640 NE 101 StPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date / - 9 G Job Address r/ 4 v L / U / S1-- Tax Folio
Legal Description 1.4-r 34 't ("OS 7 71— a/- id t S • Historically Designated: Yes
Owner/Lessee / Tenant
Owner's Address 6 4 0 IJ L 1 D 1 s 7- S:4
Contracting Co.
Qualifier
State # C P Cry / 3 7 3 9 ` Municipal # 6. 'PC 64 93 74 Competency # / /a C 3 7 3 [ 1' Ins. Co.
, �
Architect/Engineer 1 // Address //54
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION -1- g-t/ -,<w 64 A) Qdt. 5 rt < (3
Signature
FEES: PERMIT
(J J , P, : Z c:_-
Address g rd 5. Gcs. Re-./
I /=[• 3 3 i / '/• � �•c t c
k /4-r ,Les 't e /i Phone �� ya — 7 ex/
/ N
1 -
ondo President
/a2/ S /f 6
Date
Notary as to Owner and/or Condo President Date
My Commission F,xptres:
R eso✓I A /f1 /[ ip,.�// 7 me.
2 0 P BARBARA A. I�O WE,�, �
Commission # CC 21 5808
+ or FL Expire 11,1997
APPROVED:
Zoning Building wwf
Mechanical • Plumbing t.J
Square Ft.
• j /,7/ *
C.C.F.
Estimated Cost (value)
Master Permit # 4 -/L ,
Phone rI S / Z
711 Lc- It
P.)4,4-4 6 37rJ
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.
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. Furthermore, I authorize the above -named contractor to do the work stated.
Signature of Contractor or Owner - Builder
Notary as to Contractor or Owner - Builder
My Commission Expires:
ce : BARBARA A. N011YE I
Commission # CC 215808
NOTAI{ F.' Expires ApD*IV , 19Q7
TOTAL DUE ` r.''e`
Electrical
I N Engineering
1
No
el9
G Z
C .4--
Date
•
Date •
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date ' "N; Job Address 6 Q /1 / 41 S - Tax Folio
Legal Description C0 1 7` ci/c' : P e'e. 7
Owner/Lessee / Tenant Al4isflirr (r3 v v7 G/ A ac a se i Master Permit # i) k(' E' 906,o:t
/ G
Owner's Address a!A'/./ /)0 , f/ C _ c. !'t A j Phone
Contracting co _2 /'$!a -' e!QN r r?c. !! <. • Address
Q fier /' /' /'G'4 , " ti.`-.f.. SS# . Phone c'' i :i7; a - er'`.
State c g 6 j C Municipal # /7/176 Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING4LECTRICAI PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 4 4.G(O'G' rz Ven''r' j s cem..A/vj A / ° =' ,�9 i '� e)' 'yQ 1 ; � ' i : ,. <.r
<✓' •i ,p , j 6 /(Y,K ; ` z?c i 4 `�J ' 1.-✓! ,' • , 9 ;" " el ,E7, Z- i /7-4- 9 . - 'C<
A v�sL> t� ° _ _ / �"/ &I
S e ,-,:y" f < , -`� '
S 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.
Signature of owner and/or Condo President Date
FEES: PERMIT C ®' RADON
Historically Designated: Yes No
. /
a e,fl
�� / �f' � l- 't�i� "• hi •r t'l3/� ��
ontractor or Owner - Builder Date
Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner - Builder Date
My Commission Expires: My Commission Expires:
/ r✓j - - �
C.C.F. /44ea NOTARY 5:00 BOND
TOTAL DUE 1
APPROVED:
Zoning Building Electrical/ ✓ lC
Mechanical Plumbing Engineering
ITEM
BATH TUB
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIOET
LIGHT OUTLETS
CENTRAL HEATING
DISHWASHER
RECEPTACLES
A/C (WIND)
DISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN MPS
DUCT WORK
FLOOR DRAIN
_
SERVICE REPAIR/IETER CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TOP
UNDERGROUIC 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.
MOTCRS OVER 3- 5 IP
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
FIRE SPRINKLER SYSTEMS
URINAL
MOTORS OVER 25-100 HP
COOLING TOWERS
WATER CLOSET
MOTCRS 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
SWIMMING PO01 74
OUTLETS COMMERCIAL
WATER SERVICE
SIGN TUBES
SEWER CONNECTIONS
SIGN TRANSFORMERS
UTILITY -SEWER
SIGN TIME CLOCK
UTILITY -WATER
F I XTI RES
SEPTIC TANK
ANTENNA
RELAY
TELEVISION OUTLETS
DRAINFIELD, 4' TILE/RES.
_
VIOLATION
PUMP & ABANDON SEPTIC TANK _
REINSPECTION
SOAKAGE PIT CU. FT.
ah on ,,, o , i pt.0 t' / e7 ; - j
4)
CATCH BASIN
�l
DISCHARGE WELL
se c )
(()
DOMESTIC WELL
AREA DRAIN
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 BEEN
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ELECTRICAL
MECHANICAL
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 with, whether herein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Date , 19
Owner's Name and Address No Street
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done
State work to be done and purpose of building (by floors)
New Building Remodeling
To be constructed of Kind of
Addition Repairs No. of Stories
foundation Roof Covering
e '
Estimated Total cost of improvements $ 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 pennit does hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen's Compensation Act, being Section 5986, 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 to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)
STATE OF FLORIDA,
COUNTY OF DADE. i ss
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 Ile 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 , s Date " 7 Read, Sworn to and Subscribed before me.
wilding Inspector
Disapproved Date4.
(Signed)
Chairman
Member
Member ..
Council Approved Date
NOTE: A charge of $1.00 will be made for making corrections
the Planning Board.
A re- inspection fee of 51.00 will be charged
materials and /or workmanship.
and for no other purpose.
to me well known,
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Member
Member
Member
Disapproved Date
or changes to this application after approval has been obtained from
when such re- inspection is made necessary by improper notice for inspection or faulty