1226 NE 100 St (6)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
.fob Address (t)1 C I t)
Date � • - ' � � . (� � tax Folio
Legal Description " 2.2 (o i' ( ()
Owner/Lessee / Tenant k Q , 44 Cod it L a r4)
Owner's Address
Contracting Co. pi t 0.-=, t P<d L-
Qualifier 's � e � �i C Phone
State # //: C ( • ) < 16 Municipal #
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMB I OFING PAVING FENCE SIGN
WORK DESCRIPTION �S 6 �� l 4� 46 1c
Square Ft.
Notary
My Co
APPROVED:
Zoning
Mechanical
00o S
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 pennit 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 ;;�• +rk stated.
Signatur.'of owner and/or Condo President
5
FEES: PERMIT ZS ,, RADON
g 2,'S
•
s fir. u 1 �ft§t Otet �:; dalf(3
p esj(PIRES: March 4, 2002
E[s
•1,�
•F;;d•• Bonded Thru Notary Public Underwriters
Date
Date Notary as
My Co
Historically Designated: Yes No
Address
Competency #
Address
Address
Master Permit #
Phone
jo
Ins. Co.
Estimated Cost (value) , 3 0'0
JOSUE •ir YO
OMMISSION # CC 727495
• IRESot: Marc b 2!02 firers
a
l •'
ss + xpires:
C.C.F. 140 NOTARY "•— BOND
TOTAL DUE
Building
I/17"
r 6O ✓0
Date
a&'- ,) .3
Date
Electrical
Structural Engineer
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO. TAX FOLIO NO.
STATE OF FLORIDA:
COUNTY OF DADE:
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
1. Legal description of property and street address: 00E S t tt tl ( S' D'
c 00S f '
r s1-) Ft— 3 16t
2. Description of improvement: S O S i A L L A - N \ '0 ti' 0 ® ( OE-kJ-3 c c o- , t -
3. Owner(s) name and address:
5. Surety:(Payment bond required by owner from contractor, if any)
Name and address:
Amount of bond $
6. Lender's name and address:
1? — 2 - 6 r■ t4'0 S • mtA(pA, S'HO 6
Interest in property:
Name and address of fee simple titleholder:
4. Contractor's name and address: r k \ \ K_000 6.
(0Sig a °
44 •
\
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided
by Section 713.13(1)(a)7., Florida Statutes,
Name and address: Y /3P
8. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in
Section 713.13(1)(b), Florida Statutes. g
Name and address: WOO(
O
9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a
different date is specified)
Signature of Owner V
Print Owners Name 1--f_ ( 77/- C cn,r . 1"
Sworn to and subscribe before me this) O ' day of e , ,1-9,0P;
. ;:� % ' JOSUE GAMAYO
.: �► Y COMMISSION4 CC '7495
Notary Public .�i► - ' --G� r�
,p .• • en ded Thru Notary ublic Underwriters
Print Notary's Name
My Commission Expires:
Prepared by:
Address:
123.01.52 2/93
PERMIT NO.
ADDRESS:
MIAMI SHORES VILLAGE
BUILDING / ZONING DEPARTMENT'
SECTION
BY
DATE 1
ZONING
ELECTRICAL
MECHANICAL
CRITIQUE SHEET
JOB ADDRESS /22 ‘ a` e / , s1
APPLICANT
PHONE I#
APPUCATtON #
SHEET OF x/
MISCELLANEOUS / v (/ P LY
#'
/We/MO Ai 0 r
PLUMBING
FIRE
PUBLIC WORKS
STRUCTURAL
BUILDING OFFICIAL
2. This copy of plans mutt be
biding site or no (nspectian wtil h
1. Sublet to CO ca pllanca with alt Federal, State.
County,Viliage rules end regulations. Village assumes
no responsibility for accuracy offor results from
these plans.
available on
e cortdocted.
DATE COMMENTS INITIALS
10980 BISCAYNE BLVD, MIAMI, FL 33161 Phone: 3059409666 Fax: 30594096966
Pro'ect Information
Outside db
Inside db
Design TD
Building heat loss
Ventilation air
Ventilation air loss
Design heat load
Space thermostat
For: KEITH CONKLIN
1226 NE 100 ST, MIAMI SHORES, FL 33168
Notes:
Desi • n Information
Winter Design Conditions
Heating Summary Sensible Cooling Equipment Load Sizing
Infiltration
RIGHT -J LOAD AND EQUIPMENT SUMMARY
Entire House
MIAMI KOOL INC
Weather: Miami Beach CO, FL, US
48 °F Outside db
70 °F Inside db
22 °F Design TD
Daily range
Relative humidity
Moisture difference
Summer Design Conditions
89 °F
75 °F
14 °F
50 %
56 glib
28985 Btuh Structure 31203 Btuh
0 cfm Ventilation 0 Btuh
0 Btuh Design temperature swing 3.0 °F
28985 Btuh Use mfg. data n
Rate /swing multiplier 0.94
Total sens. equip. load 29331 Btuh
Method Simplified Latent Cooling Equipment Load Sizing
Construction quality Average
Fireplaces 0 Internal gains 1380 Btuh
Ventilation 0 Btuh
Heating Cooling Infiltration 1691 Btuh
Area (ft 659 659 Total latent equip. load 3071 Btuh
Volume (ft 5272 5272
Air changes/hour 1.2 0.5 Total equipment load 32402 Btuh
Equiv. AVF (cfm) 106 44
Heating Equipment Summary Cooling Equipment Summary
Make Make LENNOX INDUST
Trade Trade ELITE 13
HS26- 048-2P 3P
CB29M -51 -1 P
Efficiency 80.0 AFUE Efficiency 12.0 SEER
Heating input 0 Btuh Sensible cooling 32900 Btuh
Heating output 0 Btuh Latent cooling 14100 Btuh
Heating temp rise 0 °F Total cooling 47000 Btuh
Actual heating fan 1669 cfm Actual cooling fan 1669 cfm
Heating air flow factor 0.058 cfm /Btuh Cooling air flow factor 0.053 cfm /Btuh
Load sensible heat ratio 91 %
Printout certified by ACCA to meet all requirements of Manual J 7th Ed.
Wraghtsc Right-Suite Residential^' 5.0.37 RSR28198 2001-Aug-23 14:08:42
Project2.rsr Page 1
•
10980 BISCAYNE BLVD, MIAMI, FL 33161 Phone: 3059409666 Fax 30594096966
RIGHT -J CALCULATION PROCEDURES A, B, C, D
Entire House
MIAMI KOOL INC
Procedure A - Winter Infiltration HTM Calculation*
1. Winter infiltration AVF
1.2 ach x 5272 ft x 0.0167 = 106 cfm
2. Winter infiltration Toad
1.1 x 106 cfm x 22 °F Winter TD = 2557 Btuh
3. Winter infiltration HTM
2557 Btuh / 140 ft Total window = 18.3 Btuh/ft
and door area
Procedure B - Summer Infiltration HTM Calculation
1. Summer infiltration AVF
0.5 ach x 5272 ft x 0.0167 = 44 cfm
2. Summer infiltration load
1.1 x44 cfm x 14 °F Summer TD =
3. Summer infiltration HTM
678 Btuh / 140 ft Total window =
and door area
678 Btuh
4.8 Btuh/ft
Procedure C - Latent Infiltration Gain
0.68 x 56 grllb moist.diff. x 44 cfm = 1691 Btuh
Procedure D - Equipment Sizing Loads
1. Sensible sizing Toad
Sensible ventilation Toad
1.1 x 0 cfm vent. x 14 °F Summer TD = 0 Btuh
Sensible load for structure (Line 19) + 31203 Btuh
Sum of ventilation and structure Toads = 31203 Btuh
Rating and temperature swing multiplier x 0.94
Equipment sizing Toad - sensible = 29331 Btuh
2. Latent sizing Toad
Latent ventilation Toad
0.68 x 0 cfm vent. x 56 gr/lb moist.diff. = 0 Btuh
Internal loads = 230 Btuh x 6 people + 1380 Btuh
Infiltration load from Procedure C + 1691 Btuh
Equipment sizing Toad - latent = 3071 Btuh
*Construction Quality is:
a
No. of Fireplaces is:
0
Printout certified by ACCA to meet all requirements of Manual J 7th Ed.
vv vghtsc ft Right-Suite Residential"' 5.0.37 RSR28198
AOCA Project2.rsr Page 1
2001- Aug -23 14:08:42
RIGHT -J WINDOW DATA
MIAMI KOOL INC
10980 BISCAYNE BLVD, MIAMI, FL 33161 Phone: 3059409666 Fax: 30594096966
W S D W G L S S ON AS 0 0 W C W S
N K I AL OT H V G N H V V H H N H
D Y R L A W R A H L GC R R G T A A
W L Z E M D G Z L 0 X Y T M R R
Room1
a n s a c n 0 n 0 1 90 1.0 0.0 0.0 4.0 43.2 24.0 0.0
a n n a c n 0 n 0 1 90 1.0 0.0 0.0 4.0 26.2 24.0 0.0
WALK IN CLOSET
BEDROOM 2
Rooms
BEDROOM 1
a n ea c n 0 n 01 90 1.0 0.0 0.0 4.0 84.2 12.0 0.0
BATH 1
a n ea c n 0 n 0 1 90 1.0 0.0 0.0 4.0 84.2 12.0 0.0
KITCHEN
a n ea c n 0 n0 1 90 1.0 0.0 0.0 4.0 84.2 12.0 0.0
DINNING
Room9
BATH 2
wnghtsoft Right-Suite Residential*" 5.0.37 RSR28198 2001-Aug-23 14:08:42
• Project2.rsr Page 1
I I- N17OI
NUAL.
Name of room
Length of exposed
Room dimensions
Ceilngs
Condit.
Option
Entire
8.0 ft
House
d
Room1
17.0
8.0 ft
co q,.w A
x 12.0 ft
1
WALK
4.0x
8.0 ft
IN
5.0 ft
1
BEDROOM
9.0
8.0 ft
2
20.0 ft
x 9.0 ft
heat/cool
TYPE OF
CST
iTM
Area
Area
Area
Load (Btuh)
EXPOSURE
NO.
Htg
CIg
(
(ftt)
Htg
Clg
(ft
ft')
Htg
Clg
5
Gross
11.2
NN
NN
ININ
INN
Nada
INN
N.
walls and
0'0 0..
0.0
7 0000
70
70000
NI.
*AN
70000
NIN
/11.1/
70000
INFN
N011e
0000C
1111
INN
6
Windows and
10.4
87
.....
"-
""
glass doors
""
Heating
01
Lf
0C
OC
oC
)0
0
0I
, 0I
....
0.r
""
0.(
""
7
Windows and
glass doors
l
c0 0 N t) N
N O. 0,-0
E O o O M 0
000000
0 00000
....
".'
000000
8
Other doors
a 10C
b
c
7.9
7.8
S00
i O O
r .
42
0 0
327
000
000
000
000
000
9
Net
11.2
141
10298
1167
exposed
0.0
0
0
WallS and
0
0.0
0
0
0
0
0
O
0
0
0
0
0
0
partitions
0.0
0
0
0
0
10
Ceilings
13.2
10.4
0.0
0.0
0
0.0
,.0
0
0
0
0
0
■
0
0
10
10
0.(
0.(
0.(
11
Floors
(Note: room
perimeter
is displ.
for slab
floors)
a 017 ow
00000
00000
00000
00000
00000
00000
00000
00000
00000
00000
00000
00000
00000
00000
00000
12
Infiltration a
18.3
4.8
140
2557
678
90
1644
436
0
0
0
0
0
0
13
Subtotal loss- 6+8..+
""
""
""
""
N*'
INN
Hr.
Less extemal heating
""
""
""
""
- ---
""
""
""
Less transfer
""
0
""
""
O
""
""
O
"'*
""
0
"•'
14
Duct loss
0%
""
0%
""
09(
""
09(
""
15
Total loss = 13+14
"'"
""
""
""'
""
""
""
""
16
Int gains: People @ 300
1800
""
1800
""
0 0 2R
•"..
0
ApPI. Ilit 1200
1200
""
1200
""
""
0
17
Subtot RSH gain=7+8.. +12 +16
31203
far.
11316
""
""
26
Less external cooling
0
""
o
""
""
o
Less transfer
0
""
o
""
""
o
18
Duct gain
0
""
0
""
""
0
19
Total RSH gain= (17+18)'PLF
31203
""
11316
""
""
2654
20
Air required (cfm)
1669
498
605
52
169
142
RIGHT-.I WORKSHEET
Entire House
MIAMI KOOL INC
10980 BISCAYNE BLVD, MIAMI, FL 33161 Phone: 3059405 30594096966
Printout certified by ACCA to meet all requirements of Manual J 7th Ed.
wrrag1 tsOft Right-Suite Residential^' 5.0.37 RSR28198
Project2.rsr
2001-Aug-23 14:08:42
Page 1
1- N M R l
IIIIAUMUAL. .
Name of room
Length of exposed
Room dimensions
Ceilngs
Condit.
Option
Room5
3.0x
8.0ft1
5.0 ft
BEDROOM
8.0
8.0
8.0 ft
)
x 9.0 ft
1
BATH
5.0a
8.0 ft
1
7.0 ft
1
KITCHEN
7.0
8.0 ft
18.0 ft
x 8.0 ft
heat/cool
TYPE OF
CST
HTM
Area
Area
Area
Area
Load (Btuh)
EXPOSURE
(ft
Rf)
(ft
ft')
Mg
Clg
5
__■.
Md.
1111..
..11.
..1.
11.11.
11.11.
....
.1..
0 1
0
O
10
0 1
1111..
01
....
...1
1111..
11..11
Md.
1111..
1111..
....
....
111
....
....
.1111
6
winnows and
10.4
Irk.
*H.
1111..
1111
glass doors
11111.
.1111.
Heating
0 10 O r
E Y ! i
0000
0000
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
1111..
0 0 0 0
0000
...•
7
Windows and
1111..
0
glass doors
....
0
Cooling
0
0
101
..1.
1010
11'11'
0
""
0
11'11'
0
8
Other doors
a 10C
7.9
7.8
111
109
b
0.0
0.0
0
0
0
0
0
0
0
0
0
0
0
0
c
0.0
0.0
0
0
9
Net
11.2
729
1324
exposed
0.0
0
0
walls and
u
0.0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
partitions
0.0
0
0
0
0
10
Ceilings
13.2
10.4
275
1321
0.0
0.0
0
0
0.0
0.0
0
0.0
0.0
0
c
0
c
C
C
c
I
I c
IC
I C
0.0
0.0
0
0.0
0.0
0
11
Floors
(Note: room
perimeter
is displ.
for slab
floors)
J2 0 0 0..
00000
00000
00000
00000
00000
00000
00000
0 0000
00000
00000
00000
00000
00000
00000
00000
X 00000
12
Infiltration a
18.3
4.8
0
0
0
12
219
58
12
219
58
26
475
126
13
Subtotal loss= 6+8..+
....
"'*
t1"
..1111
MOH
2822
...11
Less external heating
1111..
****
0
....
1111..
0
fff*
Less transfer
.1..
0
HHH*
..1.
0
1111..
HHH*
0
1111
1111..
0
11111
14
Duct loss
0%
0
*..*
0%
0
****
091
....
09E
0
""
15
Total loss =13+14
1111..
929
****
.11..
3017
****
****
**H*
.1111
2822
****
16
Int. gains: People @ 300
0
**'*
111111
1111.
00g000gs
M 1+1
Appl. @ 1200
0
H"'
....
1111
17
Subtot RSH gain= 7+8.. +12 +16
742
**H*
H*H*
....
Less extemal cooling
0
....
****
1.1.
Less transfer
0
****
C
Half
1.11
18
Dud gain
0
...1
1111..
1111..
19
Total RSH gain= (17 +18)HPLF
742
..1.
.1111.
****
20
Air required (dm)
40
174
113
162
R IGJ IT-J WORKS
nt►re ouse
MIAMI KOOL INC
10980 BISCAYNE BLVD, MIAMI, FL 33161 Phone: 305940 30594096966
Printout certified by ACCA to meet all requirements of Manual J 7th Ed.
Ark wr"sgI1t50ft Right -Suite Residential"' 5.0.37 RSR28198
Project2.rsr
2001- Aug -23 14:08:42
Page 2
_ c.1 R I
MANUAL J:
Name of room
h of exposed
Room dimensions
Ceilngs
wall
Condit.
Option
DINNING
7.0r
8.0 ft
22.0 ft
8.0 ft
1
10.0
8.0 ft
33.0 ft
r 10.0 ft
1
BATH
5.0
8.0 ft
2
4.0 ft
x 4.0 ft
heaticool
TYPE OF
CST
HTM
Area
Area
Area
Load (Btuh)
Area
EXPOSURE
ft
ft')
ft')
Htg
Clg
Htg
Clg
5
....
....
....
Exposed
a u - 00
j
00000
00000
00000
:...
00000
1tHit
H.
00000
....
....
....
111 11
6
■ i ndows and
10.4
111'
11'111
11.a
....
glass doors
....
....
Heating
1) '0 0.-
f f f f
0000
0000
0000
0000
0000
0000
1111111
....
7
Windows and
26.2
....
....
glass doors
0.0
aaa'
....
g
2
84.2
0
0
0
0
0
....
0
....
0.0
....
HI.
8
Other doors
a 1
b
c
000
000
000
000
000
000
000,
000
000
9
Net
11.2
1975
exposed
0.0
0
walls and
0
0.0
0
0
0
0
0
0
0
0
0
•
0
partitions
0.0
0
10
Ceilings
13.2
10.4
131
0.0
0.0
0
0.0
0.0
0
0
0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
0.0
11
Floors
(Note: room
perimeter
is displ.
for slab
floors)
auvo..-
00000
00oo0
00000
00000
00000
00000
00000
00000
00000
00000
00000
00000
00000
12
Infiltration s
18.3
4.8
0
0
0
0
0
0
0
0
13
Subtotalloss = 6+8..4
....
....
111"11
H.:
H..
Less external heating
111111
0
..1111'
....
....
fIn.
Less transfer
....
0
....
....
0
....
0
....
....
"'a
14
Duct loss
0%
0
....
0%
01*
....
%
''1111
15
Total loss = 13+14
1111
2762
11111111
111'11
....
1111111
....
11111111
16
Int. gains: People @ 300
0
....
0
ApPI. 411 1200
0
1111111
0
17
Subtot RSH gain = 7+8..+12+16
2311
! 11111
3761
1111111
Less external cooling
0
....
0
Ht.
Less transfer
0
....
0
0
1111111
18
Duct gain
0
' 11111
0
9b
19
Total RSH gain= (17 +18)*PLF
2311
111111
3761
20
Air required (cfm)
124
251
201
....
RIG}ITWORKSHEET
Entire House
MIAMI KOOL INC
10980 BISCAYNE BLVD, MIAMI, FL 33161 Phone: 305940. 30594096966
Printout certified by ACCA to meet all requirements of Manual J 7th Ed.
wrUgt'ft50ft Right-Suite Residential"' 5.0.37 RSR28198
Project2.rsr
2001 - Aug -23 14:08:42
Page 3
RETURN NR
THRU CLOSET --
DOOR
CL.3-1 11111011/..1
rttocli PUS.
n
a..a -i no ACT
alma.
CEILING STRUCTURE
SUPPLY ANR PLENUM
FLEX CCNNECTION
NR HANDLING UNIT
r
WALL STRUCTURE
AN I LINES
CONDENSATE DRA N
1111H TRAP
NEOPRENE PAO
RETURN AIR PLENUM
N17H 1 /4' ST
ANGLE FRAME
---- tveIcALnR ursr
BELOW MR HANDLING UNIT
NTS
KEJTH= CONNKLIN_. - - - -
1226 NETOO S
MIAMI SHORES FL 33168
MIAMI KOOL INC.
10880 BISCAYNE BLVD.
-� MIAMI FL, 33161
me Mil Ws&
1 CONDENSNG UNIT
2 COMPRESSOR - ACCESS PANEL
3 BACK - SEATED REFRIGERANT
4 REFRIGERANT SUCII I L
WTH INSULATION
5 SIGHT GLASS MTh MOISTURE
INDICATOR
6 REFRIGERANT LIQUID UNE'
7 CONDUIT - PONER AND
CONTROL
8 REFRIGERANT GAUGE
CONNECTION
9 CONDENSER COIL
10 COIL GUARD
11 FAN GUARD
12 CONCRETE PAD
IF REOUIRED
13 DRYER ( SHELL. &
CORE TYPE )
CAL .1.139 WIT fra TYCO. WIC . -
mar mr¢Ta1
VALVE
TTSCaa ast
T. aa+
W W
Mai" MO ACT
AIR - COOLED \ 4
-- - CONDENSING\ \
UNIT
SLAB-MOUNTED \
24
10 X 10
305 CFM
24
C/D
LIVING ROOM
17 X 12
24
1 X 1 0
300 CFM
LENNOX _
12.0 SEER
AM CS29M -61 -1 P
COND. HS26- 048-2P
SENSIBLE - COOLING - -- -
REF LINE:: 7/8 83/8
DRAIN LINE 3/4 PVC
HEATER 10 KW
SCALE 1/4 =1"
OXR
10 X
- - 142 CFM
DINNING ROOM
7X8
BEDROOM 2
24
201CFM
24
BEDROOM 3
10X10
10X8
8
32 CFM
1 CFM
BEDROOM 1
24
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building .L ...) /1 N S
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
❑ DATE/// e 7 19 4
❑ PERMIT
❑ N9 6400 contractor's Z / , � c--
❑ License No
❑ Work to be performed under this Permit_
Architect
Contractor
or Builder /fl av
Legal Lot
Description Bl
� >1 e t c ✓ 7
Address of
Building /2 c fCi/*
1 .c►
1;''2 /1 t
Value of r
Project $ .i e
k . /,
/ / //r
t
Subdi-
vision
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 apd that he assumes respon-
sibility for work done by his agents, servants or employees.
,/ r
Signed. C. I L -/ • ` ,.4-- .,--N INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compli ce with all ordinaa, acid regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper thorities of Miami Shores Village. In ao
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY
APPLICATION FOR BUILDING PERMIT
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 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.
Owner's Name and Address
Lgc.il /a al$
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done 1
State work to be done and purpose of building (by floors)__
Q A (.'. _AT 7o 4z ? and for no other purpose.
New Building Remodeling Addition _ Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
c
Estimated Total cost of improvements $____ `rte , Amount of Permit $ " ---
Zone cubage required .Plan Cubage
_Size of Building Lot
Distance to next nearest building
1 M c4.s w a i _`
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 are required by the Act. The undersigned agrees to employ only such subcontractors, on work be performed under this
permit, as are licensed by Miami Shores Village.
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
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.
Permit No C sC c
Date ' 'J
Disapproved_________ Date
(Signed)
MIAMI SHORES VILLAGE
Building Inspe
BUILDING INSPECTION DEPARTMENT
Date ` A 4 ) , 19 k
No._� L. _�a Street'- t 1 Q O �- y
N..e.
c i i -'1 ? ' 4.L
to me well known,
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
LANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved__ Date Disapproved
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval
the Planning Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice
materials and /or workmanship.
Date
has been obtained from
for inspection or faulty