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490 NE 101 St (4)HOLD HARMLESS Miami Shores Village Building and Zoning Department Miami Shores, Fl 33138 RE: Property located at (address and legal description) 0 Date 7 Itelos Gentlemen: As legal owner of subject property, I request the cancellation of permit number- OPZooti issued to fyi E1-/2-1' _ 14- ■PJ r c) m , for the following reason: l 3 o '1 I Date of last inspection: I hereby apply as owner- builder, or authorize (new contractor) to apply for such permits as necessary to construct or complete the construction on subject property. I agree to hold Miami Shores Village, its agents and authorized;personnel harrnless and relieve them from any responsibility or liability for any legal action or damage, cost" or expense (including attorney's fee) resulting from the cancellation of the existing permit or the issuance of a new permit. I furthermore assume responsibility for the correction, if required, of work performed under the permit for which I am requesting cancellation. Very truly yours, ignature) / in (00 / (print name) Notary Public, State of Florida at Large Prime contractor (only if subcontractor holds permit or if change of qualifier). (signature) (print name) STATE OF FLORIDA COUNTY OF DADE: The undersigned, being the first duly sworn, deposes and says that he /she is the legal owner of the above property. Sworn to and subscribed before me this I $ day of Ii MONICA USSErN DIAZ EXPIRES: October 20 2 Bonded Thru Notary Publb Underwriters R. D ix, oDS 6 Ear /" ■ A I n MIN peg IN MIMI 0 o : ments Passed Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled until re- inspection fee is paid . r Inspection Date: 07/26/2006 Inspector: Levrack, James Owner: NEUWEILER, THEODORE Job Address: 275 94 Street NE Miami Shores Village, FL 33138- Project: <NONE> Contractor: TECO PEOPLES GAS SYSTEM Building Department Comments Tuesday, July 25, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 JUL 2 8 REC'D Block: Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Gas Phone Number (305)754 -0200 Parcel Number 1132060133830 Lot: Phone: (305)957 -3857 Page 2 of 2 Miami Shores Village N . Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 IS 1 23) C7(. Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING 1 COVED PLO ' — i 10 ermit No. PERMIT APPLICATION R 2 Vaster Permit No. FBC 2001 1V Permit Type (circle): Building Electrical Plumbing Mechanical Roofing Owner's Name (Fee Simple Titleholder) City ,A/\ 141 State Owner's Address Zip7� Tenant/Lessee Name Phone # 30,f d �/ - / o U Job Address (where the work is being done) City Miami Shores Village Is Building Historically Designated YES Contractor's Company Name Contractor's Address I S 7 C am ✓ Cit ArA State Qualifier Total Fee Now Due $ (Continued on opposite side) Architect/Engineer's Name (if applicable) County Miami -Dade Phone # Phone # Zip 1 Zip 3 llv 2, State Certificate or Registration No. Certificate of Competency No. & < 0 p Phone # t va�ue�4E! q4i ?For this Permit' qu re batrage ( f Work: ` i '1 v.i11 +f , 41i1 Nl 1^ ikkKn tV OW- NMI. r ITS 5 e2,111,...4.. .� �tx ! �!!C SMawrrp�� fi � yp $ '' " 'QAddition �Alter�a$tion iew w; LI Repair/Replace Demolition j ,, r , ..,,M (Z I7 v 1AV C 7S ' ( ( . , � /t4 /v Loot o oV q if s1< (7i\) +he �v t) IR `vt� . a c1/v s e a k) c C P t" A vi ****************************F Submittal Fee $ Permit Fee $ /rt�'� C CCF $ CO /CC Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ Zoning Bond $ Code Enforcement $ Structural Plan Review. $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zi Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC 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. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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." Notice to Applicant.- As a condition to the issuance of a building 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 job site for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged Signature 0 or Agent The foregoing instrument was acknowledged before me this of J' " day „ v lJ ,20 by 'Te© Nevwes 1-e^ , who is personally known to m- :r who has produced NOTA PUBLIC: Sign: Print: My Commi sion Expires: Chc 05/13/03 LUIS MONTERO Notary Panic - Stale d Fbdde • My Commission Expires Feb 2, 2010 ? '' Bonded By National Notary Assn. ***** * * * * * * * * * * * * * * * * * * * * * * * * * * * * *s* s ** APPLICATION APPROVED BY: 1 4 th. Signature who is personally NOTARY PUBLIC Sign: Print: " Contractor The foregoing instrument was acknowledged before me this t7 a day of /VMC G _I , 20(9 , by S U C V.26" 1 as id My Commission Expires: to me or who has produced ri£rtinn aati v tan .oath LUIS MONTERO ?+ : Notary Publl - Stale 01 Fl dde • y Commission Expires Feb 2, 2010 OF ''' Bonded By National Notary Alin. * * * ' e * ** * ** * ** * ** * ** * ** * ** * * ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** r C 6 Plans Examiner Engineer Zoning ATLAS: M4 SCALE: NTS DRAWN BY: LM CONSRUCTION NOTES: NE 94 STREET 6 PROPOSED RISER (275) N,R/W SIDEWALK SWALE GRASS E.O.P E.O.P ► I SWALE GRASS SIDEWALK N, R/W 1. ALL CAS PIPELINE CONSTRUCTION TO FOLLOW TECO PEOPLES CAS STANDARDS. 2. TRAFFIC CONTROL SHOULD BE MAINTAINED AND COORDINATED WITH THE APPRORIATE GOVERNMENTAL AGENCY. 3. ALL DISTRUBED ASPHALT /CONCRETE /SOD AREAS TO BE RESTORED TO PRIOR CONDITION, UNLESS OTHERWISE SPECIFIED. TECO • • • • • • • • • • • • • • • • • • ••• • • • ••• •. •• • • • • •• •• • • • • • • • • • • • • • • • • • • • • • • • ••• • • • • • • • • • • • • • • • • • • • • • •.. • • • • • • ••• PEc 1=' LE AS NEW 1/2" PLASTIC GAS SERVICE 275 NE 94 STREET. MIAMI SHORES •• • •• • • • • • 48 HOURS BEFORE DIGGING CALL SUNSHINE 1- 800 -432 -4770 DATE: 3/11/06 SHEET: 1/1 JO' 13279 Issue Date: 3/22/2006 Owner's Name: THEODORE NEUWEILER Permit Type: Plumbing - Residential Work Classification: Gas Job Address: 275 94 Street NE Additional Information Miami Shores Village, FL 33138- Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Expires: 03/20/2007 Contractor(s) Phone TECO PEOPLES GAS SYSTEM (305)957 -3857 Primary Contractor Yes Comments: NEW 1/2" PLASTIC GAS SERVICE FROM GAS MAIN LOCATED ON NE 94 ST ON THE SOUTH RAN RUN SERVICE # 275 NE 94 Type of Work: GAS LINE Additional Info: Classification: Residential Type of Piping: 1/2" PLASTIC Bond Return : 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 pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. Parcel #: Block: Section: Permit Status: APPROVED Permit Number: PL -3 -06 -720 Phone: (305)754 -0200 1132060133830 Lot: PB: Total Square Feet: 0 Total Valuation: $ 600.00 Required Inspections Press Test ROW Final Fees Due CCF Education Surcharge Permit Fee - Additions /Alterations Scanning Fee Technology Fee Total: Amount $0.60 $0.20 $160.00 $3.00 $4.00 $167.80 Invoice Number PL -3 -06 -24198 Total: Amt Due $167.80 MAR 2 9 PAID Amt Paid t, Building Department File Copy Applicant Signature NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date I'it r0 0 i Type Insp'n 'L Permit No. 7J- alaa 7 - �J Name J d'e- Address '�j y a Alt /a/ ' 4 Company Phone # r 303 Inspection Date / 0/ 0/ Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date • q • ds Type Insp'n YD�� Permit No. Name \' 1 \ Address LO O� `0 t Company Phone # Inspection Date Approved Correction Re- Insp'n Fee BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Owner's Name (Fee Simple i e old9r) //V Owner's Address City , ' it.orCS Tenant/Lessee Name Job Address (where the work is being done) City Miami Shores Village Is Building Historically Designated YES State Certificate or Registration No. $ Value of Work For this Permit Notary $ Scanning $ Radon $ Total Fee Now Due $ (Continued on opposite side) Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Electrical Phone # q6 Zip .( (J ,(_A--(4 3 OO K (U/ X57' State P7 x (50 UC lol County Miami -D de Zip NO Contractor's Company Name Contractor's Address City State Qualifier Certific Type of Work: ❑Addition ['Alteration ii ew Describe Work: —I 4 - i k. ) CoG+- Training/Education Fee $ Zoning Permit No. B • /. 0 Master Permit No. Plumbing Mechanical Roofing Phone # mi Phone # Zip ompetency No. 33l 3 X Architect/Engineer's Name (if applicable) Phone # Square Footage Of Work: (� .. * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ —' C)- Permit Fee $ ❑ Repair/Replace ❑ Demolition CCF $ CO /CC Technology Fee $ Bond $ Code Enforcement $ Structural Plan Review. $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City / -W cc if7' State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC 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. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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." Notice to Applicant: As a condition to the issuance of a building 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 job site for the first inspection which occurs seven (7) days -a • + e building permit is issued. In the absence of such posted notice, the inspection will not be approved an eij i fee w e charged. Signature Owner or Agent 2 j � The foregoing instrument was acknowledged before me this 3 v day of Chc 05/13/03 SEPT- , 20 0L( by (\A MC_ &DOM who is personally known to me or who has produced '4 NOTARY Sign: Print: \{, l My Commission Expires: APPLICATION APPROVED BY: As identification and who did take an oath. AtTe2. i0 (octc&DV ic. s* VIkkh ie, f Altgg � mi ion Signature Contractor 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 an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: a: - Expires: Aug 13, 2007 +ig ies Bonded Thru Plans Examiner Engineer Zoning PERMIT NO. ADDRESS: MIAMI SHORES VILLAGE BUILDING/ZONING DEPARTMEM SECTION BY DATE ZONING • ELECTRICAL MECHANICAL PLUMBING FIRE PUBLIC WORKS • STRUCTURAL BUILDING OFFICIAL 1. Subject to compliance with aft Federat Sta. County. Village lutes cad regulations. VH1age essuce no responsibility for accuracy offor resutts fri these plans. 2. Thls copy of plans must be available building cite or no inspection edit be conducts CRITIQUE SHEET .JOB ADDRESS _ (7 Me. /0/ 57 APPLICANT Loon PHONE# APPLICATION uG t O LL :.SHEET •OF MISCELLANEOUS M,:)0,1L / oK DATE Zan% COMMENTS INITIALS (o l y/ oy D enc rs (N 57 Yiffeo 5 & 4 c� T re. i , "lee - 4COU yv A, � bJ ? per o f' (c L/CE HE/6/17° GI Ai . E 1 0 2_ 5C75 Ar P 5 Bill To MARK BLOOM 490 NE 101 ST. MIAMI SHORES, FL 33138 Return to: Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Date Fee Name 07/18/2006 Renewal /Extension Fee Tuesday, July 18, 2006 Invoice Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Fee Type Calculated Total Fees Due: Invoice Number: imp -7 -06 -25608 Invoice Date: July 18, 2006 Permit Number: BP2004 -1311 Fee Amount Payments Date Pay Type Check Number Amount Paid Change 07/18/2006 Credit Card $60.00 $0.00 Total Paid: $60.00 Total Due: $0.00 1 $60.00 $60.00 Bill To None None Return to: Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Date Tuesday, July 18, 2006 Fee Name 07/18/2006 Renewal /Extension Fee Invoice Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Invoice Number: imp -7 -06 -25609 Invoice Date: July 18, 2006 Permit Number: PL2004 -348 Fee Type Calculated Total Fees Due: Fee Amount $175.00 $175.00 Payments Date Pay Type Check Number Amount Paid Change 07/18/2006 Credit Card $175.00 $0.00 Total Paid: $175.00 Total Due: $0.00 II REC DEC 1 0 2094 BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Electrical Owner's Name (Fee Simple Titleholder) jt.3- S p Owner's Address 17 1 c 1 54- Cr City / v1 $t.wrC 5 State F( $ Value of Work For this Permit tf' // ,200 00 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 zip 33(3 Permit No. VI (X 3u Master Permit No. Phone # Mechanical Roofing Tenant/Lessee Name Phone # Job Address (where the work is being done) Li °" vO- F ! City Miami Shores Village County Miami -D de Zip 3313 Is Building Historically Designated YES NO // _ Contractor's Company Name /v � A� � ✓r//� Nam 4, / �ti Phone # f4 ‘tSZ ".?e Contractor's Address f.-0/V.C /./E /6 "4(e City NOr7 J M / Lei% ,' // State Zip Y 2 Qualifier F/ / f (�/� /t// / la ce State Certificate or Registration No. I IC 0 y 7c 9Z Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # Square Footage Of Work: Type of Work: ❑Addition ❑Alteration ❑New ❑ Repair/ eplace Demolition Describe Work: Ltt1 C��j ie.,"1- w' kilo 7 � l iauK 1 IA) 1 A� e U ; Al F'Ai , 1 / 0 6 ► , _ `+ e - • (mil1.•esc_ Submittal F e $ C Permit Fee $ I CCF $ / ` CO /CC Notary $ l •C Training/Education ee $ 0 f' O Technology Fee $ Scanning $ Radon $ Zoning Bond $ Code Enforcement $ Structural Plan Review. $ Total Fee Now Due $ /36/ (Continued on opposite side) Bonding Company's Name (if applicable) Bonding Company's Address City State Zip • • Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a pennit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a pennit 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC 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. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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." Notice to Applicant: As a condition to the issuance of a building 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 job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approv, :. : spection,ee will be charged. Signature Chc 05/13/03 Owner or Agent The fore oing instrument was acknowledged before me this day of L° , 20 t, by MARX S. ,LtO , who is personally known to me or who has produced "'" As identification and who did take an oath. NOTARYrPU,BLIC: Sign: Print: M tC l_ , • 41/40 at O My Commission Expires: YP *** * * * * * * * * * * * * * * * * * * * * *�F'� „ +R c�4 tit s APPLICATION APPROVED BY: Commission #DD240917 Expires: Au_ 3, 2 **** Ati Signature Co( ractor The foregoing instrument was acknowledged before me this 9 day of ,4e'eem 6.,✓ , 20 e , by ei/Gvi d .7 Geldae� who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: , P nc. .4 ,. y Commission Expires: m -1 (11.,/ Of R Ines Monl�o My Commission =MID p **************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Engineer Zoning ITEM BATH TLB 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 A6PS 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 If STEAM BOILERS SHOWER 1 MOTORS OVER 1- 3 FP HOT WATER BOILERS S INK, POT /3 COMP. MOTORS 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 F IRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 If COOLING TOWERS WATER CLOSET ( MOTORS OVER 100 If VIOLATION INDIRECT WAS -TES- A/C WINDOW RE INSPECT ION 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 SWIAIING 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 REINSPECT ION SOAKAGE PIT CU. FT. CATCH BASI DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) 1 GAS PIPING 1 i ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATIQN4OR 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 Plumbing Permit Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Permit Number: PL2004 -348 Printed: 12 /13/2004 ,' Applicant: MARK BLOOM Owner: BLOOM MARK JOB ADDRESS: 490 NE 101 ST Contractor MARLIN PLUMBING OF MIAMI INC Contractor's Address: 20145 NE 16 PL Local Phone: 305 - 652 -6108 Parcel # 1132060170430 Legal Description: 6 53 42 i Page 1 of 1 PB 15 -14 AMD PL OF MIAMI SHORES SEC 4 LOT 1 BLK 90 Fees: Description Amount FEE2004 -12513 Building Fee $175.00 FEE2004 -12514 CCF $1.20 FEE2004 -12515 Training and Education Fee $0.40 FEE2004 -12516 Technology Fee $4.38 FEE2004 -12517 Submittal Fee ($50.00) Total Fees: $130.98 Total Fees: $130.98 Total Receipts: $0.00 Permit Status: APPROVED Permit Expiration: 6/8/2005 Construction Value: $1,200.00 Work: CHANGE OLD TOILET WITH NEW OILET CHANGE OUT SINK WITH NEW SINK MOVING EXISTING SHOWER OVER TO Signed: (INSPECTOR) 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 pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: Inspection Number: INSP -23275 Permit Number: PL2004 -348 Inspection Date: 07/26/2006 Inspector: Levrack, James Owner: BLOOM, MARK Job Address: 490 101 Street NE Project: <NONE> Miami Shores Village, FL JUL 2 8 RECD Contractor: MARLIN PLUMBING OF MIAMI INC Buildiina Department Comments Wednesday, July 26, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Block: Permit Type: Imported Permit Inspection Type: Final Work Classification: <NONE> Phone Number 786/253 -7552 Parcel Number 1132060170430 Lot: Phone: 305 - 652 -6108 Page 1 of 2 • D • Ins •e i. r Comments Passed �j �I Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled until re- inspection fee is paid. Inspection Number: INSP -23275 Permit Number: PL2004 -348 Inspection Date: 07/26/2006 Inspector: Levrack, James Owner: BLOOM, MARK Job Address: 490 101 Street NE Project: <NONE> Miami Shores Village, FL JUL 2 8 RECD Contractor: MARLIN PLUMBING OF MIAMI INC Buildiina Department Comments Wednesday, July 26, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Block: Permit Type: Imported Permit Inspection Type: Final Work Classification: <NONE> Phone Number 786/253 -7552 Parcel Number 1132060170430 Lot: Phone: 305 - 652 -6108 Page 1 of 2 Permit No CO - 3 3 Owner's Name and Address__ f/- Amount of Permit $ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING - e. s / e, State work to be performed and purpose of building (By Floors)_____ N B Remodeling_____ ___ Addition_ Size Septic Tank Feet of Drain Tile____ Nature of Water Supply: City —Well ( Signed) 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. No.___ _ Z _ 6 4 /____ Street_ / Ol Registered Architect and /or _ �) Employing Plumber's Name !� nn _.� o off _ S s P Q s' /V /(- i e_ �_ Q sT No. -_�c d. cAJ Street. -_s1 Location and Legal Description Lot_ Block.___ __ ____.______ ! /Subdivision L Street and Number where work is to be performed —No V g Street..- 0 / 'tic Repairs No. of Stories Type of Tank____ Capacity Gals _Dist. Feet of Tank or Drain Field from Well _ __Size of Soakage Pit 3 1: Pe Plumbing 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 leas com- plied 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 tlie Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. ' i (. ( Signed Master umber. STATE OF FLORIDA, f 58. COUNTY OF DADE. 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, 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. My Commission Expires Notary Public, State Of 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. CLOSETS BATH TUBE SHOWERS LAVA. TORIES INKS SINKS SLOP SINKS LAUNDRY Tues U RINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM•G POOL Comic LIST CHECK Permit No CO - 3 3 Owner's Name and Address__ f/- Amount of Permit $ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING - e. s / e, State work to be performed and purpose of building (By Floors)_____ N B Remodeling_____ ___ Addition_ Size Septic Tank Feet of Drain Tile____ Nature of Water Supply: City —Well ( Signed) 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. No.___ _ Z _ 6 4 /____ Street_ / Ol Registered Architect and /or _ �) Employing Plumber's Name !� nn _.� o off _ S s P Q s' /V /(- i e_ �_ Q sT No. -_�c d. cAJ Street. -_s1 Location and Legal Description Lot_ Block.___ __ ____.______ ! /Subdivision L Street and Number where work is to be performed —No V g Street..- 0 / 'tic Repairs No. of Stories Type of Tank____ Capacity Gals _Dist. Feet of Tank or Drain Field from Well _ __Size of Soakage Pit 3 1: Pe Plumbing 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 leas com- plied 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 tlie Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. ' i (. ( Signed Master umber. STATE OF FLORIDA, f 58. COUNTY OF DADE. 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, 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. My Commission Expires Notary Public, State Of 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. MIAMI SHORES VILLAGE. FLORIDA BUILDING ❑ ELECTRICAL ❑ DATE rl PERMIT N? 6331 PLUMBING ❑ ROOFING ❑ Owner of Building Architect Contractor or Builder . a'> ' 1 . i et Legal Lot 1 Description 1 Bl Address of ,.° - ; / Building f ,ht �- CONTRACTOR OR BUILDER BY Work to be performed under this Permit t",` Subdi- vision INSPECTOR S7' r/4 Value of Project $ Contractor's 195 License No. 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 application 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 in the stateme or specifications and at he assumes responsibility for work done by his agents, servants or employees. / / 5 Signed In consideration of the issuance to me of this permit I agree to perform the work covered hereun ef` in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submittedA6 the proper authorities of Miami Shores Village. In ac- cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. AUTH)RITY MIAMI SHORES VILLAGE, FLA. JOB � ADDRESS 4- 9 b O INSPECTION TIME READY REMARKS: INSPECTOR r''k • //E /S- Z 4t- 1 1 Art N9 5293 r DATE M AMI SHORES VILLAGE, FLA. JOB k .s To .s < <I C c e^. ( 7 ADDRESS 4 o AL /0/ s N° 5226 INSPECTION r>i P/ ,, /ai/3,- -al'y - TIME READY / ° - 3 - -- Z. Pity REMARKS: INSPECTOR DATE /0 - JrZ. MI�NOii SHORES VILLAGE, FLA. JOB 1.1 ADDRESS 7 O / /-45 1 INSPECTION TIME READY REMARKS: cje,r� Ls% LL #'i 7 At N9 5010 0 — R / c /2 AC 4-7:€ 4 .P '- Ia toJr , -. INSPECTOR DATE (' ? C `�� Village of Miami Shores JOB let-:,,s70,./ 6 ADDRESS '�} C. N - � Ity INSPECTION p- a► ✓ 1✓ PC,) • w i3 ^� / - TIME READY j610 REMARKS N° 4836 INSPECTOR DATE BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Architect Contractor or Builder Legal. Description ❑I El a MIAMI SHORES VILLAGE, FLORIDA PERMIT N? 4645 Lot ow oils Address of 4 ? ' Building G Work to be performed under this Permit B1 Signed. 4 BY IfJr :a � _ l� • t) P DATE / % 1953' Contractor's License No. "'Pi , IC* Subdi- vision Value of � Amount of :►'"' Project $ S-© 'I 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 application 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 authorizatioV A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thor.Qgh knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings cr in the statements or spA ' cations a i d that he assumes responsibility for work done by his agents, servants or employees. INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work cove hereunder in compliance wi ' all ordinances and regulations pertaining thereto and in strict "conformity with the plans, drawings, statements or specification•, ubmitted to the proper authorities of Miami Shores Village. In ac- cepting this I ssuinejre y. � sponsibility.for all work done b'either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER AUTHORITY 644335° ;UILDING :LECTRICAL 'LUMBING .00FING Avner of uilding �� ontractor r Builder .t o PERMIT N9 4202 o rchitect CONTRACTOR/ OR BUILDER MIAMI SHORES VILLAGE. FLORIDA ►a i s t 41) C egal Lot 'ascription ddress of `f wilding `I % e' .t. L. / r DATE Contractor's License No. 195 Work to be performed under this Permit Subdi- B1 vision E Sr sie BY Value of Project $ 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 application crefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, awings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any ue 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 anted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations :rtaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work me by his agents, servants or employees. Signed. ( d� �' INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered reunder in compliance with all ordinances and regulations rtaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac- :pting this permit I assume responsibility for all work done by either, myself, my, agent, servant or employee. AUTHORITY Permit No 7 ° Z 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 i P ov Registered Architect and /or Engineer ..... ________ _ .______-_.___— _ .___.. _.____. Employing Plumber's Name O'- .� S _— P Vii c+/t _-- _ - -_._ No._ Location and Legal Description Lot _._____.... ----- _t__- _______ __ Blocic_ 50 - /e- Subdivision 44 S I' L ?- Street and Number where work is to be performed -No 49 t' i/. .,"2.--* '°( St�'eet MIAMI SHORES VILyAG PLUMBING INSPECTION DEPARTMEi '' APPLICATION FOR PLUMBING 1- State work to be performed and purpose of building (By Floors)_ New Building Remodeling_ -___ _ —____ Addition._ Date ✓e C a /..) S No.� � Street "• c✓, 2 le Repairs Amount of Permit $ 1 -- ° r' —____ -- - - -- -- -- (Signed) — Street._____ My Commission Expires Notary Public, State of Florida No. of Stories_ _ Size Septic Tank - Type of Tank__ Capacity Gals. Feet of Drain Tile_____.... _................ . -__._..Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: it ell. _______.___._____________._.___ _____.Size of Soakage Pit Plumbing 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 coin - plied 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 sub- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. (Signed) - 5-4-'2- --------------- - -- Master Plumber. STATE OF FLORIDA, 1 COUNTY OF DADE. 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, 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. 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 worlonanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS U URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' Ns TOTAL FIXTURES CONTR. LIST 3 i I '7 f, CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM•G POOL A) t44 CONTR. LIST ) / V —_- CHECK Permit No 7 ° Z 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 i P ov Registered Architect and /or Engineer ..... ________ _ .______-_.___— _ .___.. _.____. Employing Plumber's Name O'- .� S _— P Vii c+/t _-- _ - -_._ No._ Location and Legal Description Lot _._____.... ----- _t__- _______ __ Blocic_ 50 - /e- Subdivision 44 S I' L ?- Street and Number where work is to be performed -No 49 t' i/. .,"2.--* '°( St�'eet MIAMI SHORES VILyAG PLUMBING INSPECTION DEPARTMEi '' APPLICATION FOR PLUMBING 1- State work to be performed and purpose of building (By Floors)_ New Building Remodeling_ -___ _ —____ Addition._ Date ✓e C a /..) S No.� � Street "• c✓, 2 le Repairs Amount of Permit $ 1 -- ° r' —____ -- - - -- -- -- (Signed) — Street._____ My Commission Expires Notary Public, State of Florida No. of Stories_ _ Size Septic Tank - Type of Tank__ Capacity Gals. Feet of Drain Tile_____.... _................ . -__._..Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: it ell. _______.___._____________._.___ _____.Size of Soakage Pit Plumbing 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 coin - plied 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 sub- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. (Signed) - 5-4-'2- --------------- - -- Master Plumber. STATE OF FLORIDA, 1 COUNTY OF DADE. 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, 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. 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 worlonanship. ^. • LORIDA I SUBMIT HEREWITH, APPLICATION EMPLOYING PLUMBER STORY LOT BATH TUB BIDET DENTAL CUSPIDOR DISHWASHER DRINKING FOUNTAIN FLOOR DRAIN GREASE TRAP INDIRECT WASTE LAVATORY LAUNDRY TRAY LAUNDRY WASHER SHOWER SINK, BAR SINK, GLASS SINK, POT SINK, RESIDENCE SINK, SLOP SINK, 3- COMPARTMENT TEMPORARY WATER CLOSET URINAL FIXTURES SET ON OLD ROUGH INTERCEPTORS WATER CLOSET BLDG. PERMIT NO. NEW OLD ADDITION REMODEL WS ■11. DWELLING DUPLEX ROOMING HOUSE APARTMENT AND MECHANICAL PLAN FOR A PLUMBING PERMIT. DATE p HOTEL OFFICE BUILDING GARAGE STORE OWNER OR AGENT k4 YS TO A J ,11)‘'✓' tote) ADDRESS OF JOB We- / ® / . a ) BLOCK / SUBDIVISION ,H �- �' � nn G,aJ O c••7 SEWER CONNECTIONS: AT CENTER OF STREET AT CURB AT PROPERTY LINE IN ALLEY EXISTING BUILDING SEWER EXISTING BUILDING DRAIN TO SEPTIC TANK / TO SOAKAGE PIT RAIN WATER TO: STREET GUTTER PERVIOUS AREA STORM SEWER SOAKAGE PIT DRAINAGE WELL WATER PIPING TO: AIR - CONDITIONING UNIT BOILER BOOSTER FOR SOLAR BOTTLED GAS WATER HEATER ELECTRIC WATER HEATER FIRE - SPRINKLER SYSTEM FIRE- STANDPIPES , HOT & COLD FOR WASHING MACHM/ IRRIGATION SYSTEMS SIAMESE CONNECTION SOLAR WATER HEATER STANDPIPES STORAGE TANK SWIMMING POOL WATER SERVICE WATER SOFTENER l• A SIGNATURE: DRAW MECHANICAL PLAN ON BACK LUNCH AND JUICE STORE RESTAURANT BEER AND LIQUOR BAR WATER DRAINAGE: AREA DRAIN ROOF INLET BUILDING DRAIN SEWER PIPE SOIL PIPE SIPHON - BREAKER VENT PIPE WASTE PIPE WATER PIPE BUILDING DEPARTMENT REPAIRS: EXTENDING, REMODELING, ADDING TO OR REPAIRING THE FOLLOWING: MISCELLANEOUS