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PLUMBING PERMITMIAMI SHORES VILLAGE BUILDING DEPARTM T 305- 795 -2204 Building Inspection Reques Date , Type Insp'n Permit No. X4 2, O,3 r 33 Name C o m P4 Yf 41 Address )) g Ale )E9/ S7L Company /GAD le S "[- Phone # 3 ®, 9 3 : -/ ih■ If NT Inspection Date Approved Correction Re-Insp'n Fee bi965-101se 0 • Date /2( 3' 63 lob Address Legal Description Owner /Lessee/Tenet Owner's Address Contracting CoT'e CO Qualifier `fie S G S State # F< Permit Type (circle one): BUILDING WORK DESCRIPTION: re Signatur Notary as to d/or Con My Commis �f xpires FEES: PERMIT APPROVED: Zoning Mechanical r RECEII1y/8 1 EPUI t ifee l3C 11,n)50 N.E. 2nd Ave /2/ I 1Z IS IQ lvr kloq e -eciyks. U e Bu Municipal # ON FOR MIAMI SHORES VILLAIGErIEC "- e • Miami Shores, Florida 33138.305- 795 -2204 Tax Folio I/ 32- 5 Oa I 06 2 0 Historically Designated: Yes No if- Master Permit # ? I CX 6 - - 6 - ) IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY, THERE WILL BE NO INSPECTION. Rz- INSPECTION FEE IS $50.00 AND MUST BE PAID IN ADVANCE BEFORE CALLING FOR ANOTHER INSPECTION. riEwe ICC Ca ■ ICAL PLUMB MECHANICAL ROOFING '' / ; ( 44 G 4f Se") 1 C e - 0 /2/8 be /0 /sS - r« /ti CAS M- IA/ 6 A.s° rbe © /01 s/" , Square Ft. Estimated Cost (value) h&° WARNING TO OWNER: YOU MUST RECORD ADTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS 1 YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR ANY ATTORNEY BEFORE 'CORDING YOUR NOTICE OF COMMENCEMENT.) Application is hereby made to obtain a permit to do wand installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all h regulating construction in this jurisdiction. I understand that separate permits are required for all disciplines. OWNERS AFFIDAVIT: I certi y that all the foregoiniformation is accurate and that all work will be done in compliance with all applicable laws ction and zo ing. Furthermore, 1 autt a the above named contractor to do the work stated. f own • add/. C.ndo President Nota .? E;orm - Pltf �, CXZI r ? t O C1 Date Si re of Contractor or 044r Builder / Date svallbribeadair■orill t MONTERO 4 - State of Florida Etpies Jan 27, 2008 Bond &tional NEt&EyAnn. Nota e' cC RADON C.C.F ss# Phone ' c 7 S 7 / S e Address t/5 7 9 ui p I ?Uf' 1-140/ A,e( 1 ontractor ssion Expire NOTARY Phone Competency # !(°en Ins. Co. d 3‘,6 (7$ ��`,ii'r " "' LUIS MONTERO ar - W\ � �: Notary Public - State of Florida • � • My Commission Ems Jan 27.2008 ocommission f DD084905 to ■ Bonded By National Notary Assn. BOND TOTAL DUE Electrical Structural Engineer • ATLAS: M 12 SCALE: NTS DRAWN BY: LM 50' c, 50' CONSRUCTION NOTES: N. R/W /S. VW SP CAS MAIN I. ALL CAS PIPELINE CONSTRUCTION TO FOLLOW TECO PEOPLES CAS STANDARDS. 2. TRAFFIC CONTROL SHOULD BE MAINTAINED AND COORDINATED IVITH THE APPRORIATE GOVERNMENTAL AGENCY. 3. ALL DISTRUBED ASPHALT /CONCRETE /SOD AREAS TO BE RESTORED TO PRIOR CONDITION, UNLESS OTHERWISE SPECIFIED. 1 NEW 1/2" PLASTIC' GAS SERVICE TO: 1218 NE 101 STREET. MIAMI SHORES, FLA TIE IN TO CAS MAIN. -N.E 101ST STREET 15' SIDEWALK 25' SWALE ASPHALT. 25' SWALE 15' SIDEWALK 50' 48 HOURS BEFORE DIGGING CALL SUNSHINE 1- 800 - 432 -4770 DATE: 12/09/03 SHEET: 1/1 JO: 1218 50' N.R/W S. R/W 0. ATLAS: M 12 SCALE: NTS DRAWN BY: LM 50' c. 50' CONSRUCTION NOTES: N.R/W /S. R/W SP CAS MAIN 1. ALL CAS PIPELINE CONSTRUCTION TO FOLLOW TECO PEOPLES GAS STANDARDS. 2. TRAFFIC CONTROL SHOULD BE MAINTAINED AND COORDINATED WITH THE APPROR /ATE GOVERNMENTAL AGENCY. 3. ALL DISTRUBED ASPHALT /CONCRETE /SOD AREAS TO BE RESTORED TO PRIOR CONDITION. UNLESS OTHERWISE SPECIFIED. 2' NEW 1/2" PLASTIC GAS SERVIC'E TO: 1218 NE 101 STREET. MIAMI SHORES, FLA TIE IN TO CAS MAIN. 15' SIDEWALK 25' SWALE -N.E 101ST STREET ASPHALT. 25' SWALE (1218) PROPOSED RISER. 5' SIDEWALK 50' 50' 48 HOURS BEFORE DIGGING CALL SUNSHINE 1- 800 - 432 -4770 DATE. 12/09/03 SHEET: 1/1 JO: 1218 N.R/W S.R/W 0. Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 12 /15/2003 Applicant: ROBIN Owner: CONNEARNEY JOB ADDRESS: 1218 NE 101 Contractor TECO PEOPLES GAS SYSTEM Contractor's Address: 1218 NE 101 ST Local Phone: 957 -3857 X7383 Parcel # 1132050210020 Plumbing Permit Permit Number: PL2003 -337 CONNEARNEY ROBIN ST Legal Description: MIAMI SHORES SEC 8 AMD PB 42-40 N100FT LOT 5 Fees: FEE2003 -8209 FEE2003 -8210 FEE2003 -8211 FEE2003 -8212 FEE2003 -8213 Description Building Fee CCF Technology Fee Scanning Fee Training and Education Fee Total Fees: Amount $120.00 $0.60 $3.00 $3.00 $0.20 $126.80 Total Fees: $12 80 Total Receipts: $ t 3 Permit Status: APPROVED Permit Expiration: 6/7/2004 Construction Value: $600.00 Work: New 1/2 plastic natural gas service Signed: (INSPECTOR) Signed: (Contractor or Builder) BY: Page 1 of 1 DEC 19 RAID BLK 184 A LOT SIZE 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 responisibility for all work done by either myself, my agent, servants or employes. Dat Type Insp'n Permit No. Name C 49 Adt, - mot Address Q • C 1 . 4, Compa Phone # Inspection Date Approved Correction Re-Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPART 305- 795 -2204 Building Inspection Reque L oy -3r 3 r 7.1103 BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Tenant/Lessee Name atc- I543 (Continued on opposite side) i--e be\ (21eA-0-1 Miami Shores Village G Building Department b _ 3 zo , O 0. 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Submittal Fee $ iO.0 Permit Fee $ - Notary $ Training/Education Fee $ Scanning $ Radon $ Code Enforcement $ Structural Plan Review. $ Total Fee Now Due $ Master Permit No. Plumbing Building Electrical Owner's Name (Fee Simple Titleholder) ?•1,1\4) ■ r1 C n vk f An'v Owner's Address / 1 try C t 0 City ''k - j State Job Address (where the work is being done) ► ,►13 lot Phone # Zip Phone # Permit No. 1 - 3c0 Mechanical Roofing 32(4 -O4 \ la $ Value of Work For this Permit 1-1;' 0° Type of Work: ❑Addition teration ❑New ❑ Repair/Replace ❑ Demolition Describe Work: City Miami Shores Village County Miami -Dade Zip Is Building Historically Designated YES NO Contractor's Company Na ie p JAS J r(\ 2`... CP S ?I.0 MbirC\ Phone # J (7 — 6 0g- 00 Contractor's Address 4s io v+.) i s L '?1.... 3.� City �x �P.�� State Zip Qualifier (1.OY'2 Lo OZ._ J Z Architect/Engineer's Name (if applic4ile) Phone # Square Footage Of Work: C `, 4\ 1.-N;;Ne_, /36 - CCF $ Technology Fee $ ✓ Bond $ N say.b Bonding Company's Name (if applicable) �- ..111 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 Rill 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. .fir the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Owner or Agent Con The fore oing instrument was acknowledg ' before me this 3 ` The foregoing instrument was ac owled : - d before me this 4 day of _ , 20'0.. by ' \ R,p�,y v ��'rvv� y * da • of It7J . 20 by � + 62_ who is personally known to me or who has produced vho is personalty known to me or who has produced As identification and who did take an oath. NOTAR PUBILCr Sign: e' e r Print: My Commission Expires: (Certificate of Competency Holder) State Certificate or Registration No. ` Certificate of Competency No. ************* * * * * * * * * * * * * * * * * * * * * * * : : * *. * * ** ***************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: Chc 10/14/03 NOTARY PUBLIC: CARLOS PEREZ- Sign: EXPIRES. 43I713 APRIL I3 2004 Print: K ndq�v. • '""'— My Commission Expires: as identification and who did take an oath. M . CARLOS i C EXPIRES: APRIL 13 * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Engineer Zoning 4 TUB UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE ET LIGHT OUTLETS CENTRAL HEATING ••R RECEPTACLES A/C (WINO) SAL SERVICE TEMPORARY A/C (CENTRAL) �:<ING FOUNTAIN SERVICE SIZE IN AM?S DUCT WORK CR DRAIN SERVICE REPAIRNETER CHA.4BE REFRIGERATION SE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING E CEPTCR • RANGE TOP UNDERGROUND TANKS ATORY OVEN ABOVE GROUND TANKS 'DRY TRAY WATER HEATER U.F. PRESSURE VESSELS :TrIES WASHER MOTORS 0- 1 HP STEAM BOILERS :,_R MOTORS OVER 1- 3 HP HOT WATER BOILERS : <, POT /3 COMP. MOTORS OVER 3- 5 HP MECHANICAL VENTILATION RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES ..<, _<, SLOP MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS - CRARY WATER CLOSET MOTORS OVER 10- 25 H' FIRE SPRINKLER SYSTEMS 'MX MOTORS OVER 25-100 HP COOLING TOWERS "ER CLOSET MOTORS OVER 100 FP VIOLATION IRECT -WASTES A/C WINDOW REINSPECTION :ER SUPPLY TO: AIR CONDITIONERS ./C UNIT STRIP HEATER " =IRE SPRINKLER GENERATORS TRANSFORMERS • i CATER -NEW INST. GENERATORS TRANSFCRMERS i - EATER- REPLACE GENERATORS TRANSFORMERS I LAWN SPRIh7(LER -WELL SPECIAL PURPOSE • I W I NG POOL OUTLETS COM€RC R AL LITER SERVICE SIGN TUBES TER CONNECTIONS SIGN TRANSFORMERS ILITY -SEWER SIGN TIME CLOCK IL ITY -WATER FIXTLRES 'TIC TANK _ ANTENNA _AY TELEVISION OUTLETS , ;INFIELD, 4' TILE/RES. VIOLATION •P & ABANDON SEPTIC TANK REINSPECTION , ':<AGE PIT CU. FT. TCH BASIN S iARGE WELL YESTIC WELL EA DRAIN • CF INLET 1 • LAR WATER HEATER . nE STANDPIPE CL PIPING _ FM SPRINKLER SYSTEM - --+- -- S RANGE TER SET.(GAS) PIPING APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. STAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) ADDENDUM TO BUILDING PERMIT APPLICATION ELECTRICAL MECHANICAL Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Permit Number: PL2003 -300 Printed: 11/5/2003 Applicant: ROBIN CONNEARNEY Owner: CONNEARNEY ROBIN JOB ADDRESS: 1218 NE 101 ST Plumbing Permit Contractor CONSUMER GAS PLUMBING CORP. Contractor's Address: 4510 SW 154 PLACE Local Phone: 305 - 608 -5400 Parcel # 1132050210020 Page 1 of 1 Legal Description: MIAMI SHORES SEC 8 AMD PB 42-40 N100FT LOT 5 BLK 184 A LOT SIZE Fees: Description Amount FEE2003 -6942 Building Fee $130.00 FEE2003 -6944 Scanning Fee $3.00 FEE2003 -6945 Training and Education Fee $0.20 FEE2003 -6946 CCF $0.60 FEE2003 -6947 Technology Fee $3.25 Total Fees: $137.05 Total Fees: $1],A Total Receipts: W Permit Status: APPROVED Permit Expiration: 5/3/2004 Construction Value: $475.00 Work: GAS METER Signed: (INSPECTOR) NOV 0 6 PAID 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 responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: ICISS3 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 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. ,19.. 272 Owner's Name and Address ....111...Philpott ........__ ....__ ... No....121.8....__. Street_. •....E • ....1 � �.S _.S t . Registered Architect and/or Engineer Name and address of licensed contractor Lang. _RQQ.1. ... ...�'].1�....�r.O... }. ZSlU....., �... NL ...7.1.S.t...cs ..... 1.s'�II17. Location and legal description of lot to be built on: LotN..1.Q0 t af... Block 1.8L. -k Subdivision Miami thorns ..Se c Linn . A Street and Number where work is to be done 1218 N E, 101st Street ___._.___ State work to be done and purpose of building (by floors) Tear off 1 -30# felt to sheathing boards including new addition, mop 1 -90# slate and comer.... with... a... lairer. .....A.f....1,vhit .e....cemant ..shingle tile... . and for no other purpose. New Building Remodeling Addition x Repairs R e -ro of No. of Stories 1 To be constructed of Kind cf foundation Roof Covering....Cem.eft ..tile._.. Estimated Total cost of improvements $2250.00 Amount of Permit $.7.a00 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 pennit 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 ctors employed by hire in the work to be performed under this permit; and will post or cause to be posted for inspecti• on the a of the ork such public notice or notices as arc required by the Act. The undersigned agrees to employ only such subcontr rs on ork to performed , ij er pennit, as are licensed by Miami Shores Village. 23sgs. Remarks ( Signed) 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 Member MIAMI SHORES VILLAGE 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 ! /-_ arre e. Permit No. ._.. ` Date 1 (f— '2- / p - 7 - Read, Sworn to and Subscribed before me. Disapproved (Signed) Building In /ector PLANNING BOARD DATE Chairman Member MIcrnber Member Member Notary Public, State of Florida My Commission Expires 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 oe faulty materials and /or workmanship. to me well known, BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Architect Contractor or Builder Legal Lot Description Address of Building r' PERMIT 3850 Contractors License No. ❑ Work to be performed under this Permi CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA B1 DATE Subdi- vision Value of Project $ Amount of Permit $ 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 applica- tion 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 respon- sibility for work done by his agents, servants or employees. Signed. s `" -- 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 ac• cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. BY AUTHORITY AYEO? pIu{ �F� Permit No 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. 2 eti-C-d is /? NE / " No. .Street F____ Registered Architect and /or Engineer Employing Plumber's Name �/l , 1 ( Location and Legal Description Lot Block Subdivision hh(( •" i � 1 _`:i ,C11_�_!�_� f _ _ � 7 Street and Number where work is to be performed —No f Street 1 � State work to be performed and purpose of building (By Floors) °`ti' �' i �_ ..d * New Building Remodeling 1' Owner's Name and Address Size Septic Tank Type of Tank Capacity Gals Feet of Drain Tile Dist. Feet of Tank or Drain Field from We11 Nature of Water Supply: City —Well Size of Soakage Pit ' j- Amount of Permit $___,.. My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Addition Repairs No. of Stories ( Signed)_--_-_ I The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligation as an employ of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent ,upplement, and has com- plied with the provisions thereof, and will require similar compliance from all contactors 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- contractois, on work to be j cfQ med under this ermit, as are licensed by Miami Shores Village. Signed STATE OF FLORIDA, 1� II ss. COUNTY OF DADE. Date t . l Plumbing Infpector. Before me, the undersigned authority, a notary public, duly authorized to admiiister 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 appication, and that he did sign the same, and that all facts therein by him stated are true. Notary Public, State of Florida aster Plumber. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is rade necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINAL S CATCH BASIN FLOOR DRAIN DRINKING FOUNT 'NS TOTAL FIXTURES CONTR. LIST ) ( •) '\._ CHECK - SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL CONTR. LIST - CHECK Permit No 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. 2 eti-C-d is /? NE / " No. .Street F____ Registered Architect and /or Engineer Employing Plumber's Name �/l , 1 ( Location and Legal Description Lot Block Subdivision hh(( •" i � 1 _`:i ,C11_�_!�_� f _ _ � 7 Street and Number where work is to be performed —No f Street 1 � State work to be performed and purpose of building (By Floors) °`ti' �' i �_ ..d * New Building Remodeling 1' Owner's Name and Address Size Septic Tank Type of Tank Capacity Gals Feet of Drain Tile Dist. Feet of Tank or Drain Field from We11 Nature of Water Supply: City —Well Size of Soakage Pit ' j- Amount of Permit $___,.. My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Addition Repairs No. of Stories ( Signed)_--_-_ I The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligation as an employ of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent ,upplement, and has com- plied with the provisions thereof, and will require similar compliance from all contactors 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- contractois, on work to be j cfQ med under this ermit, as are licensed by Miami Shores Village. Signed STATE OF FLORIDA, 1� II ss. COUNTY OF DADE. Date t . l Plumbing Infpector. Before me, the undersigned authority, a notary public, duly authorized to admiiister 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 appication, and that he did sign the same, and that all facts therein by him stated are true. Notary Public, State of Florida aster Plumber. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is rade necessary by improper notice for inspection, or faulty materials and /or workmanship. BUILDING ELECTRICAL PLUMBING Owner of Building Architect Contractor or Builder Legal Description Lot Building of 9/ / Building / CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA 41:' ERM1T N° 6684 Work to be p formed under this Permit ` °� 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 appli- cation herefor in strict compliance with all ordinances pertaining thereto and w th 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 proffer 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 ssumes,the respon bility for a thorough knowled • e • The ordinances and regulations pertaining to the work covered hereby whether shown on the plans or i aw gs or in statements or S ification%e.'ii1n:*: mes respon- sibility for work done by his agents, servants or employees. In consideration of the issuance to me of this permit I agree to perfo o the work covered hereunder in compliance with tllbrdinances and 3eg7a5ns pertaining thereto and in strict conformity with the plans, drawings, state nts or specifications submitted to the proper authorities of Miami Shores Village. I cepting this permitTf ssdme respo r-iiit� for all work done either r self, mY gent, servant pe ► employee. l (� I f • o '•s r w Signed • Subdi- vision Value of Project BY DATE Contractor's License No Amt. o Permi By INSPECTOR AUTHORITY 194 • BUILDING' MIAMI SHORES VILLAGE, FLORIDA ELECTRICAL RMIT N° 4940 PLUMBING Work to be performed under this Permit'�"R e Owner of Building Architect �• , Contractor IP or Builder Legal Lot Description pellet Subdi- vision C s ,�► i !" Value of Amt. of �, Project Permit 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 appli- cation 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 . change witho authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above a es t sponsi), ity for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans o . titestaterrreniiroolspecifications an that he assumes respon- sibility for work done by his agents, servants or employees. ,, • .,P r .. ,,i Signed. Address of Building • DATE - 2;4 CTO Contractor's License No C, IS t(ap By R� 194 In consideration of the issuance to me of this permit I agree to perform the work coved hereunder in compliance with all o dinances and egyia ons - pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authoritiVg of Miami Shorh-Villifge. . In accepting glis permit I assume responsibility for all work done by either myself, my agent, servant or employee. / CONTRACTOR OR BUILDER ' — d o AUTHORITY Permit No.' ! L `✓ 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. Owner's Name and Address Registered Architect and /or Engineer Employing Plumber's Name l Location and Legal Description Lott& 11 T _11 Nature of Water Supply: City —Well Amount of Permit $ ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT / r r -// 1 No Street and Number where work is to be performed —No. V Street State work to be performed and purpose of building (By Floors) New Building -. Remodeling____ Addition Size Septic Tank Type of Tank Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well ,Size of Soakage Pit mock__k Subdivision /a r - ( Signed) ( Signed) No. 9.0 (I Street, 7r4<_j Repairs Sl,_.w 4c Date D( C - / 6 — lib Street ( 1:2 -- Capacity Gals. No. of Stories Plumbing Inspector. 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 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. Master Plumber. STATE OF FLORIDA, 1 COUNTY OF DADE. 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. My Commission Expires Notary Public, State of Florida 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 HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL ,j /LL. 4,,, CONTR. LIST �S v CHECK Permit No.' ! L `✓ 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. Owner's Name and Address Registered Architect and /or Engineer Employing Plumber's Name l Location and Legal Description Lott& 11 T _11 Nature of Water Supply: City —Well Amount of Permit $ ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT / r r -// 1 No Street and Number where work is to be performed —No. V Street State work to be performed and purpose of building (By Floors) New Building -. Remodeling____ Addition Size Septic Tank Type of Tank Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well ,Size of Soakage Pit mock__k Subdivision /a r - ( Signed) ( Signed) No. 9.0 (I Street, 7r4<_j Repairs Sl,_.w 4c Date D( C - / 6 — lib Street ( 1:2 -- Capacity Gals. No. of Stories Plumbing Inspector. 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 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. Master Plumber. STATE OF FLORIDA, 1 COUNTY OF DADE. 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. My Commission Expires Notary Public, State of Florida 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. PLUMBING IN MIAMI 90 YEARS '1 AY C 1 OS c . , — Nr k' // NORTON PLUMBING CO. CONTRACTING — REPAIRING MAINTENANCE 8011 N. W. Is,' PLACE PHONE 7-3897 MIAMI 38. FLORIDA W, /2(v `A (0 tot '4 CL. ESTIMATES CHEERFULLY GIVEN 51fGVEW ( 0 C BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Electrical Plumbing Mechanical Roofing • Owner's Name (Fee Simple Titleholder) � ''�'�r Owner's Address 1 2-t/ J & /t' J Miami Shores Village Building Department City /11t ,ftbst`,.. State gi Zip 77/ cr7 $ Value of Work For this Permit t4 Square Footage Of Work: 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. Y 1 ° Master Permit No. c 2c( - Phone # Tenant/Lessee Name Phone # Job Address (where the work is being done) ' /1)/We-it City Miami Shores Village County Miami -Dade Zip Is Building Historically Designated YES NO 7/1i . I_ f eri 3 1 Phone # Contractor's Company Name "� � �''� Contractor's Address l ' 5 7, ilivi. 7 (14, City /q '✓I'i -i `` ■` . State ill Zip ) 7/�' : ' Qualifier Architect/Engineer's Name (if applicable) - Phone # Architect/Engineer's Address City State Zip Number of: Bays Stories Families Bedrooms Baths Type of Work: ['Addition DAlteration DNew ❑ Repair/Replace ❑ Demolition Describe Work: f e_._.. "Ci1.r * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ..--------_____—, County Escrow Fee $ 1 L- 0 Permit Fee $ K) Notary $ S CDC) Education/Training Fee $ Tech $ Scanning $ Radon $ Code Enforcement $ Bond $ Struct. $ Minus Plans C eck Fee $ Total Fee Now Due $ (Continued on opposite side) it CI (2.2 ncyl Bonding Company's Name (if applicable) Bonding Company's Address City 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." Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State State 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 or Agent The foregoing instrument was acknowledged before me this day of , 20 , by who is personally known to me or who has produced State Certificate or Registration No. APPLICATION APPROVED B chc7nros As identification and who did take an oath. Zip Signature Contractor The foregoing instrument was acknowledged before me this St day of who is rsonally NOTARY PUBLIC: NOTARY PUBLI Sign: Sign: Print: Print: Certificate of Competency No. 20 Q, by to me or who has produced entification and who did take an oath. ■ My Commission Expires: '� f My Commission Expire s•,+ 6 B B ded Th"' (Certificate of Competency Holder) as ******* * * * * * ** * * * * * * * * * * * * * * * * * * * * * * ** ************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Engineer Zoning CONTRACTOR Mg ,. /C � I� ic ,1,�� (% ( EE- Name Ep#1 ) J _t a cl� License No. S e� OA 41 ^ 5 .�] , SSS ___ Enclosure Address 41 9 w iv , Address 21 r /4 I (, 6 Telephone 3a .„ 0 ,1 t - Fax 36• - 6 . 3 - 1 .16 1 / 0, Qualifier Name c i_� a /7 �_, PROPERTY OWNER New Construction Name a 12 14 Enclosure � _/ Address 21 r /4 I (, 6 . (c 1 i 4 Home Telephone 3 . S .. 7 _. C f 1d 7/ / c Business Telephone Relocation of Structure Fax Shell Only TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'I Detachment Other Job Address: PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Folio Number Lot Block Subdivision PB PG Current Use of Property Proposed Use of Property Tenant Information INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted along with this permit application. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. APPLICATION 12 /JE, 101 Address Apt. Chg. Contractor Renewal Revision Extension Supplement Reinspection PERMIT CHANGE (✓ ) ARCHITECT Name License No. Address Telephone Fax Zoning Square Feet Po'ct c ' if Coll ��� PEERMIT APPLICATION Master Permit No. PI �l�•t��' Oct Subsidiary Permit No. City State �° Zip Description of Work G l .-t / om 4t, Linear Feet Units Floors Value of Work .2 Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax SECTION BY DATE Zonis Electrical Mechanical Plumbing ( / 3 Fire Public Works Structural Building Official Page 4 OFFICE USE ONLY CHECKLIST L] OWNER - BUILDER FORM (Attach) LI FIRE DEPARTMENT APPROVAL (Commercial / multi - family) U CONCURRENCY (New Construction) . LI OTHER (Specify & Attach) LI PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) PERMIT FEES $3.00 per page (Scanning Fee) $ Miami Shores Village Bond Metropolitan Dade County (C.C.F.) Inspector State Educational Fund $ State DCA (Radon) $ Code Enforcement Fine Zoning Review $ ° ?30) $ado $ I ? $ ( sq.ft. = x/1000 x 0.60) (0.005 /sq.ft.) (0.01 /sq.ft.) REVIEWED AND PREPARED BY: PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ 3 O G • 'KO ISSUING OFFICIAL DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com CONTRACTOR M, ,. /C t ( EE_ s 11)(44 i L Name slEP/r1 G,4I a c�� License No. 5- E� pH ei ^ 5 , Address (q 2 Z d it4 , 2_4„....,_ - Telephone 314_641-7 4fCr V Fax 3 , 6 -SK, -SK, / Qualifier Name S e � / a !_ PROPERTY OWNER / Name i� j2,4 N eA IJ Address 12 o p ./.rte . t 1 l 4 4 ,.. Home Telephone 3 , ®S — 7 - Ct�0 �f ' / Business Telephone Fax TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'I Detachment Other INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted along with this permit application. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. Job Address: 2 1 rJ E, 101 5 Address Apt. City �— State Zip Folio Number Description of Work ID � 'f— T a Lot Block Subdivision PB PG Zoning Linear Feet Current Use of Property Square Feet Units Floors Proposed Use of Property Value of Work% 1 - Bldg Value Tenant Information Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax ?G\`0, Gq n PERMIT APPLICATION Master Permit No. PI - ' XP Subsidiary Permit No. 4 3313& ENGINEER Name License No. Address Telephone Fax Page 2 INI POR'I'ANT NOTICES 1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. 1)0 NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. EEI DAN 1'1' - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other govemmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1a' Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. Signature of Notary Public - State of Flo SEAL: Personally known COUNTY OF MIAMI - DADE Print Name Sworn to and subs ribed before me this day of �t Sy - — STEPHEN E. COCKING ,j�e :* MY COMMISSION # OD 031747 EXPIRES: Juna 20, 2003 Bonded ThN Notary Public Underwdxn OR, Produced Identification Type of Identification Produced: SEAL: Signature of Contractor / Qualifier ' {' �y ' e ,(c.....h� t � Print Name day to and subscribed before me this y of PERMIT APPLICATION of Notary Public 01 Commission #DD23 e Expires: Jul 13, 2 0 9 07 Bonded Thu Inc. 9j �pP,^ Atlantic Bondir3 Co Personally known OR, Produced identification Type of Identification Produced: ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. TYPE Outlet, Appliance QTY. 'TYPE Service Repair Q"I'1'. A/C Central 1 -3 Ton Fan Outlet, Wall Service, Temporary A/C Central 4 -7 Ton Fire Pump Outlet, Switch Signs A/C Central 8 -15 Ton Fixture - Fluorescent Oven Space Heater (kw) A/C Central 16-20 Ton Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial s Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic 1 Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps 1 Water Heater New MECHANICAL TYPE Minimum Fee QTY. TYPE Condensate Drain QTY. TYPE Generator QTY. TYI'E Refrigeration, Tons QTY. A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Supply, AC Well Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Temporary Toilet PLUMBING 'TYPI:. A/C Condensate QTY. TYPI:, Drains, Roof QTY. Tl'1'1': Miscellaneous Fixture QTY. Tl'l'I{ Soakage Pit QTY. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet s Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair 1 Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank 1 Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: SECTION BY DATE Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official Page 4 [ OFFICE USE ONLY CHECKLIST U OWNER - BUILDER FORM (Attach) U FIRE DEPARTMENT APPROVAL (Commercial / multi - family) LI CONCURRENCY (New Construction) . fJ OTHER (Specify & Attach) $3.00 per page (Scanning Fee) Miami Shores Village Bond Metropolitan Dade County (C.C.F.) Inspector State Educational Fund $ State DCA (Radon) $ Code Enforcement Fine Zoning Review ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) PERMIT FEES $ ?S'D) $3 $ ` t ( ? (sq.ft. = x/1000 x ¢.60) $ (¢.005 /sq.ft.) (¢.01 /sq.ft.) REVIEWED AND PREPARED BY: PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ 3SG• *KV ISSUING OFFICIAL DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com STATE OF FLORIDA DEPARTMENT OF HEALTH 'j ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATIOI/AND SYSTEM SPECIFICATIONS CANT: 14b CD/V / - )be.Nq /, A/Pd -530 41/71) GENT: BLOCK: ! VA SUBDIVISION: /2/1/974 ROPERTY ID #: ,l 6 / c c C) p BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHE �.OUALI IED PERSO . ENGINEER'S MUST ROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. ROPERTY SIZE CONFORMS TO SITE OTAL ESTIMATED SEWAGE FLOW: UTHORIZED SEWAGE FLOW: NOBSTRUCTED AREA AVAILABLE: ENCHMARK /REFERENCE POINT LOCATION: LEVATION OF PROPOSED SYSTEM SITE ISc.; 4INCHES /FT] [ABOVV/BELOWJ'BENCHMARK /REFERENCE HE MINIMUM SETBACK, WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES: URFACE WATER: /7 4 FT ELLS: PUBLIC: fall q4 FT UILDING FOUNDATIONS: ITE SUBJECT TO FREQUENT FLOODING: 0 YEAR FLOOD ELEVATION FOR SITE: OIL PROFILE INFORMATION SITE 1 Munsell # /Color ti.3 U t/ <1 ) P h _. USDA SOIL SERIES: Texture to ITE EVALUATED BY : C "f f' .(�h_r;y (' PLAN: [A.-YES [ ] NO NET USABLE AREA AVAILABLE GALLONS PER DAY [RESIDENCES -TABLE 1 / GALLONS PER DAY [1500 GPD /ACRE OR SQFT UNOBSTRUCTED AREA REQUIRED: 'j Q c7 0 DITCHES /SWALES: PA FT NORMALLY WET? [ ) YES [L] „ _NO LIMITED USE: Pf 'h FT PRIVATE: r/ Evfr FT NON - POTABLE: //h , FT FT PROPERTY LINES:_ j FT POTABLE WATER LINES: i FT Depth Q to t to 1 7 • [ ] YES [+- ) 10 YEAR FLOODING? [ ] YES d_]_ .10 FT MSL /NGVD SITE' EIEVATION: , 7 FT MSL /NWVD A , SOIL PROFILE SNFORMATION SITE 2 t) , ` .3, 3 to t to lo H 4015. 10/96 (Replaces HRS -H Form 4015 (Vane •1 whirr, may Po ,,. .1l rr (2 1 IN 1 PERMIT # ® _ /5 ; I D L I— - [Section /Township /Range /Parcel No. I / or Tax ID Number] ACRES OTHER -TABLE 2) SQFT POINT BSERVED WATER TABLE: , ,r1 / 1 INCHES [ABOVE / BELOW] EXISTING GRADE. PE c f#E4CHED / APPARENT] STIMATED WET,SEASON WATER TABLE ELEVATION: ( Z., f./ INCHES [ ABOVE BELOW”) EXISTING GRADE. IGH WATER 'TABLE VEGETATION: [ ] YES [L- ] MOTTLING: [ ] YES [L N6 DEPTH: OHES DEPTH OF EXCAVATION: 7 Z." INCHES OIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: RAINFIELD CONFIGURATION: [ ] TRENCH [,,,.]'"BED [ ) OTHER (SPECIFY) EMARKS /ADDITIONAL CRITERIA: DATE: Page 3 of 3 Permit No. 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. - Owner's Name and Address MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date - ....... No.1 l _ /!!. _ _ Street_M / if .7_, ° Z . CB Registered Architect and /or Engineer ..... ____�____�__ _ , J. _ Employing Plumber's Name_ _ - /1- -- — - a �/! /..t . -_ No. _ 2. 9 .5° .6/ _.___ Street_ J.51.7 5 7 Location and Legal Description Lot - - - -.. _ - -_ - -- _ -- - - - - -_ ._ Block_ — / — - - - - -- Subdivision - - - - -- _------------- _- - - - - -� Street and Number where work is to be performed —No j _ -Q_ _L) g__1 1 Street_ State work to be performed and purpose of building (By Floors)__---- ___ ... _...__. New Building _- _ -- Remodeling _ Addition. Repairs_ No. of Stories. _ Size Septic Tank _- - 'sf. Fe o £ auk__ Capacity Gals Feet of Drain i1tri 2S 5 -- — of Tank or Drain Field from Well Nature of Water Supply: City —Well Amount of Permit $ Size of Soakage Pit — -- (Signed)- Plumbing Inspector. 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 com- plied with the provisions thereof, and will require similar compliance from all contractors or ub- 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 sit- o the wo k such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub- contractors, • wor to perf der this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. (Signed)._ Master 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. My Commission Expires Notary Public, State of Florida 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 Tues URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'N6 TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST ` -- CHECK Permit No. 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. - Owner's Name and Address MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date - ....... No.1 l _ /!!. _ _ Street_M / if .7_, ° Z . CB Registered Architect and /or Engineer ..... ____�____�__ _ , J. _ Employing Plumber's Name_ _ - /1- -- — - a �/! /..t . -_ No. _ 2. 9 .5° .6/ _.___ Street_ J.51.7 5 7 Location and Legal Description Lot - - - -.. _ - -_ - -- _ -- - - - - -_ ._ Block_ — / — - - - - -- Subdivision - - - - -- _------------- _- - - - - -� Street and Number where work is to be performed —No j _ -Q_ _L) g__1 1 Street_ State work to be performed and purpose of building (By Floors)__---- ___ ... _...__. New Building _- _ -- Remodeling _ Addition. Repairs_ No. of Stories. _ Size Septic Tank _- - 'sf. Fe o £ auk__ Capacity Gals Feet of Drain i1tri 2S 5 -- — of Tank or Drain Field from Well Nature of Water Supply: City —Well Amount of Permit $ Size of Soakage Pit — -- (Signed)- Plumbing Inspector. 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 com- plied with the provisions thereof, and will require similar compliance from all contractors or ub- 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 sit- o the wo k such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub- contractors, • wor to perf der this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. (Signed)._ Master 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. My Commission Expires Notary Public, State of Florida 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 . Owner of Building 1 CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA DATE PERMIT N2 5005 Contractor's License No. Work to be performed under this Permit Bl. CO- ■ Subdi- vision alue of Project 194_ Architect Contractor or Builder Legal Lot Description P Address of Building This permit is granted to the contractor or buildep amed above to construct the building or to install the equipment oc evice scribed in the appli- cation herefor in strict compliance with all ordinances pertaining thereto and w'th the understanding that the work will be performed i compliance with any p lans, 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 anged without a thorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above ass s the,, nsibilit or a .rough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or . . . n • Mill M, - . ecifipations and that he assumes respon- sibility for work done by his agents, servants or employees. /r� /1�'' f SP :_ •: In consideration of the issuance to me of this permit I agree to perform the war"k cbvered eunder in compliance with a urdinances and e .l ai ons pertaining thereto and in strict conformity with the plans, drawings, statements or specification ubmitted to the proper autho �t}rei of Miami Sh . y -. illdge. In accepting this permit I assume responsibility for all work done by either myself, my agent, s ant or employee. 4. ( _ ,, a i- ( � .lr it t L., j !r )1 AUTHORITY Permit N Nature of Water Supply: City —Well ill MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Size of Soakage Pit (Signed) Date ! Owner's Name and Address____ No Street Size Septic Tank Type of Tank___ ___A ' "' f Capacity Gals. • 1 Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well My Commission Expires Notary Public, State of Florida • Registered Architect and /or Engineer r , .• Employing Plumber's Name__ / r . -- -==— =--- - - - - -- No. Street -- -C - -- Location and Legal Description Lot — ____ —_ Block Subdivision Street and Number where work is to be performed —No ' Street r State work to be performed and purpose of building (By Floors) _ New Building Remodeling Addition____ Repairs 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. No. of Stories Amount of Permit $ (Signed) J) (l Plumbing Inspector. The undersigned applicant( 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 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. Master Plumber. STATE OF FLORIDA, } COUNTY OF DADE. 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 N Nature of Water Supply: City —Well ill MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Size of Soakage Pit (Signed) Date ! Owner's Name and Address____ No Street Size Septic Tank Type of Tank___ ___A ' "' f Capacity Gals. • 1 Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well My Commission Expires Notary Public, State of Florida • Registered Architect and /or Engineer r , .• Employing Plumber's Name__ / r . -- -==— =--- - - - - -- No. Street -- -C - -- Location and Legal Description Lot — ____ —_ Block Subdivision Street and Number where work is to be performed —No ' Street r State work to be performed and purpose of building (By Floors) _ New Building Remodeling Addition____ Repairs 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. No. of Stories Amount of Permit $ (Signed) J) (l Plumbing Inspector. The undersigned applicant( 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 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. Master Plumber. STATE OF FLORIDA, } COUNTY OF DADE. 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. MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Buileing Inspection Requ St Date 0 2 T Type Insp'n p) U 1' i PI o?- Name aOf O r ft Q , r 1 Address 1 oL' IV t O' JT Permit No. Company f �, Phone # Inspection Date Approved Correction Re -Insp' n Fee 01V t • BUILDING PERMIT APPLICATION FBC 2001 Miami Shores Village Building Department Permit Type (circle): Building Electrical Plumbing Mechanical Roofing Owner's Name (Fee Simple Titleholder) Owner's Address 121s State City v\wv\i 5 \1 e5 Tenant/Lessee Name 101 4cEe- Zip Job Address (where the work is being done) City Miami Shores Village County Miami -Dade Is Building Historically Designated YES NO $ Value of Work For this Permit I. County Escrow Fee $ Education/Training Fee $ Code Enforcement $ Minus Plans Check Fee $ Total Fee Now Due $ Permit No. PLac03. a38 Master Permit No. Tech $ Scanning $ Bond $ Struct. $ ) 'q - ,K), 0_0_, $30 .0 Phone # Phone # Zip 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Contractor's Company Name VI.A1 Y V1Kt I IVC Phone # 3Q.5 9 (.40 gig - 0 Contractor's Address )9 7 /U � Cit A Y ' l \1}/V� State f � L Zip / Si Qualifier �� 1 \.i A- ( —A ¥t_J J Phone # Architect/Engineer's Name (if applicable) Architect/Engineer's Address City State Zip Square Footage Of Work: Baths Number of: Bays Stories Families Bedrooms Type of Work: Addition ❑Alteration ❑New ❑ Repair/Re•lace ❑ Demolition Describe Work: )) si �r ∎. iiL ! VC`s ki\' (J" t �� 1,N) WA -- Tn * * * * * * * * * * * * * * * * * * * * * * * * * ** *F * * * * ** * * * * * * * * * * * * * * * * * * * * * ** Permit Fee - W Notary $ Radon $ (Continued on opposite side) 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 (Certificate of Competency Holder) State Certificate or Registration No. Certificate of Competency No. chc7nros Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this Z 2 — day of , 20 _ , by day of 6Q u.s r , 20 03 by Si AV A f h40 who is personally known to me or who has produced who is personally known to me or who- lasspreelneet}— N L2N As identification and who did take an oath. _ as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: OYV Sign: Sign: Print: Print: JOSE • < S f') �1� My Commission Expires: My Commission Expit.. Y i ::' JOSEPH P. SI 4 4MOOMMISSIelli 110138140* ps EXPIRES: July 3 2006 'if Pf NQ; •' Baled TTxu Nole P ubl ic UndMmil * * * * * * * * * * * * ** * * * * * * * * * * * * * ** iI * * * ** ************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY / „ti Plans Examiner Engineer Zoning TEM ,ATH TUB UNIT 1 FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE 1 LIGHT OUTLETS CENTRAL HEATING .IDET iISHWASHER RECEPTACLES A/C (WIN iISPOSAL SERVICE TEMPORARY A/C (CENTRAL) :RINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK •LOOR DRAIN SERVICE REPAIR/METER CHANGE REFRIGERATION :REASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING 'NTERCEPTOR RANGE TOP UNDERGROUND TANKS 2. OVEN ABOVE (ROUND TANKS TRAY WATER HEATER U.F. PRESSURE VESSELS .AUNDRY :LOTHES WASHER I MOTORS 0- 1 HP STEAM BOILERS {OW 1 MOTORS OVER 1- 3 FP HOT WATER BOILERS ;INK, POT /3 COMP. MOTDRS OVER 3- 5 HP MECHANICAL VENTILATION ;INK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES SINK, SLCP MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS JRINAL LOTORS OVER 25-100 HP COOLING TOWERS KATER CLOSET I MOTORS OVER 100 HP VIOLATION INDIRECT • WAS - TES A/C W I I OOW REINSPECTION WATER SUPPLY T0: AIR CONDITIONERS A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS • 'HEATER - NEW INST. GENERATORS TRANSFORMERS I HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL .' SPECIAL PURPOSE SWIMt1ING POOL OUTLETS COWERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS JTILITY -SEWER SIGN TIME CLOCK JTILITY -WATER FIXTLRES SEPTIC TANK ANTENNA 1ELAY TELEVISION OUTLETS 3RAINFIELD, 4' TILE/RES. VIOLATION 'U4' 5 ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. CATCH BASIN DISCHARGE WELL OOMESTIC WELL AREA DRAIN ROOF INLET i 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