131 NE 101 St (12)•
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 7 /g.4- U0 Job Address 1 , 3 / 1 0 / 1 - Tax Folio
' 'Deli r
Legal Description /Cot L
/,�g� .lt,'b �'� ��,8�'G `Histo�cally g�na�ed: es � e ° No
Owner/Lessee / Tenant ,16. r Da ,/ / Master Permit # ! 4- ! 3 8 )
Owners A d d r e s s f 4 7 W i 6 / 4 1 . )e . g3 / ,4 / Phone ?r:3 " 75/-e7//
Contracting Co. �a N s o ele.Gtri-r'c.q / Address 3 9 9S -5. w t f -- /�'L th 33/34.
Qualifier ED tti(u. v C) LA_ /A Phone 4-42 - 8 80 8
State # ao/ `,.5 Municipal #
Architect/Engineer ;_ma (f a ( /eh/ 7 i1 Address
WORK DESCRIPTION / 7 7 -o /2-1
up xp es: MARY MORENO
2 i ' N t i 0 COMMISSION NUMBER
✓ ? !j�! Q CC606964
O
9> FL� � MY C COMMISSION EXPIRES
EAL
2
z
Signs of owner
Notary as
My Comr
FEES: PERMIT CC RADON
APPROVED:
Zoning
Mechanical
d/or Condo President
7
7
Date
Date
00
00
C.C.F.
NOTARY
Building Building Electrical
Competency # 94E DOQOS4 Co.
Bonding Company Address a T S5
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
Square Ft. Estimated Cost (value)
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 permit 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 the work stated.
744.4a
Date
Notary
My Co
Y SEAL
Ion xpre MARY MORENO
114 i1 ' n COMMISSION NUMBER
+ �'lll' - C
�!F ' • "` j MY COW P/MSION EXPIRES
�F FLC t1 102° )0
BOND
TOTAL DUE
2
2. /O-o
Date
Plumbing Structural Engineer
It is understood that the temporary - electrical approval by the Miami Shores Village, Building & Zoning Department
given in connection with the building being constructed under: /
Building Permit No. 4 //
/ 0 `7^ 0 Electrical Permit No. V 4 93
/ 31 �l /p
O gy
1 S_F
for owners: /(/)1616 � �' a ✓ / r c_
at address:
is being given only for construction purposes or for testing the following installations b / ing made in said structure:
l 3 / Ne 70/ or _5
Sub - paragraph 4501.3 (d) (3) of the South Florida Building Code provides for a 30 day maximum approval only in an
URGENT NECESSITY for electric current exists. Necessity shall include the use of current for irrigation, security,
humidity control, emergency power and lighting, such as for testing or construction purposes, provided the Electrical
Contractor and owner do hereby agree to assume the responsibility of maintaining the installation in such a manner that
there is no hazard to life and property.
Such approval is in no event to be considered a release of said structure for purposes of use and occupancy, and no
occupancy shall be granted or permitted until final inspections have been called for and approved by the inspection
divisions concerned, and an occupancy permit obtained.
The undersigned also understand that the temporary- electric approval is subject to rescission and cancellation, and
electric power can be cut off at the discretion of the Building and Zoning Department and will be disconnected if the
building concerned is occupied before final inspections are approved and occupancy permit obtained.
, being first duly sworn,
depose and that I am the owner of the above described property, and that I agree that the structure covered in this
agreement shall not be occupied until the building contractor has ob • .• inspections.
i
I_i,
/SIGNAfCi
Page I of
NOTE: ELECTRIC SERVICE WILL BE DISCONNECTED "WITHOUT NOTICE"
UPON 30 DAY TERMINATION UNLESS APPLICATION IS RENEWED
Sworn and subscribed before me this / S
day of .fi , g000
Notary Public, State of Florida at Large
My Commission Expires:
jZiiuuL Ito -Wyk ),,,ila
BUILDING AND ZONING DEPARTMENT
10050 N.E. SECOND AVENUE
MIAMI SHORES. FLORIDA 33138 -2382
TELEPHONE (305) 795-2204
FAX (305) 756-8972
AFFIDAVIT FOR 30 DAY TEMPORARY- ELECTRIC SERVICE
(To be executed by Owner and/or Tenant, Building & Electrical Contractor)
It -:
(' ?A MO►mEl
P TV p'& S tA
~ �j G ( 1 s m ARGARI
coNlassoN HUMBER
li Cc797
4 " G CO
MY , ,H assZON2
1 r FOF F �O Q DEC. 17
F OWNER
LIC
iii DAY TEMPORARY- ELECTRIC SERVICE (continue)
I, A /. 14 `2-G //24
depose and say that I am the Electrical Contractor for the above
now existing will not create a safety hazard if temporary- service
Sworn and subscribed before me this Z 4-
day of S ,R D
Notary Public, Sta of Florida at Large
My commission expires:
1,
depose and said that I am the Building Contractor of the above described
of this building until final division obtained and that I have the au
concerned to prohibit occupancy until such final inspections a > stained.
Sworn and subscribed before me this a s
day of
ow
Notary i blic, : to of Florida at Large
My Commission Expires:
" " "% Jennie L. Mathias
%Commission # CC 799181
Expires MAR. 16, 2003
BONDED THRU
ATLANTIC I#QNQINfi F,Q„ INC.
SIGNATURE OF ELECTRICAL LtiSPECTOR
Dale:
Page 2 of 2
, being first duly sworn,
described property and that the electrical installations as
is connected.
II 1.' a .1•
Release to FLORIDA POWER & LIGITT CO.
bw ( name)
Date::
SIGNAI
It., O ' OTARYAR f i C
it
u,, ? Q CC606964
�� i c `• �� MY COWk14;3SION EXPIRES
OF r\.0 UEC. 10,2000
O !� MARY MORENO
COMMISSION NUMBER
*
To: (name)
- CTRICAL CONTRACTOR
, being first duly sworn,
that I will not permit occupancy
insofar as the o • er of said property is
ATURE OF BUILDING CONTRACTOR
NATURE OF NOTARY PUBLIC
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Tax Folio
Date 9b ChM' Job Address l 3 / / G 10
Legal Description QQ Historically Designated: Yes No
Owner/Lessee / Tenan" , pit/ /.4e , Gf -"L Master Permit # y7,1 gs"
Owner's Address Phone
Contracting Co. ....
)s o— 1 Q- '--' C04 / ® 2 — Address 3 7 9 S S • (,e) 4 -ZG
Qualifier 4L6 (,LA 17- 61t,t- .-t'sv Phone 77‘ / /
State # 14 RS / Municipal # Competency # e ° 66 Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELEC TRICAL PL BING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
/ /
-tm � ��
Signs of owner and/or Condo President Date
FEES: PERMIT D RADON
Square Ft. Estimated Cost (value)
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 permit 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 the work stated.
Notary as to Owner and/or Condo President Date No
My Commission Expires: My
C.C.FD P NOTARY
Signature of C , >ror Owner- Builder
Electri
OFF
Date
EdL
• for 4G1
, ,;:�,. 4E 1rC COMPASSION NUMBER
9 I' CC606964
�l ` e n F F` 0 9- MY COMMISSION 0 00 E S -
7i
Date
APPROVED:
Zoning Building
Mechanical Plumbing Structural Engineer
S'
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
CENTRAL HEATING
A/C (WIND)
.
A/C (CENTRAL)
DUCT WORK
REFRIGERATION
PROCESS AND PRESS PIPING
UNDERGROUND TANKS
ABOVE GROUND TANKS
U.F. PRESSURE VESSELS
STEAM BOILERS
HOT WATER BOILERS
MECHANICAL VENTILATION
TRANSPORTING ASSEMBLIES
ELEVATORS/ESCALATORS
FIRE SPRINKLER
SYSTEMS
COOLING TOWERS
VIOLATION
REINSPECTION
•
ir
Auutivuum i u bUILUINV PERMIT APPLICAI TUN
(AN"APPLICATION FOR BUILDING PERMIT RUST ACCOMPANY THIS ADDENDUM. IF A RASTER PERMIT HAS B.
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS,)
PLUMBING
3ATH TLB
310ET
)IShWASHER
IIS?OSAL
:RINKING FOUNTAIN
'LOCK DRAIN
:REASE TRAP
NTERCEPTCR
.AVATCRY
AUNDRY TRAY
LOTHES WASHER
HOWER
INK, POT /3 COW.
INK, RESIOENCE
INK, SLOP
EbPORARY WATER CLOSET
RINAL
ATER CLOSET
MOIRECT WASTES
ATER SUPPLY TO:
A/C UNIT
FIRE SPRINKLER
HEATER -NEW INST.
HEATER - REPLACE
LAWN SPRINKLER —WELL
SWIWI11G P00L
WATER SERVICE
:WER CONNECTIONS
I L I TY- SE'IIER
ILITY -WATER
PTIC TANK
LAY
AINFIELO, 4' TILE/RES. _
SP & ABANDON SEPTIC TANK
AKAGE PIT CU. FT.
fcH BASIN
RCIARGE WELL
ESTIC WELL
:A DRAIN
)F INLET
.AR WATER HEATER
E STANDPIPE
I PIPING
N SPRINKLER SYSTEM
RANGE
ER SET (GAS)
PIPING
ELECTRICAL
UNIT FEE
ITEM
ITEM
SW 1 TCH CURETS •
LIGHT CURETS
RECEPTACLES
SERVICE TEMPORARY
SERVICE SIZE IN AMPS
SERVICE REPAIR/f,ETER•CHANGE
APPLIANCE CURETS
RANGE TCP
OVEN
WATER HEATER
MOTORS 0- 1 HP
MOTORS OVER 1 - 3 HP
MOTORS OVER 3- 5 HP
MOTORS OVER 5- 8 HP
MOTORS OVER 8- 10 HP
MOTORS OVER 10- 25 PP
MOTORS OVER 25-100 HP
MOTORS OVER 100 FP
A/C WINDOW
AIR CONDITIONERS
STRIP HEATER
GENERATORS TRANSFORMERS
GENERATORS TRANSFORMERS
GENERATORS TRANSFCRMERS
SPECIAL PURPOSE
OUTLETS COMMERCIAL
SIGN TUBES
SIGN TRANSFORMERS
SIGN TIME CLOCK
FIXTLRES
ANTENNA
TELEVISION CUTLETS
VIOLATION
RE INSPECTION
./ L
MECHANICAL
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date e//4-177 Job Address 13 / b 101 s Tax Folio
' Legal Description Historically Designated: es�i 75_ No
Owner/Lessee / Tenant Mast r Pe #
Owner's Address D lit/ + •Q / 4 r 0 en- Phone
Contracting Co. �rlw a N 61 c �� 1 Address 3°11 S - 4 � R3312
Qualifier 4-o ""\-- ss# Phone 443 -88o8
Competency # 9.r�D0054 Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor
Permit Type (circle one): BUILDING LECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION v .
state # OO /481
Municipal #
Address
---0 a 02(.4 -tee -ri e-t_.
Square Ft. Estimated Cost (value)
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 permit to do work and installation as indicated above, and on the attached addendum (if applicable). I
1, 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 the work stated.
Signature of dwner and/or Condo President Date
Notary as to Owner and/or Condo President Date Notary
My Commission Expires: My Co
FEES: PERMIT ' RADON
• s
wner- Builder
P RY P� FICIAL NOTARY SEAL
k O <� MARY MORENO
i COMMISSION NUMBER
. At. . : c aw5rM Q - .65 EXPIRES
• ? . x� es: DEC. 10,2000
Signatur
C.C.F. NOTARY
BOND
r
TOTAL DUE
//4 r?
Date
‘/ ¢l;
Date
APPROVED:
Zoning
Mechanical Plumbing Engineering
Building Electrical �✓�rZ".
ITEM!
BATH TIC
UNIT
FEE
ITE]d
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS
CENTRAL HEATING
DISHWASHER
RECEPTACLES
A/C (WIND)
O(SPOSAL
SERVICE TEMPORARY
1
A/C ()
DRINKING FOUNTAIN
SERVICE SIZE IN A6PS
DUCT WORK
FLOOR DRAIN
SERVICE REPAHOETER OIANGE
REFRIGERATION
GREASE TRAP
APPLIANCE CUTLETS
PROCESS Ala PRESS PIPING
INTERCEPTOR
RANGE TOP
UNDERGROIRO TANKS
LAVATORY
OVEN
ABOVE MOO TANKS
LAUNDRY TRAY
WATER HEATER
U.F. PRESSL4RE 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
MOTORS OVER 25-100 HP
FIRE SPRINKLER SYSTDS
COOLING TOWERS
URINAL
WATER CLOSET
MOTORS OVER 100 HP
VIOLATION
INDIRECT WASTES
A/C WINDOW
, REINSPECTICN
WATER SUPPLY TO:
AIR CONDITIONERS
A/C UNIT
STRIP HEATER
.
FIRE SPRINKLER
GENERATORS TRANSFORMERS
HEATER -NEW INST.
GENERATORS TRANSFORMERS
HEATER - REPLACE
GENERATORS TRANSFORMERS
LAWN SPRINKLER -WELL
SPECIAL PURPOSE
SWIMMING POOL
OUTLETS COISERCIAL
WATER SERVICE
SIGN TUBES
_
SEWER CONNECTIONS
SIGN TRANSFORMERS
_ _
UTILITY-SEWER
SIGN TIME CLOCX
UTILITY -WATER
FIXTURES
SEPTIC TANK
ANTENNA
RELAY
TELEVISION OUTLETS
DRAINFIELO, 4' TILE/RES.
VIOLATION
PUMP & ABANDON SEPTIC TANK
REINSPECTION
SOAKAGE PIT CU. FT.
CATCH BASIN
_
0 I SCHARGE WELL
DOMESTIC WELL
AREA CRAIN
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
ELECTRICAL
MECHANICAL
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
41 1 14 (q Job Address 131 h - I k
Legal Description Historically Designated: Yes No
,1 -/5?7-S) Ef
Date
Tax Folio
Owner/Lessee / TenantX D f= re-- \ J P----t l Master Permit #
Owner's Address 13 t ( t n PhonA Zi - l2_7-1-
AL-A 1ZP'1-, Om per.s n # \ 1'1. 1 t, C (j-Z-4--7
Contracting Co.)( AtZ-*!e4==.:. r a[" r" Address
Qualifier r PP LL- - P g(NZP- SS# ( Phony L n t - 7 t <
State # c�6 C� � 8 Municipal #
Architect/Engineer
Bonding Company
Mortgagor
WORK DESCRIPTION
OWNER'S AFFIDAVIT: I certify that all the foregoing information is acc
iltrr ature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMI (3"2 RADON
C.C.F.
Competency #
Address
Address
Address
-at 0e),
Ins. Co.
Permit Type (circle one): BUILDIN ELECTRICA PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
n / at CZCZ -C- S �
Square Ft. Estimated Cost (value
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 permit 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.
!:�r•Stfi.. t
ork will be done in compliance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the above to do the wor stated.
r or .Owner- Builder Date
Notary as to Contractor or Owner- Builder
My Commission Expires:
iaY,.Py Leopoldo de la Hoz
MY COMMISSION # CC709293 EXPIRES
�'; ":; May 18, 2002
• SANDED THRU TROY FAIN INSURANCE, INC
Date
(
NOTARY - TOTAL DUE l0
APPROVED:
Zoning Building Electricak�i�cr� // / .J /
Mechanical
Plumbing Engineering
ITEM
BATH 11.8
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS
CENTRAL HEATING
DISHWASHER
RECEPTACLES
A/C (WIND)
DISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN ALPS
DUCT WORK
FLOOR ORAIN
SERVICE REPAIR/METER CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TOP
UN OINO TANKS
LAVATORY
OVEN
ABOVE %MIN) TANKS
LAUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
MOTORS 0- 1 if
STEAM BOILERS
SHOWER
MOTORS OVER 1- 3 1f
HOT WATER BOILERS
SINK, POT /3 COMP.
MDTCRS OVER 3- 5 If
MECHANICAL VENTILATION
SINK, RESIDENCE
MOTORS OVER 5- 8 If
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTORS OVER 8- 10 If
ELEVATORS/ESCALATORS
TEMPORARY WATER CLOSET
MOTORS OVER 10- 25 If
FIRE SPRINKLER SYSTEMS
UR INAL
MOTORS OVER 25-100 IP
COOLING TOWERS
WATER CLOSET
MOTORS OVER 100 If
VIOLATION
I
INDIRECT WASTES
A/C WINDOW
RE INSPECTION
WATER SUPPLY T0:
AIR CONDITIONERS
-
A/C UNIT
STRIP HEATER
FIRE SPRINKLER
_
GENERATORS TRANS
-
•
HEATER -NEW INST.
GENERATORS TRANSFORMERS
HEATER - REPLACE
GENERATORS TRANSFOR6¢RS
.
AWN SPRINKLER -WELL
SPECIAL PURPOSE
SW I 44 I NG POOL
OUTLETS COM RC UAL
WATER SERVICE
•
SI TUBES
SEWER CONNECTIONS
SIGN TRAUSFORERS
UTILITY -SEWER
1
SIGN T(ME CLOCK
UTILITY -WATER
F IXTLRES
SEPT IC TANK
ANTENNA
RELAY
-
TELEVISION OUTLETS
ORAINFIELD, 4' TILE/RES.
VIOLATION
PUMP & ABANDON SEPTIC TANK
RE INSPECT I
SOAKAGE P IT W. FT.
•r RCrrr z S' f - r i cn•
CATCH BASIN
/ nr
\JaLurr, C_cn'T x
1�
.
rIj.I\
D ISCHARGE YELL
S i 11-137-* Z. cal L ;1,1
DOMESTIC WELL
y7,5Z s y- p —
AREA GRAIN
ROOF INLET
===
SOLAR WATER HEATER
✓/
FIRE STANDPIPE
_
4(..e
POOL PIPING
LAWN SPRINKLER SYSTEM
GAS RANGE
METER SET (GAS)
GAS PIPING
PLUMBING
ADDENDUM TO BUILDING PERMIT APPLICATION
(AN APPLICATION FOR BUILDING PERMIT MUST ACCOHPANT THIS ADDENDUM. IF A MASTER PERMIT HAS B.
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
ELECTRICAL
MECHANICAL
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 6/14- t 1 5 Job Address /3 Me: /6 / S - Tax Folio
Legal Description ' Historically Designated: Yes No
6 Owner/Lessee / Tenant X p /' Y\- Master Permit # p p 7s-)99,3Y
�/ ^� / Phone
Contracting Co. S
�.. �(R-s't %c.� 1' ^ p- Z. Address 319 s S. c,U ¢`)? M.r Q f" 3 30 4-
1 4-
Qualifier (.% AA. to Quo o . SS# , Phone 4-4-3-8806
(dos) cl> C7331
State # EYZ 0 014. e Sl Municipal # Competency # 7 6 d000s¢ Ins. Co.
Owner's Address
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING LECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
((x,a
Square Ft. Estimated Cost (value)
s-54-0 _
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 permit 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 the work stated.
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date Notary as to contra
My Commission Expires: My Commission Expires:
FEES: PERMIT % 3g. RADON
APPROVED:
Zoning
Mechanical
Building Electrical
or or owner- rsuuaer
C.C.F. 61' A - NOTARY BOND
Plumbing Engineering
ITEM
(AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B.
OBTAINED, THE OWNERS NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
BATH 1113
BIDET
0 I S1- WASHER
D► 4SAL
DRINKING FOUNTAIN
FLOOR ORAIN
GREASE TRAP
INTERCEPTOR
LAVATORY
LAUNDRY TRAY
CLOTHES WASHER
SHOWER
SINK , POT /3 COMP .
SINK, RESIDENCE
S INK, SLOP
TEMPORARY WATER CLOSET
URINAL
WATER CLOSET
f ND I RECT NASTES
WATER SLPPLY TO:
A/C UNIT
FIRE SPRINKLER
HEATER -NEW INST.
HEATER - REPLACE
LAWN SPRINKLER -WELL
SWIWAING POOL
WATER SERVICE
SEWER CONNECTIONS
rTILITY -SEWER
IT IL I TY-WATER
;CPT IC TANK
IELAY
RA 4 TILE/RES.
U P & ABANDON SEPTIC TANK
OAKAGE P CU. FT.
ATCH BAS
ISO-LARGE WELL
NEST IC ELL
;EA GRA
)OF INLET
)LAR WATER HEATER
IRE STANDPIPE
101 PIPING
iWN `PRINXLER SYSTEM
S RARE
TER SET (GAS)
S PIPING
ADDENDUM TO BUILDING PERMIT APPLICATION
ELECTRICAL
MECHANICAL
UNIT
FEE
ITEM
SW I MI OUTLETS
UNIT
X®
LIa T OUTLETS 3 0 01 p
RECEPTACLES
.50
SERV ICE TEMPORARY
A/C (CENTRAL)
SERVICE SIZE IN AMPS sot A , // 2.f cU T WORK
SERVICE REPAIRA€TER CHANGE
REFRIGERATION
APPLIANCE CUTLETS
RANGE TCP
OVEN
WATER NEATER
MOTORS 0- i if
MOTORS OVER 1- 3 If
MITCRS OVER 3- 5 FP
MOTORS OVER 5- 8 If
MOTORS OVER B- 10 FP
MOTORS OVER 10- 25 if
!TORS OVER 25-100 FP
MOTORS OVER 100 If
A/C WINDOW
AIR CONDITIONERS firaN ervcr+ 3 40,6
3 p �
STRIP HEATER
GENERATORS TRANSFORtRS
GENERATORS TRANSFORMERS
GENERATORS TRANSFORMERS
SPECIAL RIME
OUTLETS C01tf.RCIAL
SI REES
S I GN TRANSFORMERS
SIGN TIME CLDCX
FIXTLRES
ANTENNA
TELEVISION CUTLETS
VIOLATION
RE INSPECT ION
/
FEE ITEM
SPAN HEATERS
4'3 CENTRAL !VATING
>J A/C (MIND)
PROCESS AND PRESS PIPING
/ 4%.e UNJER(ROIRo TANKS
ABOVE GROIN TANKS
1 3;13' U.F. PRESSLRE VESSELS
STEAM BOILERS
i
10T WATER BOILERS
MECHANICAL VENTILATION
TRANSPORT I NG ASSEk8L1 ES
ELEVATORS/ESCALATORS
FIRE SPRINKLER SYSTEh1S
COOLING TOWERS
VIOLATION
REINSPECTICN
I
UNIT
FEE
•
D
Owner of i }
Building DC‘
kA Architect
W it Contractor �^1� (°
or Builder Ell 1 et PI CO ` ��hsr(^ oat on
CONTRACTOR or BUILDER
MIAMI SHORES VILLAGE, FLORIDA 19q9 Date (O
BUILDING
ELECTRICAL ❑
PLUMBING 0 PERMIT N_ 44875
R00FIN6 ❑
Work to be performed under this Permit E re ct house .
2 .STo r» � r r} 31 e_____Fct c
Subdi-
vision
Sq. Ft.:
Value of Q
Project $ 00
Contractor's
License No.
[� Legal Lot
4,J 1 Description BI.
Address of 13 1 M 1_ 1 0 I Sire el
Building
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 berefor 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 thoroufb 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 employe s.
J1 ' 9
Signed (INSPECTOR) BY
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
pertainin thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting )b ? v,rmh I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY
Permit:
CCF:
- 7 1 r (�
Notary: f' 0
Bond: 3 Q 0 .—cam
Radon: LI- 4 . o 9
Amount of
Permit: