1155 NE 100 St (10)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date en.0 -O ( Job Address //5 A�67. //e (97 Tax Folio
Legal Description
Owner/Lessee / Tenant v 7 )
Owners Address ) &S G.- /GYM
Contracting Co. f�j 1
Qualifier
State # �Cc el9_2 Municipal # Competency #
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING (MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 1 C 3 0 �� 7 ee e/ , 2L7 / ?
Square Ft. /C' 2 Estimated Cost (value) K7s °N
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.
No
My
Zoning
i
of o er
and/or r Condo ' sident Date
xph l/6N AL.VAREZ
. t . =J My COMMISSION • Ce 837012
"I•o f p EXPIRES: May 16, 2003
1 4 1 20, 1 16O r A N Y Ra I V eanla & Boni%00,
FEES: PERMIT 2 "{ RADON
APPROVED:
Date
Y -a6
Building
Historically Designated: Yes No
Master Permit #
Pho[
C�J.J 7S/ S" /2/
Address 7t/K,2—
Ins. Co.
VIVIAN ALV
MY COMMISSION 0 iti7013
Q � or iveF EXPIRES: Mny 16, dtii1
14202-3-NOTARY Notary ! i
+ybaYi�Q 410'
Signature of Contractor or Owner -Build Date
Notary as to C
My Commissi
C.C.F. � ()NOTARY V BOND
Electrical
Date
Mechanical ( 76? 4 g I Plumbing Structural Engineer
ITEM .
BATH TLB
UNIT
FEE
ITEM
SNITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT CUTLETS
CENTRAL HEATING
D I ShYIASHER
RECEPTACLES
A/C (WIND)
01 SSAL
SERVICE TEWCRARY
A/C (CENTRAL)c3•4 70 N..S'
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
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
MOTCRS 0- 1 HP
STEAM BOILERS
SHOWER
MOTCRS OVER 1- 3 FP
HOT WATER BOILERS
SINK, POT /3 COMP.
MOTCRS OVER 3- 5 HP
MECHANICAL VENTILATION
SINK, RESIDENCE
MOTCRS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTCRS OVER 8- 10 HP
ELEVATORS /ESCALATORS
TEMPORARY WATER CLOSET
MOTORS OVER 10- 25 NP
FIRE SPRINKLER SYSTEMS
URINAL
MOTORS OVER 25-100 HP
COOLING TOWERS
WATER CLOSET
MOTORS OVER 1C0 If
VIOLATION
INDIRECT WASTES
A/C WINDOW
REINSPECTION
WATER SUPPLY TO:
AIR CONDITIONERS .3.6 TO A9 S
A/C UNIT
STRIP HEATER /D AU)
Je
FIRE SPRINKLER
GENERATORS TRANSFORMERS
HEATER -NEW INST.
GENERATORS TRANSFORMERS
HEATER - REPLACE
GENERATORS TRANSFORMERS
LAWN SPRINKLER -WELL
SPECIAL PURPOSE
SWIMf lhG POOL
OUTLETS COMMERCIAL
WATER SERVICE
SIGN TUBES
SEWER CONNECTIONS
SIGN TRANSFERS
JTILITY SEWER
SIGN TIME CLOCK
1TILITY -WATER
FIXTURES
;EPTIC TANK
_
ANTENNA
1ELAY
TELEVISION CUTLETS
?RAINFIELO, 4' TILE/RES.
'LIMP
VIOLATION
& ABANDON SEPTIC TANK
REINSPECTION
;OAKAGE PIT CU. FT.
:ATCH BASIN
IISCHARGE WELL
OMESTIC WELL
-
REA DRAIN
OOF INLET
-
OLAR WATER HEATER
IRE STANDPIPE
OOL PIPING
AWN SPRINKLER SYSTEM
AS RANGE
:TER SET (GAS)
MS 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
ADDE4DU'M TO BUILDING PERMIT APPLICATION
ELECTRICAL
MECHANICAL
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 Vffllage 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 the work. ;
Date °2/ c2- S , 19 6, /
Owner's Name and Address._ Ge No S
Registered Architect and /or Engineer l /-S� l0 O
Name and address of licensed contractor 4 ,C eR Z
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done /1 . S71/
State work to be done and purpose o building (by floors)
New Building
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Disapproved Date
(Signed)
APPLICATION FOR BUILDING PERMIT
Cpl/ °e- ?'tic -c
and for no other purpose.
Reruodeling. Addition Repairs No. of Stories
To be constructed of Kind f foul tion R f Covering
Estimated Total cost of improvements $ ' 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 permit does hereby certify that he understands and accepts his obligations as an emploj ;er
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 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 subcon actors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)r� ° ��
Notary Public, State of Florida
STATE OF FLORIDA,
COUNTY OF DADE. j Ss.
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 are true.
Permit No / c , Date___„ Read, Sworn to and Subscribed before me.
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chainnan 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 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and/or workmanship.