PL-04-366Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 12/28 /2004
Applicant: EDGAR PALACIOS
Owner: PALACIOS EDGAR
JOB ADDRESS: 161 NW 105 ST
Contractor ROJAS EDWARD
Local Phone:
Parcel # 1121360080110
Plumbing Permit
Permit Number: PL2004 -366
Contractor's Address: 880 NE 111 ST
Legal Description: DUNNINGS MIAMI SHORES EXT 4
Fees: Description Amount
FEE2004 -13148 Building Fee $140.00
FEE2004 -13149 CCF $1.20
FEE2004 -13150 Notary Fee $5.00
FEE2004 -13151 Training and Education Fee $0.40
FEE2004 -13152 Technology Fee $3.50
FEE2004 -13153 Submittal Fee ($50.00)
Total Fees: $100.10
Total Fees: $100.10
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration: 6/20/2005 Construction Value: $2,000.00
Work: INSTALL NEW WATER LINE COOPER 3/4
Signed: (INSPECTOR)
Page 1 of 1
PB 48 -20 LOT 11 BLK 204
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:
Date
Type Insp'n
Permit No.
Name
Address
Company
Phone #
Inspection Date
MIAMI SHORES VILLAGE 0
BUILDING DEPARTMENT 1(0
305- 795 -2204
Bu lding I spection Request
NUJ IO_S
RO U F Ciwci f
Approved
Correction
Re- Insp'n Fee
co S
to
MIAMI SHORES VILLAGE (D
BUILDING DEPARTMENT (0
305-795-2204
B lding I spection Request
Date C 0 'S
Type Insp'n 0
Permit No. LW ev_.1__))kci
Name t: CI CP i —) C110C 1CO
Address I (Li N N ud I0,S 54
IZO iC.r) F duuc_if
Compan 0
Phone #
Inspection Date
Approved
Correction
Re-Insp' n Fee
74
BUILDING
PERMIT APPLICATIO
FBC 2001
Permit Type (circle): Building Electrical
Owner's Name (Fee Simple Titleholder) Ji .i Z't y ez AIecS hone #
Owner's Address / C� / A/& / 0 J S'7' -r e-7
City Nisi 531!lY>°S State 70/7‘046
Tenant/Lessee Name
Job Address (where the work is being done) / 6 I , ( 2 0 5 !
City Miami Shores Village County Miami -Dade Zip (�
Is Building Historically Designated YES NO
Contractor's Company Name t s e A?)/ /J #ct j�f � / %I%q Phone # 3 os g / - 6 / 0
Contractor's Address S 0 ,s.1 Cp . / 11
'5T I
Cit "af-5c14111/4/e, p` AV. State 11 Zip 3 3/6/
Qualifier ' Cfilla )( 16/65
State Certificate or Registration No. CFA', d 4/9 4/3/
Architect/Engineer's Name (if applicable)
$ Value of Work For this Permit
Type of Work:
Describe Work:
Total Fee Now Due $ 1 o O
(Continued on opposite side)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (30/) 795.2204 Fax: (305) 756.8972
Plumbing
RECEUVED
DM 2
Boa
Permit No. PLO4
Master Permit No.
Zip
,33/ s 0
Phone #
Certificate of Competency No.
Phone #
Mechanical
310S-
Roofing
Square Footage Of Work:
❑Alteration ❑ 'ew ' Repair/Replace ❑ Demolition
UJa(i Lt'dvCe rpoet
2 1 PAID F ees a��ia� Technology Fee $
Submittal Fee $ .� ( — Permit Fee $ 1 'Ye
Notary $ Training/Education Fee $ a s
Scanning $ Radon $ � Zoning Bond $
Code Enforcement $ Structural Plan Review. $
CCF $ ` CO/CC "�
Bonding Company's Name (if applicable)
tet
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 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
COMIVIENCEMENT."
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 com emen : e posted at the job site
for the first inspection w' 'c occurs seven (7) days after the building permit is issued. 1 the .sence of eh posted notice, the
inspection will not b pproved and a reinspection fee will be charged.
Si
.1.10 .
or Agent - on tor
The foregoing instrument was acknowledged before me this c) The foregoing instrument was ac .. ow edged before me this �A(
day of C.' , 20 Of, by , day of
whop is personally known to me or who has produced 0, t')
�--� As ide
Chc 05/13/03
Print:
My Commission Expires:
who is personally known to m or who has produced 1C,
7Q �� ° — adentifi cation and who did take an oath.
S i, ► ��_ t.AA∎ a
Prin /l `
My Commission Exp; ' ° . ,'S Co on#DD323870
******************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ****************************S94** •- g 7Kp 1 �i & 31 r (4 * **
"1:41-4W Bonded Thru
i" Atlantic Bonding Co., Inc.
**** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * ** ** **********************+***** * * * * * * * * * * * * * * * * * ** ** *** * * *** **
APPLICATION APPROVED BY: / -0 cif Plans Examiner
Engineer
Zoning
ITEM
BATH TUB
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 AMPS
DUCT WORK
FLOOR DRAIN
SERVICE REPAIR/METER CHAFE
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
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 HP
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:
7
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
SWIMdING POOL
OUTLETS COMI+IFRCIAL
WATER SERVICE
SIGN TUBES
SEWER CONNECTIONS
.SIGN TRANSFORMERS
UTILITY —SEWER
SIGN TIME CLOCK
UTILITY —WATER
FIXTURES
SEPTIC TANK
ANTENNA
RELAY
TELEVISION OUTLETS
GRAINFIELD, 4' TILE/RES.
VIOLATION
PUM? & ABANDON SEPTIC TANK
REINSPECTION
SOAKAGE PIT CU. FT.
CATCH BASIN
DISCHARGE WELL
DOMESTIC WELL
AREA DRAIN
ROOF INLET
SOLAR WATER HEATER
FIRE STANDPIPE
POOL PIPING
LAWN SPRINKLER SYSTEM
GAS RANGE
METER SET (GAS)
GAS PIPING
1
,
ADDENDUM TO BUILDING PERMIT APPLICATION
(AN APPLICATION FOR 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