868 NE 100 St (4)Signa ure o
Date:
APPROVED:
/li /ter
er and /o
Notary as to Owner and
My Commission Expires:
** * *
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address 16 , la Tax Folio / / -30W- D - -qo
Legal Description
c
/ Lessee / Tenant / /, � ii� ' 7, ! Master Permit 1f -5t:R=.2>
Owner's Address Y' L / y / S Phone / 02 -;? , / /
Contracting Co. CSW • i ?d V- a. Add ress 3 g° 2 5 "
/ ) ; AV
� Y ' r
Qualifier di*/ mil' i A S ;‘ - / Phone g V7 ig
State # O /3?2 Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address.
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING r CRANK P ROOFING PAVING FENCE SIG
Zoning
Mechanical
ondo President
*
WORK DESCRIPTION 3 Y:.) 'i ' c cerna ea/7 7
Alt *gar � w % ffl k, w. ° geett 0/4/
Square Ft. Estimated Cost(value
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO D
SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEN
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOU
NOTICE OF COMMENCEMENT).
Application is hereby made to obtain a permit to do work and installation as indicated above, ar
on the attached addendum (if applicable). I certify that all work will be performed to meet th
standards of all laws regulating construction in this jurisdiction. - understand that separat
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFIN an• MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information i. acc ate =n• tha all work wi]
be done in compliance with all applicable laws regulating cons r tion and , o ng, Furthermore,
authorize the above -named contractor to do the work stated.
FEES: PERMIT 4'4 RADON C.C.F.
Plumbing_
•
� r as to Contrat
ie
y Commission Expires:
r Owner- Builder
der
* * * * * * * **
NOTARY TOTAL DUE0
Fire Other
Building Electrical
Engineering
3
NOTICE OF COMMENCEMENT .
PERMIT NO. TAX FOLIO NO. 30 e 62 e 2 02 .0.
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.
gg / /w 7
1. Legal description of property and street address:
2. Description of improvement:
3. Owner(s) name and address:
Section 713.13(1)(b), Florida Statutes.
Name and address: .
Notary Public
- Print Notary's Name
My Commission Expires:
4 a7eovad
54i dey %; yes
Interest in property:
Name and address of fee simple titleholder:
4. Contractor's name and address:
Sears Roebuck & Co.
20701 So. Allapattah Drive Miami, FL 33189 (305) 378- 4692/378 46 75 / 378 -4696
5. Surety:(Payment bond required by owner from contractor, if any)
S OF FLORIDA; COUNTY OF DADE v",n COU
Name and address:
Amount of bond $
6. Lender's name and address:
uaew:v o ,d
7. Persons within the State of Florida designated by Owrie?
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
different date is specified)
o i
Signature of - owner
Print Owners Name � 0 L
Sworn to and subscribed before me thi a day of
fr
,19 _
94-. IR 4739e 1 1994 OCT 07 14:05
ea 4/.4 74
33/34
t o.c.
r *es or other document e�sy'd as provic
9. Expiration•date of this Notice of Commencement: (the expiration dat 1 year from the date of recording unless
a
. isnael Rams
preparPrf hy• RPnrS Pr 1nirk
20701 So. Allapattah Drive
Address: Miami. FL 33IR9
ITEM
BATH TUB
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS
CENTRAL HEATING /o k.t',
(
DISHWASHER
RECEPTACLES
A/C (WIND)
DISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL) /j/ /D 1
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 TOP
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 If
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
HEATER - REPLACE
GENERATORS TRANSFORMERS
LAWN SPRINKLER -WELL
SPECIAL PURPOSE
•
SWIIJ ING POOL
OUTLETS COMMERCIAL
WATER SERVICE
SIGN TUBES
SEWER CONNECTIONS
SIGN TRANSFORMERS
UTILITY -SEWER
SIGN TIME CLOCK
UTILITY -WATER
.
FIXTURES
SEPTIC TANK
ANTENNA
•
1ELAY
TELEVISION OUTLETS
)RAINFIELD, 4" TILE/RES.
VIOLATION
AN S ABANDON SEPTIC TANK
REINSPECTION
SOAKAGE PIT CU. FT.
;ATCH. BASIN
)ISCHARGE WELL
)OMESTIC WELL
AEA DRAIN
100F INLET
;OLAR WATER HEATER
ARE STANDPIPE
00L PIPING
.AWN SPRINKLER SYSTEM
;AS RANGE
1ETER SET (GAS)
;AS PIPING
- ADDENDUM_TO BUILDING PERMIT APPLICATION
(AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEEN
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
MECHANICAL
ELECTRICAL
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
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 m with, whether herein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Date — 3 v ...._._.........._ 19? 1
Owner's Name and Address ..... - -. -- ----- -._.._ No 15 4?..�t...... Street.—tJ.l,....LQQ.. 'C
Re Architect and /or Engineer
Name and address of licensed contractor .Q?jw..tade .
Location and legal description of lot to be built on:
.o Block Subdivision.
Street and Number where work is to be done "b
4 rla nett, k to be done and purpose of building (by floors) 4.0115 rq.&-r- q .._. — .. .. � 2..
ss.tct lLK
New Building Remodeling Addition
To be constructed of Kind of foundation _..._..._.._ R
Estimated Total cost of improvements $_ 2 .__.___ __.._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
be sent to_ —_ -.
STATE OF FLORIDA,
COUNTY OF DADE. f ss
Date_
Disapproved (4,)/(-
(Signed)
Building Inspector
Remarks__.___ (Signed)
PL if INC BOARD DATE
Chairman
Member
Member Member
'' •J
Read, Sworn to and Subscribed before me.
and for no other purpose.
Repairs No. of Stories
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
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 in . . on on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subco • act , on k to be performed under this
permit, as are licensed by Miami Shores Village.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared - - _ _ - - - -- - - -- -
t o 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.
Permit No. — (a ____- - - - - -- Date
Notary Public, State of Florida
My Commission Expires
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 nppmval 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 or faulty
materials and /or workmanship.