MECHANICAL PERMITType Insp
Permit No.
Name
Address
MIAMI SHORES VILLAGE ,
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Req
Date )1V0 y
Correction ❑
Re- Insp'n Fee ❑
(lisC. laa,
Compa 1 // <i. •
Phone #30-S; g�- �ro �� l
Inspection Date 9)0/0\f
Approved fi-g 4J , ( . 3 <c 4
Q J A Q 4,
3os- T91 03n?
/vuzsizto 1x- 30
Miami Shores Village
BUILDING
PERMIT APPLICATION
FBC 2001
$ Value of Work For this Permit
Type of Work:
Describe Work:
❑Addition
000
❑ Alteration
F n_ c�pCLAat=
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 rR E C E 8 �g �p
E )
JAN ! 2004)ild
Permit No.,
Master Permit No. P1 6'i Di /3
Tel: (305) 795.2204 Fax: (305) 756.8972
❑New
Zip 3 3 (
Permit Type (circle): Building Electrica lumbing /Mechanical Roofing
Owner's Name (Fee Simple Titleholder) //At' - a-Aiiii Phone #
Owner's Address ( 6 IQ ( (n L s 1
City M , A S I- p(i,�sf State F(_
Tenant/Lessee Name Phone # or- 7q - 1 11c
Job Address (where the work is being done) 1 (7 C N ( o L ST
City Miami Shores Village County Miami -Dade Zip - ;"3 1 8 1
Is Building Historically Designated YES NO
Contractor's Company Name S voq tU S e J-�€T f eT L Phone # 1 IN 30C err-- t ‘ S c
Contractor's Address ct t N LJ h A-
City Pr L.-'r`.0 State Zip 1/1 1
Qualifier C n R Rc
Architect/Engineer's Name (if applicable) Phone #
Square Footage Of Work:
❑ Repair/Replace
A ►-+ It 2_e -- 3 ro 7 - - 317
co &,p * R2e4 a 3 .
❑ Demolition
$$$$$t$$$$$$$$$$$$$$$$$$$$$ F ees $$$$$$$$$$$$$$$$$$$$$$$$$$$$$*
Submittal Fee $ U 3O Pe mit Fee $ f ( . ` CCF $ • 6 6 CO /CC
Notary $ Training/Education Fee $ . Technology Fee $
Scanning $ Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $ 51
(Continued on opposite side)
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable) At /a
Mortgage Lender's Address
City 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 pennit 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 bject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first insp s seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will n reinspection fee will be charged.
Chc 12/15/03
N /A
ndre Owiler o mjit ier
The foregoing instrument was acknowledged before me this 16
day of Jan . , 2004 , by Andre' R. Fournier ,
who is personally known to me or who has produced N . A .
As identification and who did take an oath.
NOTAR
Sign:
Print:
My Commis
e1:
_
' ey .V COMMISSION # OD 211421
OF 4 EXPIRES: July 25, 2007
* #tk'$19CKA 1 / 4 t * * * MA?, bitztUA 1
* * * * * * * * **
LIC:
APPLICATION APPROVED BY:
Zip
Signature
Sign:
Print:
My Co
* * * * * * * * * * * * * * * * * * * * * * * * * **
off 6 (. o ei
t
Contractor — Norman Gabe
The foregoin - t was acknowledged before me this 16
day of Jan . , 20)04, byNorman Gabe
who is personally _known to me or who has produced N . A .
as identification and who did take an oath.
NOTARY PUBLIC:
* 1 / I ** Notary Discount Assoc. Co.
* * * * * * **
ertificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Plans Examiner
Engineer
Zoning
,NDRE R. FOURNIER ATTORNEY AT LAW
'AY:
ANDRE R. FOURNIER
ATTORNEY AT LAW
P.O. BOX 610277
1747 N.E. 124TH STREET
NORTH MIAMI, FL 33261
(305) 891 -0308
l ecN 4-14
, pleo2wv-i3
1000307411' x:0660 L03771: 11'40 ' 032306"
1►111DC D CA1 1D1111CD .++.11..... -.. ..11 . , . .••
COMMERCIAL BANK OF FLORIDA
NORTH MIAMI OFFICE
12255 NE. 16TH AVENUE - MIAMI, FL 33161
63- 1037 -660
DATE
///4/6/
A OUNT d CI
3074
3074
COUNT
DAYS
3074
W
H TIM3
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE •
ET
LIGHT OUTLETS
CENTRAL HEATING
HRASER
RECEPTACLES
A/C (WIND)
SAL
SERVICE TEMPORARY
A/C (CENTRAL)
i
NKING FOUNTAIN
SERVICE SIZE IN AtiPS
DUCT WORK
e)
CR DRAIN
SERVICE REPAIR/10ER CHAtE
REFRIGERATION
:ASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
TERCEPTOR
RANGE TCP
UNDERGROUND TANKS
'ATCRY
OVEN
ABOVE GROUND TANKS
JNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
ITHES WASHER
MOTORS 0- 1 HP
STEAM BOILERS
)W'ER
MOTORS OVER 1- 3 HP
HOT WATER BOILERS
.
IX, POT /3 COMP.
MOTORS OVER 3- 5 HP
MECHANICAL VENTILATION
IK, RESIDENCE
MOTORS OVER 5- 8 HP
TRANSPORTING ASSEM3LIES
II(, SLOP
MOTORS OVER 8- 10 HP
ELEVATORS/ESCALATORS
FORARY WATER CLOSET
MOTORS OVER 10 25 HP
FIRE SPRINKLER SYSTEMS
INAL
MOTORS OVER 25-100 HP
COOLING TOWERS
TER CLOSET
MOTORS OVER 100 HP
VIOLATION
DIRECT WASTES
A/C WINDOW
REINSPECTION
TER SUPPLY TO:
AIR CONDITIONERS &
''
A/C UNIT
STRIP HEATER
Q
FIRE SPRINKLER
GENERATORS TRANSFCRMERS
•
HEATER -NEW INST.
GENERATORS TRANSFCRMERS
HEATER- REPLACE
GENERATORS TRANSFCRMERS
LAWN SPRINKLER-WELL
SPECIAL PURPOSE
.
•
SWIMMING POOL
OUTLETS COMMERCIAL
HATER SERVICE
SIGN TUBES
WER CONNECTIONS
SIGN TRANSFORMERS
ILITY -SEWER
SIGN TIME CLOCK
ILITY -WATER
FIXTURES
?TIC TANK
•
ANTENNA
LAY
TELEVISION OUTLETS
AIRFIELD, 4' TILE/RES.
VIOLATION
4P & ABANDON SEPTIC TANK
REINSPECTION
AKAGE PIT CU. FT.
TCH BASIN
Gv t itto TO
SCHARGE WELL
t 1 S Ti ) G 01SCeNal
f
_--.-
MESTIC WELL
EA DRAIN
OF INLET t
LAR WATER HEATER `
RE STANDPIPE
DL PIPING
•
,--
NH SPRINKLER SYSTEM
S RANGE
TER SET (GAS)
S PIPING
ADDENDUM TO BUILDING PERMIT APPLICATION
4 APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A RASTER PERMIT HAS B.
3TAINED','THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ELECTRICAL
MECHANICAL
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 -795 -2204 Permit Number: MC2004 -13
Printed: 1/21 /2004
Applicant: ANDRE
Owner: FOURNIER
JOB ADDRESS: 1175 NE 102
Contractor SUNRISE SHEET METAL DBA ENVIRONMENTAM diili3RQAtttiiess: 916 NW 6 AVENUE
Local Phone: 305 - 895 -6696
Parcel # 1132050190090
Signed: (INSPECTOR)
Mechanical Permit
FOURNIER
ANDRE
ST
Legal Description: MIAMI SHORES SEC 8 REV PB 43 -67 LOT 9 BLK 175 LOT SIZE
Fees: Description Amount
FEE2004 -604 Building Fee $106.00
FEE2004 -606 CCF $0.60
FEE2004 -607 Training and Education Fee $0.20
FEE2004 -608 Technology Fee $2.65
Total Fees: $109.45
Total Fees: $1 09.050 44 30
Total Receipts: 0.00 ,
L)) - 51. `fS
Permit Status: APPROVED Permit Expiration: 7/14/2004 Construction Value: $1,000.00
Work: REPLACEMENT USED 3 TON NC UNIT FOR GARAGE
SAN 2 6 PA/0
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:
1 y
4.
75/ - / ,217 L Nom, Atfa 90
MIAMI SHORES VILLAGE
.4.N.Q HEAT
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Building Inspec ,. r
Notary Public, State of Florida
My Commission Expires
e�
Application is hereby made for the approyal 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 Miam
Shores Village, Florida, and all provisions of the Laws of they 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. �/
7
tY ,197
Owner's Name and Address . / . . l NO ✓ 4 A NN . . . . . 2 : 5 E ... .. _ No.N`t 0 Qij Street _LS "2 —S /-
Registered Architect and /or Engineer JAN 7 J 1. e- OE f-di f PEt
•
Name and address of licensed contactor P I�o. ? _. Si'P'v 1C rE T N C .
Location d legal description of lot to be built on: M 1
Lot Block 1 Subdivision /` ! , 5 ... FAT
Street and Number where work is to be done .1 75 1 —) E. 1 C) P5 .o1v
pure building ( Y floors) .. I-_� eO 1 1 on)) P(_j r.v
State work to be done and purpose of buildin b floors , 1- � V Aa
dibr no purpose.
New Building ,C Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation , Roof, v ring
p t7 Amount of Permit $. I
Estimated Total cost of improvements $..... . .
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 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 - • actors employed by him
in the work to be performed under this permit; and will post or cause to be posted for ins • Y.n on th of the • ch public notice
or notices as are required by the Act. The undersigned agrees to employ only such su. ctors, ogr to • •% ed under this
pennit, as are licensed by Miami Shores Village.
Remarks (Signe
STATE OF FLORIDA,
COUNTY OF DADE. j ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared —•-
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 con uction, that he has carefull re d foregoing application, and that he did sign the same, and that all facts
therein by him staa L /
Permit No._ Lb Date Read, Sworn to and Subscribed before me.
Disapproved
(Signed)
PL NNINC BOARD DATE
Chairman Member
Member Member
: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 approval has been obtained from
the Planning Board.
A re- inspection fee of 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection oe faulty
materials and /or workmanship.