MC-04-213Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 12/16 /2004
Applicant: JEFFREY
Owner: LAWRENCE
JOB ADDRESS: 42
Contractor COOL BREEZE AIR COND CORP Contractor's Address: 13120 SW 130 TERR
Local Phone: 305 - 226 - 2665
Parcel # 1121360070130
Signed:
NE 107
Mechanical Permit
Permit Number: MC2004 -213
LAWRENCE
JEFFREY
ST
Legal Description: DUNNINGS MIAMI SHORES EXT NO 3
Fees: Description Amount
FEE2004 -12695 Building Fee $100.97
FEE2004 -12696 CCF $1.80
FEE2004 -12697 Technology Fee $3.00
FEE2004 -12698 Technology Fee $2.52
FEE2004 -12699 Submittal Fee ($50.00)
Total Fees: $58.29
Total Fees: $58.29
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration: 6/12/2005 Construction Value: $2,885.00
Work: 3 TON A/C SYSTEM
(INSPECTOR)
Page 1 of 1
PB 42 -33 LOT 5 BLK
,DEC 1 6 PAID
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:
BUILDING
PERMIT APPLIC (EVE® Master Permit No.
FBC 2001 % DEC 1 3 H94
Permit Type (circle): Buil i ing = E1 etr cal Plumbing Mechanical Roofmg
Owner's Name (Fee Simple Titleholder) ZUFS ` LAW SLE t CC Phone # ("N5) (ac►S - S4 5`e>
Owner's Address Al- til. 1kD1 ST
city M\ Pin ■ S IADNE..S state FL zip 3► l0
Tenant/Lessee Name
Scanning $ Radon $
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $
(Continued on opposite side)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Permit loo.
Phone #
Job Address (where the work is being done) 4 ME. 101 ST
City Nfiami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES NO
Architect/Engineer's Name (if applicable) Phone #
33 1 "o
Contractor's Company Name Cool_ )3 ii..Ct�E Mc CO 9--E Phone # C3(35) 22„ (o - 2 (a(ac
Contractor's Address C31 110 TE $12_
City 11 I o State TA- Zip 3'51 eil®
Qualifier f 1\L D. C L
State Certificate or Registration No. C ACO2432 -6 Certificate of Competency No.
$ Value of Work For this Permit 2. ? bS . aD Square Footage Of Work:
Type of Work: ❑Addition (Alteration :New ❑ Repair/Replace ❑ Demolition
Describe Work: ( 10 3To NtC. S `(Sly
* * * * * * * * * * * * * * * * * * * **** *, *,* Fees* ** **** ** * * *** * *** ** *,�,� *****
Submittal Fee $ 1;� 1✓ , a Permit Fee $ 1,001q1 CCF $
Notary $ Training/Education Fee $ Technology Fee $
Zoning 7ond $
CO /C C
Bonding Company's Name (if applicable)
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
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.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
APPLICATION APPROVED BY:
Cho 05/13/03
FERNANDOOBESO
, . e . , • is 1•
, . • EXPIRES: December 22, 2006
Signature
gent Contractor
ent was acknowledged before me this The foregoing instrument was acknowledged before me this 13
day of !r' C , 20 0q , by , day of bFC-. , 20 &A., by
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Sign: '•`d+'i
Print:
My Commission xpires:
FERNANDOOBESO
# DD 173702
• " EXPIRES: December 22, 2006
Bonded lieu Notary Underwriters
***it* * :C* 9 zst:Y & it* * **9r8c &*** Wit** * *9c9c &** ****it* * **is*** *** *** Be ** * *it 9a8c* **a* *Wield:**
****************************************** * ** * * * * * * * * * ** * * * * * * * * * * *** * * ** *** * * * * * * * ** * ** ** * * * ** ** * * * ** ** * **
Plans Examiner
Engineer
Zoning
ITEM
BATH TUB
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS
CENTRAL HEATING \o 16."3
1
DISHWASHER
RECEPTACLES
A/C (WINO)
DISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL) 31t4
r
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 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.
_
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 If
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:
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 POOL
OUTLETS COM4ERCIAL
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
PUMP & 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
• 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