications submitted to the proper authorities of Miami
myself, my agee t, �. sservant or employee.
BY -
AUTHORITY
195
and regulations
Shores Village.