MECHANICAL PERMITMIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date 5
Type Insp'n 1 U (
Permit No. 1-4 7��
Name
Address r2-)V NE 101 5
Company cf 551 q PDoI s.
Phone # ' 4 V C c 6 o
Inspection Date
Approved
Correction
Re- Insp'n Fee
1 009 a,o4
CI
' 0 03
A1ll.�e .
BUILDING
PERMIT APPLICATION
FBC 2001
Tenant/Lessee Name
Contractor's Company Name
Contractor's Address
Qualifier L r 6 - (� S I V 1 F T Z E- 4 R_
°' $ Value of Work For this Permit 10 C)
Miami Shores Village
Building Department
Permit No. 0, h I 6 3
Master Permit No. '3 P7O(..5 tO
Permit Type (circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) Pac Cr. rn Pc y v1 Phone #
Owner's Address \ IS J O H
City 161 State e \—L Zip
Phone #
Job Address (where the work is being done) Gj7
City Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES NO 4
J , /YVW olew Phone #
City IWt i .4 wt i State C Zip 3 3/‘ /
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Architect/Engineer's Name (if applicable) - Phone #
Architect/Engineer's Address
City State Zip
Square Footage Of Work:
Number of: Bays Stories Families Bedrooms Baths
Type of Work: ['Addition ['Alteration ❑New
❑ Repair/Replace ❑ Demolition
Describe Work: ��'
Sc. 'r- i : - :,„ -t pi, —, ue.,Lti,
• .............
* * * * * * * * * * * * * * * * * * * * * * * * * * * Fees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
County Escrow Fee $ Permit Fee $ Notary $ . GO
Education/Training Fee $ Tech $ Scanning $ Radon $
Code Enforcement $ Bond $ Struct. $
Minus Plans Check Fee $ Total Fee Now Due $ (Continued on opposite side)
a Q
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.
Signature Signature
Owner or Agent
The foregoing instrument was acknowledged before me this
g Tie foregoing instrument was acknowledged before me thi
day of , 20 , by day of 20 j by
who is personally known to me or who has produced who is personally kn
As identification and who did take an oath.
NOTARY PUBLIC: NOTARY P
Sign: Sign:
Print: Print:
My Commission Expires:
Chc7t7 /03
My Commission Expires:
eommts
c6tipireeidailid4 an oath.
AtIanta o., lnc.
tredWIDECOAWIA
!V
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
APPLICATION APPROVED BY: . ('f t) Plans Examiner
Engineer
Zoning
(q�
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby wade 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 i3uilding 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... —.... ( . G .._ -- - ..... ,19.Z.2
Owner's Name and Address /"Y //1. / 4,- ... r _ No ..... Street— ...
Registered Architect and /or Engineer �•.... _,.,...,? ..,.= *._..,*._ .,I•,SI,_- _ ... . .., f
Name and address of licensed contactor /f ,._._. - ../.. — — - �� - -• - -=
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done /6 -f sf 4 4E Zal
State work to be do and purpose of uilding (by floors) /./.11(.::-177. L. -L--
A A__.. ^ /v_✓.7, f,..- :,1.7 . -.._.
peared
Remodeling
Kind of
Building Inspccto
i
p2
and for no other purpose.
✓— Addition Repairs No. of Stories
New Building
To be constructed of
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 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 inspection on the site of the work such public notice
or notices as arc required by the Act. The undersigned agrees to employ only such su tracto , on work be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)
foundation Roof Covering .........
STATE OF FLORIDA,
COUNTY OF DADE. ss
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally op-
Notary Public, State of Florida
My Commission Expires
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.._. _ Date -..T' �/ — �l Read, Sworn to and Subscribed before me.
Disapproved
(Signed) . -..
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.