EL-05-344BUILDING DEPARTMENT
305 - 795 -2204
Building Inspection Request
Date I 1 16 O �.�'
Type Insp'n • "'Al-
Permit No. E--LOS- 344
Name
Address 1 Z- r° 1•1(- CD CD ST
Company 1
Phone #
Inspection Date 1 ) ' Z I c05
‘1,A177;f44- ,4e 1)111P /d
Approved
Correction
Re- Insp'n Fee
440
MIAM VTC.I:Abi
(ao5) 9 &=I .
/V- 3- 00 Pr
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BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building lumbing Mechanical Roofmg
Owner's Name (Fee Simple Titleholder) 2f4c.42e - ,1 / - 9 ei e Z. Phone #
Owner s ddress / 4,09e9 9 } 4, -'
City W � State /.-
Tenant/Lessee Name
Job Address (where the work is being done) /2 , te.) 404
City
Miami Shores Village County Miami -Dade
Is Building Historically Designated YES . NO
Contractor's Company Name l #3,9/2_- / � Phone # Ze - .�`. -- 2
Contractor's ddress 97/ 5 ed.) /32 £-7
City State ��
Qualifier ee__- /4 /e
$ Value of Work For this Permit
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 F, x• 1. )- 756.8972
State Certificate or Registration No. Certificate of Competency No. 09S e9 ,
Architect/Engineer's Name (if applicable) Phone #
Type of Work: DAddition ['Alteration ENew
Describe Work: COhneC4 - urn ( SP2t
(Continued on opposite side)
Square Footage Of Work:
Total Fee Now Due $ 1 (26•..a:::)
Zip o`
Phone #
Permit No. 3
aster Permit No.
Zip
Zip
(30S) 7s 207'7
- Repair/Repl'ace=_ El Demolition
****************************F
Submittal Fee $ 0 Permit Fee $ /4'6 " CCF $ 0 •6C) CO /CC
Notary $ Training/Education Fee $ d • 2.0 Technology Fee $ 2.. • 45O
Scanning $ 3 CXD Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
Bonding Company's Name (if applicable)
Bonding Company's Address
City State 7 , . 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
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
The fore • g ' . ►; ent was ackncya9ledg;� befQire m
day of `� /, OUP, by
who is personally knowq to me or d'h.' as produced
As identification and who did take an oath.
* * * * * * * **
NOT ' : LIC:
Sign:
Print.
My Commission Expires:
* * * * * * * * * * * * * * * * * * * **
'r or Agent
APPLICATION APPROVED BY:
Chc 05/13/03
Contractor A
• 6 g ' strument was acknowledged before me thi/
�� ✓.� 2005, by
o me or who has produced
NOTARY PUB
Sign:
Print:
My Commission Expires:..
fl 1 diki take an oath.
ra Zabian
oaD,
********************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
*************** * * * * * ** * * * * *` * * * * * * * * * * * * * * * * **
Gel 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 TE6PORARY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN AMPS
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 BOUND TANKS
LAUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
(TORS 0- 1 HP
STEAM BOILERS
SHOWER
MOTORS QVER 1- 3 HP
jg
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 If
'ELEVATORS/ESCALATORS
TEMPORARY WATER CLOSET
MOTORS OVER 10- 25 HP
FIRE SPRINKLER SYSTEMS
URINAL
MOTORS OVER 25-100 FP
COOLING TOWERS
WATER CLOSET
MOTORS OVER 100 HP
VIOLATION
INDIRECT WASTES •
A/C WINDOW
REINSPECTION
WATER SUPPLY T0:
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
SWIMAING POOL
OUTLETS COMRC IAL
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
_
PUM' 8 ABANDON SEPTIC TANK
REINSPECTION
^
SOAKAGE PIT W. 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
(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
ADDENDUM TO BUILDING PERMIT APPLICATION
ELECTRICAL
MECHANICAL
{
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 10/7 /2005
Applicant: RAFAEL
Owner: PEREZ
JOB ADDRESS: 126
Parcel # 1121360080030
NW 106
Electrical Permit
Permit Number: EL2005 -344
PEREZ
RAFAEL
ST
Contractor BARSI ELECTRICAL CONTRACTORS CORP!Contractor's Address: 9715 SW 132 CT
Local Phone:
Legal Description: DUNNINGS MIAMI SHORES EXT 4
Page 1 of 1
PB 48 -20 LOT 3
Fees:
FEE2005 -13315
FEE2005 -13316
FEE2005 -13317
FEE2005 -13318
FEE2005 -13319
Description
Building Fee
CCF
Training and Education Fee
Technology Fee
Scanning Fee
Total Fees:
Amount
$100.00
$0.60
$0.20
$2.50
$3.00
$106.30
Total Fees: $106.30
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration: 4/2/2006 Construction Value: $660.00
Work: CONNECT PUMP
Signed:
(INSPECTOR)
LT 0 is
c
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:
BLK 204