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1270 NE 100 St (2)MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date 31 Time Type Insp'n 1 n n Permit No. A C 2a3 �` 2 Name ? / /''ree Address l Ross' Pt /bg sr Company Phone # ?OS. 7 r7 z, For Inspector: 3. /0,2 Name & Date Approved Correction Re- Insp'n Fee ❑ 7 J dZ- Page 2 IMPORTANT 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. DO 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. AFFIDAVIT - 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 governmental 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, 1" 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. STATF,OF FLORIDA, COUNTY OF MIAMI -DADE STATE O ORIDA, COUNTh OF MIAMI -DADE ignat a of Owner Signature o Contractof /Qualifier /te /l '7 ' S Print Name Print Name z! Sworn to and subscribed before me this 0 day of X002 SEAL: ignature of Notary / Pn�blic - State of Florida Signature of Notary Public - State of Florida Personally known `/R Type of Identification Produced: Type of Identification Produced: .............. • • • • norary . • • ri re OF • • noRau 3. _ • ,.•••••••• - SARA BROCKWELL COMMISSION • AC9e1642 EIDMES AUG 27 2004 WM= WWII ApiWdWr! NOON Sworn to and subscribed before me this day of SEAL: PERMIT APPLICATION Personally known OR, Produced Identification PROPERTY OWNER Name // 9 G-,/,, d9 �J j.e) A, Address /4 X/ e • ADD 51 /h. 4 , P1-- ;/ , Home Telephone ice - 03 Business Telephone .3,‘ � � 9 — �l3 /f Fax 1435 134 `- 4 CONTRACTOR New Construction Name `� ' Enclosure License No. C"' p c ,c-26-- / el Alteration Exterior Address / 0 % 1�'rei S 12 ; c; i) Inc; /c_c 1 I ��i�c� Telephone( yin2 5( Fa.) 11 �� Alteration Interior Qualifier NameJJ /J C. Demolish TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'l 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 trust 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. A PPLICA'I'ION J\ Job Address: ./" (" ' ° /e �t' fr7144 / Address Apt. City Folio Number /1- O'9 0ADescription of Work Lot Block Subdivision PB PG Current Use of Property Square Feet 44 , Units Floors Proposed Use of Property )(Value of Work ` X- Ut✓ N t 0 Bldg Value Tenant Information Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Chg. Contractor Renewal Revision Extension Supplement Reinspection PERMIT CHANGE (✓ ) ARCHITECT Name License No. Address Telephone Fax PERMIT APPLICATION Master Permit No. ' - • C ' 01.0 Subsidiary Permit No. _ ski ®e5 / ef State Zoning Linear Feet X ENGINEER Name License No. Address Telephone Fax ELECTRICAL TYI'1: Minimum Fee QTY TYPE; Dryer QTY TypE Outlet, Appliance QTY TYPE Service Repair QTY. A/C Central 1 -3 Ton Fan Mil Dryer Vents, Number of Outlet, Wall Ventilation, Cost Service, Temporary Air Handler, Tons A/C Central 4 -7 Ton Piping, Flammable Liquid Fire Pump Outlet, Switch Fire Sprinkler System Signs A/C Central 8 -15 Ton Bath Fan - Vented, # Fixture - Fluorescent - Pressure Vessel 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 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 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 Water Heater New MECHANICAL TYPE Minimum Fee QTY' TYPE Condensate Drain QTY TYPE Generator Q'I'1' TYI Refrigeration, Tons QTY. A/C Central, Tons 4 1 1 .E% , Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Mil Dryer Vents, Number of Paint Booth Ventilation, Cost Solar Water Heater Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System - Process/Pressure Piping Cap - Fixture Bath Fan - Vented, # Fireplaces, Number of - Pressure Vessel Pump and Abandon PLUMBING TYI'I', A/C Condensate QTY. TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture (in'. TYPE 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 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 Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank 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: Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi - family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) PI RN1I'I' 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 ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) $ 'r $ (sq.ft. = x/1000 x ¢.60) (0.005 /sq.ft.) (¢.01 /sq.ft.) REVIEWED AND PREPARED BY: SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ 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 Village of Miami Shores 10050 NE 2nd Avenue Miami Shores, FL 33138 Phone: 305 - 795 -2204 Printed: 2/25/2002 Applicant: CARLOS M DE Owner: OLIVEIRA Contractor ROSS AIR CONDITIONING Local Phone: 561 - 792 -5604 Parcel # 1132050090030 Job Address: 1270 NE 100 ST If there is no permit package accessible on the job -site for in fee is $50.00, which must be paid in advance before calling for This Permit is granted to the contractor or builder named above to construct the ordinances pertaining thereto and with the understanding that the work will be perfc and approved by the proper municipal authorities. This Permit may be revoked at authorization. A further condition upon which this permit is granted is the understa ordinances and regulations pertaining to the work covered hereby whether shown by his agents, servants or employees. Signed: &.7 Z- r 'v 2- (INSPECTOR) In consideration of the issuance to me of this permit, I agree to perform the wo with the plans, drawings, statements or specifications submitted to the proper at. myself, my agent, servants or employes. Signed: Mechanical Permit Permit Number: MC2002 -20 Address: Cellular: 5 OLIVEIRA CARLOS M DE 16996 NORRIS RD Legal Description: EARLETON SHORES PB 43 -80 LOT 3 Permit Status: Approved Permit Expiration: 8/24/2002 Construction Value: $3,000.00 Work: AIR CONDITIONING CHANGE OUT PAY TO THE ORDER HYACINTH THOMAS ROSS THOMAS 16096 NORRIS ROAD WEST PALM BEACH, FL 33470 //, 2 784 Congress, Avenue 3 ' -388 -7300 33481 Page 1 of 1 MEMO 1:26 ?0912501 :011 ?00273 (Contractor or Builder) _ . BLK 1 LOT SIZE 75.000 X 109 Total Fees: $0.00 Total Receipts: $0.00 Sterlin - BANK. +ions. Re- inspection 6 3 -91251 2670 011001 7002737 DATE 337 $ 14f /, v DOLLARS 8 ,�'� 02R 132542 2002 MAR 05 14:01 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. .�-,/ •.v I Iva vvtavtavicl\ltrC ii IVIt 1 1 PERMIT NO. `t L ' OOG . 9 TAX FOLIO NO. STATE OF FLORIDA: COUNTY OF DADE: 1. Legal description of property and street address: Wtd 1-320s co • do 3� 2. Description of improvement: ()( IAA t+, " 1 /('i 3. Owner(s) name and address: Cu 4,4 - ;,, ell ��. ,�„ f ■ l`�.�0 "0.C�. loth S/ ,1j.. sv' 'ioi c'S 3313& Interest in property: Name and address of fee simple titleholder: 4. Contractor's name and address: )21.-3•14 (l(€ 5. Surety:(Payment bond required by owner from contractor, if any) Name and address: Amount of bond $ 6. Lender's name and address: 211 kALsis■-flgaig-W■11 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: 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. Name and address: 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) / /e/ signature dl Owner My Commission Expires: 4 1 wonurr COAV ISSON # cC963642 s re o t'U $ N 327 2004 noarw ears DIouOH NNAMAGI NOSY Print Owners Name �vD / j /L/ i/r' //2- Sworn to and subscribed before me this 9re day of ' ,Z oD,2-- Notary Public A cl Print Notary's Name \c y ' , c / c U < < L Prepared by: STATE OF FLORIDA, COUNTY OF DADE 1 HERESY CERTIFY that this is a true copy of the Ongrno; Ned in this office on day of , A D 20 0r?" WITNESS my hand and Official Seal. ItARVEY RUVIN ' K •� c unt and County Courts by d D.C. Address: /[n. ( :6 wy" / et7 /� /C/ic,\ Page 2 INIPORTANT 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. DO 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. AFFIDAVIT - 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, 1" 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. STAT OF FLORIDA, COUNTY OF MIAMI -DADE K Signature of Owner 47015 ,?1 S7 TE of 1 • . oa Print Name Sworn to and subscribed before me thisdi day of X00 2_ ignature of Notary Pu4 c - State SEAL: Personally known uced Identi 'cation Type of Identification Produced: STATE ORTD , C:OY OF MIAMI - DADE � ac Signature of (.a • Print Name tor-LQualtht f Sworn to and subscribed before me this day of Signature of Notary Public - State of Florida SEAL: PERMIT APPLICATION Personally known OR, Produced Identification Type of Identification Produced: CONTRACTOR _ ,, Name ° ` r, c- License No. / r/ c ) ^C '7, - / C ` Add /C.(yC /(' /'T "/S (!</J 4 OtGia/C.h ee) // ,�sV"l c) Telephone( C /)si , Er Qualifier Name /4,1, z PROPERTY OWNER Name p , /� eel/Z2.-.04/Z.— j di f1 /✓ /4/ Qi Address /, A /, E- . /d0 7 Home Telephone G ./^ 76'4 + ei q /� `/ ij Business Telephone O � 9 , i , i1 f Fax / - .?4 1 - # 1 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. K Job Address: P d / v e /2 C /97/7 I / _ ;3/S' Address Lot Block Subdivision, Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other PB PG Apt. Folio Number /1""__::2 7 t/' g ._ Pi 0. VDescription of Work :',t v' 6,-6/;(1,47 e' r C : 'J Current Use of Property Square Feet Units Floors '3 • � Bldg Value Proposed Use of Property Value of Work g PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Master Permit No. Subsidiary Permit No. City Zoning vi PERMIT APPLICATION a State Zip Linear Feet Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. TYPE. Outlet, Appliance QTY. TYPE Service Repair QTY. A/C Central 1 -3 Ton Fan Dryer Vents, Number of Outlet, Wall Ventilation, Cost Service, Temporary Air Handler, Tons A/C Central 4 -7 Ton ✓ Fire Pump Outlet, Switch Fire Sprinkler System Signs A/C Central 8 -15 Ton Bath Fan - Vented, # Fixture - Fluorescent Pressure Vessel 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 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 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 Water Heater New MECHANICAL TYPE Minimum Fee QTY. TYPE Condensate Drain QTY. TYPE Generator QTY. TYPE 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 Solar Water Heater Air Handler, Tons Ductwork, Cost of - Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Cap - Fixture Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Pump and Abandon PLUMBING TYPE. A/C Condensate QTY. TYPE Drains, Roof QTY. TYPE. Miscellaneous Fixture QTY. TYPE 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 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 Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank 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 ?- -�3Ft Mechanical (� ?, Z t • ��. Plumbing r Fire Public Works Structural Building Official Page 4 OFFICE USE ONLY CHECKLIST L 1 OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi - family) ❑ CONCURRENCY (New Construction) ❑ 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 $ 0 “? $ 0 (sq.ft. = x/1000 x ¢.60) (¢.005 / sq.ft.) (¢.01 /sq.ft.) TOTAL REVIEWED AND PREPARED BY: PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) $ 417 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 Village of Miami Shores 10050 NE 2nd Avenue Miami Shores, FL 33138 Phone: 305 - 795 -2204 Printed: 2/28/02 Applicant: CARLOS M DE Owner: OLIVEIRA Contractor ROSS AIR CONDITIONING Address: 16996 NORRIS RD Local Phone: 561 792 - 5604 Cellular: Parcel # 1132050090030 Job Address: 1270 NE 100 ST Permit Status: Approved Permit Expiration: 8/24/02 Work: AIR CONDITIONING CHANGE OUT This Permit is granted to the contractor or builder named above to construct the ordinances pertaining thereto and with the understanding that the work will be pert and approved by the proper municipal authorities. This Permit may be revoked at authorization. A further condition upon which this permit is granted is the underst2 ordinances and regulations pertaining to the work covered hereby whether shown by his agents, servants or employees. Signed: (INSPECTOR) In consideration of the issuance to me of this permit, I agree to perform the worts with the plans, drawings, statements or specifications submitted to the proper autt myself, my agent, servants or employes. Signed: (Contractor of Electrical Permit Permit Number: EL2002 -64 Legal Description: EARLETON SHORES PB 43 -80 LOT 3 Fees: FEE2002 -1256 FEE2002 -1258 FEE2002 -1262 Description Amount Building Permit Application Fe$60.00 Notary Fee $5.00 CCF $1.80 Total Fees: $66.80 Total Fees: $66.80 Total Receipts: $0.00 If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection fee is $50.00, which must be paid in advance before calling for another inspection. OLIVEIRA CARLOS M DE Construction Value: $3,000.00 Sterlin BANK. 2764 Congress Avenue Pat 55481 5 - 588 -7500 a PAY TO THE ORDE MEMO HYACINTH THOMAS ROSS THOMAS 16096 NORRIS ROAD WEST PALM BEACH, FL 33470 . 7 l4- e 1 :26709 L 2501:0 L LOO L 70 273 Page 1 of 1 vi c" BLK 1 LOT SIZE 75.000 X 109 63 -91251 2670 0110017002737 DATE 0.0t- • DOLLARS IJ 337 1 $ i•��,. Yoalry a Oct Ose. SW c 4,69 j 1 tk.F VA °11149 1 010 ° 410 1: S OL43 0 163 0.0 4 614 0 1 C651 04G ‘ 01 0P. . 0. St 04 OA 0 14 gr.:(31 STATE OF FLORIDA, COUNTY OF DADE. j ss. Disapproved 7 /,.. Date_( (Signed) 11�s_1. But ding Inspect MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT. APPLICATION FOR BUILDING PERMIT Application is hereby wade for the approval of the detailed statement of the plans and specifications herewith submitted for the build - ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida. and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. Date ..6.:7.7.- ...._._.._._.......__ ._._....__. ,1971 Oµvner s Name and Address ....1914..• 917' I. — No. .I ?Z.Q...._. Str e E /Q.Q... Registered Architect and /or Engineer ._.... L_Ld. -.,... Name and address of licensed contractor. .S.�.�l l� R`1 _ P/l /OP /11._ & . ,__. / D1 V CO 1 7.S' _ , r _ . _,__,._„ Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done ... .7.. ®_// L 10_0 - s7.... Stat w•t k to be done and purpose of building (by floors) yv e and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $.P fo &1O Amount of Permit $.. Zone cubage required .Plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work t. . performed under this pennit, as are licensed by Miami Shores Village. / Remarks (Signed) " /ice , r e 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 forgoing application, and that he did sign the same, and that all facts therein by him stated are tru Permit No.. C Date �._ �L � Read, Sworn to and Subscribed before me. to me well known, Notary Public, State of Florida My Commission Expires PLANNING BOARD _.._ DATE Chairman Member Member Member Member ...... _..--•- -.._._._...-- .-_ -.. Member Council Approved Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re inspection fee of 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. • eiZe /e-'7 7)2 e 1 - 7 &15) - 7-1 „2-6 /6e-e /; 1 - HE Cow S- c s /lc( . 9; MI 7, e. Al& /®e) -4i `j J RAYMOND O. CHRYST PRESIDENT AIR CONDITIONING CO. .1301 N.W. 175th Terrace Miami, Florida 33169 Phone: 621-4347 / 7' -a1 ' -' / 70 Al& /ac 4z - _e.ee 3)(3.x' 476 /a C 6 7e7-e-) 0 � e 1,14 <., r