1235 NE 100 StMiami Shores Village
Building Department
BUILDING
PERMIT APPLICATION
FBC 2001
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Permit No. H X63 -- ` 1
Master Permit No. 'B? Z aj" BSO
Permit Type (circle): Buildin DE Mechanical Roofing
Own er's Name (Fee Simple Titleholder) 0 U tS D 7 o ,PI Phone # 3 Or --'75 9
Owner's Address / Z 3 r Li • E • / D O /
, ' n d ft F State 7 L - Zip
City Al r a 2 3 0 T - '7 5' /— `J G r / If
Phone #
Tenant/Lessee essee Name ,U L
Job Address (where the work is being done)
City Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES
NO �/
. .5A(. 1 s 6 elec(1 / rh
Contractor's Company Name ±
Contractor's Address 36 q) -S' - °
State Zip
City_ tom—"- ----. � /y 0- `'`��'v •
Qualifier (---------D __ 0 0-'0
Architect /Engineer's Name (if applicable) 11 a r' ou 6 - /V rd Q at S c/ LfRllohe # �
Architect/Engineer's Address S 7 4"5" `I' `�`' j
N L-
City -- f I-/ u Pcii 04 ZI c� State P- L' Zip
$ Value of Work For this Permit
County Escrow Fee $
Education/Training Fee $_
Code Enforcement $
Minus Plans Check Fee $
Phone APT! 443 `6 0 g
/3 4
Square Footage Of Work:
Number of: Bays Stories
Families Bedrooms Baths
❑ ['New ❑ Repair/Replace ❑ Demolition
Type of Work: ['Addition alteration
Describe Work: P-) ) 2 /c C
* * * * * * * * * * * * * * * * * * * * * * * * * * * Fee * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Permit Fee $ 4c:'t ee' Notary $
Tech $ Scanning $
Bond $ Strict. $
Total Fee Now Due $
Radon $
(/
a e. l2�
Co
i11l�
(Continued on opposite side)
eC. � 2SS "PGia
Bonding Company's Name (if applicable)
Bonding Company's Address
City
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
Signature
State
State
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
As identification and who did take aona oath.
NOTARY PUBLIC:
Sign:
Tint:
Ay Commission Expires:
PPLICATION APPROVED BY:
:717/03
Zip
Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify
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 ELE that no work or installation has
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, E CAL WORK, PLUMBING, SIGNS,
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance wi th all
applicable laws regulating construction and zoning.
mP
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN Y OUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE
COMMENCEMENT." O OF F
Notice to Applicant: As a condition to the issuance of a of posted notice, the
buildin g 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
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence o such p
inspection will not be approved and a reinspection fee will be charged. job site
Signatures
Contractor
The foregoing instrument was acknowledged before me this I Z
day of A t . S 20 c3 , by ?
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY P
Sign:
Print:
My
(Certificate of Competency Holder) * * * * * * **
tate Certificate or Registration No.
Certificate of Competency No.
******************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Plans Examiner
Engineer
Zoning
ITEM
BATH TUB
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS
CENTRAL HEATING
DISHWASHER
RECEPTACLES
A/C (WINO)
DISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN AMPS
DUCT WORK
FLOOR DRAIN
SERVICE REPAIR/METER CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TCP
UNDERGROUND TANKS
LAVATORY
OVEN
ABOVE GROUND TANKS
LAUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
MOTORS 0- 1 HP
STEAM BOILERS
SHOWER
MOTORS OVER 1- 3 HP
HOT WATER BOILERS
SINK, POT /3 COMP.
MOTORS OVER 3- 5 HP
MECHANICAL VENTILATION
SINK, RESIDENCE
MOTORS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTORS OVER 8- 10 HP
ELEVATORS/ESCALATORS
TEMPORARY WATER CLOSET
MOTORS OVER 10- 25 HP
FIRE SPRINKLER SYSTEMS
URINAL
MOTORS OVER 25-100 HP
COOLING TOWERS
WATER CLOSET
MOTORS OVER 100 HP
VIOLATION
INDIRECT WASTES ..
A/C WINDOW
REINSPECTION
WATER SUPPLY TO:
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
SWIMMING POOL
OUTLETS COMMERCIAL
WATER SERVICE
SIGN TUBES
SEWER CONNECTIONS
SIGN TRANSFORMERS
UTILITY -SEWER
SIGN TIME CLOCK
UTILITY -WATER
FIXTURES
SEPTIC TANK
ANTENNA
RELAY
TELEVISION OUTLETS
DRAINFIELD, 4' TILE/RES.
VIOLATION
PUMP & ABANDON SEPTIC TANK
REINSPECTION
SOAKAGE PIT CU. FT. • ..
Si lmYh1N6 Pool, (.14tAJ1C}
CATCH BASIN
PIooL PVVUI f •
DISCHARGE WELL
DOMESTIC WELL
AREA DRAIN
ROOF INLET
SOLAR WATER HEATER
FIRE STANDPIPE
POOL PIPING
LAWN SPRINKLER SYSTEM
GAS RANGE
METER SET (GAS)
GAS PIPING
ADDENDUM TO BUILDING PERMIT APPLICATION
(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
C
MECHANICAL
MIAMI SHOES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Permit No / €2 Date
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 'y�)
Owner's Name and Address No 1 r .3 Je . N E Street I. e')
STATE OF FLORIDA, 1
COUNTY OF DADE. I �''
Amount of Permit $ ® (Signed)
(Signed)
to administer oaths and take
i
Registered Architect and /or En eer �an -
Employing Electrician's Name...` S3k� C No .....).2 .o Street C
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Service Overhead Amps
Size Feeders Conduit Main Sw Amps Main Fuses Am
Underground p p
Type of Installation — Conduit Tubing B.X.L .Metal Moulding
Electrical 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 complied with the provisions thereof, and will require similar compliance from all ntractors or sub-contractors employed by him in the
work to be performed under this permit; and will post or cause to be posted for inspec ono the site the work such public notice or notices
as are required by the Act. The undersigned agrees to employ only such sub•contracto , nor to b performed under this permit, as are
licensed by Miami Shores Village.
Master Electrician.
Before me, the undersigned authority, a notary public, duly authorized
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, and he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
acknowledgments, personally
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.
SWITCH
OUTLETS
LIGHT
OUTLETS
PLUG
RECE'P'T'S
FIXTURES
NO. LAMPS
REFRIG.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. H EAT.
CONN.
SPACE
HEATER
STRIP
HEATER
TOTAL
CONTR.
LIST
/0
) 0
0 /
/N
)
/96
CHECK
ENT.
SW.
DIET.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
vJ E f C
` I
MOTORS
0.1 HP
/
MOTORS
1.5 HP
/
N EON
TRANS.
RADIO
TOTAL
q,00
CONTR.
LIST
A /pD
CHECK
M 77 PS'
I
MIAMI SHOES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Permit No / €2 Date
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 'y�)
Owner's Name and Address No 1 r .3 Je . N E Street I. e')
STATE OF FLORIDA, 1
COUNTY OF DADE. I �''
Amount of Permit $ ® (Signed)
(Signed)
to administer oaths and take
i
Registered Architect and /or En eer �an -
Employing Electrician's Name...` S3k� C No .....).2 .o Street C
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Service Overhead Amps
Size Feeders Conduit Main Sw Amps Main Fuses Am
Underground p p
Type of Installation — Conduit Tubing B.X.L .Metal Moulding
Electrical 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 complied with the provisions thereof, and will require similar compliance from all ntractors or sub-contractors employed by him in the
work to be performed under this permit; and will post or cause to be posted for inspec ono the site the work such public notice or notices
as are required by the Act. The undersigned agrees to employ only such sub•contracto , nor to b performed under this permit, as are
licensed by Miami Shores Village.
Master Electrician.
Before me, the undersigned authority, a notary public, duly authorized
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, and he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
acknowledgments, personally
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.
Permit No
Amount of Permit $
-2,
STATE OF FLORIDA, 1
COUNTY OF DADE. 11
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address L/ ... . No /2 ... Street / �s
Registered Architect and /or Engineer
Employing Electrician's Name.. NO. .. 2 C Street
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps
Underground p P
Type of Installation— Conduit Tubing B.X.L Metal Moulding
The undersigned applicant for this building permit does hereby certify that he understands and accepts Is ' bligations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of o ' a Permanent Supplement, and
has complied with the provisions thereof, and will require similar compliance from all contractors or b•oontractors employed by him in the
work to be performed under this permit; and will post or cause to be posted for inspectio n the sit • work such public notice or notices
as are required by the Act. The undersigned agrees to employ only such sub-contractors, on v4Ork donned under this permit, as are
licensed by Miami Shores Village. II'I t
ss.
(Signed)
(Signed)
Date
a
Electrical Inspector.
M. ter Electrician.
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, and 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.
SWITCH
OUTLETS
LIGHT
OUTLETS
PLUG
RECE'P'T'S
FIXTURES
NO. LAMPS
REFRIO.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
H EATER
W. H EAT.
CONN.
SPACE
HEATER
STRIP
HEATER
TOTAL
CONTR.
LIST
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1.5 HP
N EON
TRANS.
RADIO
TOTAL
CONTR.
LIST
CHECK
Permit No
Amount of Permit $
-2,
STATE OF FLORIDA, 1
COUNTY OF DADE. 11
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address L/ ... . No /2 ... Street / �s
Registered Architect and /or Engineer
Employing Electrician's Name.. NO. .. 2 C Street
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps
Underground p P
Type of Installation— Conduit Tubing B.X.L Metal Moulding
The undersigned applicant for this building permit does hereby certify that he understands and accepts Is ' bligations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of o ' a Permanent Supplement, and
has complied with the provisions thereof, and will require similar compliance from all contractors or b•oontractors employed by him in the
work to be performed under this permit; and will post or cause to be posted for inspectio n the sit • work such public notice or notices
as are required by the Act. The undersigned agrees to employ only such sub-contractors, on v4Ork donned under this permit, as are
licensed by Miami Shores Village. II'I t
ss.
(Signed)
(Signed)
Date
a
Electrical Inspector.
M. ter Electrician.
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, and 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.