561 NE 101 St (11)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date ////a/5:3 Job Address .5 /94s7 • Tax Folio //z . 06 - / :7
Legal Description�� ' /7/1,L- .(� "5--Z
Owner / Lessee / Tenant I /�- s•.1�� 4 Master Permit
Owner's Address � fo� �`� /7/S7 Phone
Contracting Co. MA-T srlc_ £L &CTZ1C Address /L i Niu G
Qualifier 4L /5k/ia SS4 # Phone 6.2 ��71 c3 -�
State # # COO /2533 Municipal # Competency ifrCPi'ra/, Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION /E jc744t j7-77 A-
vrt9
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, 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 complia wit 1 applicable laws regulating construction and zoning. Furthermore, I
authorize the abo ame• cotractor to do the work stated.
No
Signs / •re of owne - and or Condo Pre�,j'jep _ _ _ Signature of Contra for or Owner- Builder
Date J
41 ' Li,
of :ry as to Owner and
My Commission Expires:
APPROVED:
,; ;ay GINA TRACEY REED
111% MY CO ISSION 6 CC 292178
: July 19, 1997
Date:
Notary as to Contractor or Owner- Builder
My Commission Expires:
FEES: PERMIT 3741 RADON C.C.F. NOTARY TOTAL DUE '3"/
Fire Other
Zoning Building Electricals"
if rf
hr
Mechanical Plumbing Engineering
3Fc, - /.57� 1,
ITCW
BATH TUB
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT FEE
/.
ITEM
SPACE HEATERS
CENTRAL HEATING
UNIT
FEE
BIDET
LIGHT OUTLETS /,3
DISHWASHER
RECEPTACLES
,3s
A/C (WIND)
DISPOSAL
SERVICE TEMPORARY
PIO
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE I N ASPS /Sajj,ii
/
DUCT WORK
FLOOR DRAIN
SERVICE REPAIR/METER CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TOP
UNDERGROUND TANKS
LAVATORY
LAUNDRY TRAY
OVEN
WATER HEATER S vela
ABOVE GROUND TANKS
U.F. PRESSURE VESSELS
CLOTHES WASHER
MOTORS 0- 1 HP
Si"LMI BOILERS
SHOWER
MOTORS OVER 1- 3 HP
HOT WATER BOILERS
SINK, POT /3 COMP.
MOTORS OVER 3- 5 If
MECHANICAL VENTILATION
SINK, RESIDENCE
MOTORS OVER 5- 8 HP •
TRANSPORTING ASSE OLIES
SINK, SLOP
MOTORS OVER 8- 10 HP
ELEVATORS/ESCALATORS
TEMPORARY WATER CLOSET
MOTORS OVER 10- 25 HP
F E SPRINKLER SYSTEMS
URINAL
MOTORS OVER 25-100 HP
LING TOWERS
WATER CLOSET
MOTORS OVER 100 If
VIOLATION
INDIRECT WASTES
A/C WINDOW
(
REINSPECTION
WATER SUPPLY TO:
AIR CONDITIONERS 3 7 J
A/C UNIT
STRIP HEATER 3 , .6164;
FIRE SPRINKLER
GENERATORS TRANSFORMERS
HEATER —NEW INS f.' - .
}
GENERATOR SI TRANSFORMERS
HEATER — REPLACE
GENERATORS''TRA,NSF;:MERS .
/ il t
_
y
LAWN SPRINKLER —WELL
SPECIAL PURPOSE Pc/4,(/?
SWIMMING POOL
OUTLETS COMMERCIAL
WATER SERVICE
SIGN TUBES
SEWER CONNECTIONS
SIGN TRANSFORMERS
UTILITY -SEWER
SIGN TIME CLOCK
UTILITY -WATER
FIXTURES
SEPTIC TANK
ANTENNA
RELAY
TELEVISION OUTLETS
DRAINFIELD, 4' TILE/RES.
VIOLATION
PUMP & ABANDON SEPTIC TANK
REINSPECTION
SOAKAGE PIT CU. FT.
WA/. di ,4 C' /fl 4 l/iiv
'
CATCH BASIN
DISCHARGE WELL
DOMESTIC WELL.
f
ADM
AREA DRAIN
_.
j
'
` OA
ROOF INLET
, , _
1
SOLAR WATER HEATER
- -- _ . _ {
FIRE STANDPIPE
y`�`1�„ 7-f--- #-
POOL PIPING
•
LAWN SPRINKLER SYSTEM
GAS RANGE
METER SET (GAS)
GAS PIPING
PLUMBING
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.)
ELECTRICAL
MECHANICAL
3yp
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date o%s /9 Job Address Slot NE 101 Sic a e4.- Tax Foliox 1132610Cal 14 I'Do
X Legal Description 9 '9 aPleC 17 �../L
',: Owner / Lessee / Tenant 01Nt. G clZbr)De_ Master Permit i f- ' ,V
X Owner's Address S (o 1 N c `C e. �- Phone
Contra Co. 14,R.R�=EV C S I � Nc , Address 9lZ /Nt - 3`1 S41 6._ ., Ar.-,. 1
Qualifier 081-1 SS# Phone (3o5 7S 1 - 9(r755
State W Municipal # Competency # Ins.Co.
Architect /fir 1-r W t e ct Mo
WORK DESCRIPTION N - ( - l ac viL.)nk) 1 13
Square Ft. I t d L)
� Signa
Date:
t( Not
My Co
r�
f caner and/or Condo President
3
sePfa�� 59
/ /
;,., ,- - '4`' -, :� :.— r sident
.,:' 292178
** *
Ind
'c t1 ME& Ally •1997
F.. 9onded bru Notary POW {tiulenvrtters
*
*
Address 1,9 o2 5S ME: S4 g� •
Bonding Company Address
Mortgagor
Permit Type(circle one
Address
ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
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
authoriz the above -named contractor to do the work stated.
.arA I I ‘11
rac�or or Oi
Sign- ure of Cyn
Date: 7 2e/
ota ' as to
My Commission
* *
FEES: PERMIT " " RADON C.C.F. NOTARY ✓ ° p TOTAL DUEICO k
APPROVED:
Other
Fire
Zoning Buildin
Mechanical Plumbing, Engineering
Electrical