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318 NE 102 St (2)PERMIT APPLICATION FOR MIAMI SHORES %-I VILLAGE Date 3- 2 ® - Job Address 3/O /'t/L' / S /• Tax Folio �1 " 3W ( 0/5 'i f�C) Legal Description LOT /D i) % . Lo7 q Historicall Designated: Yes No Owner/Less e / Tenant a 'Q/!ff 4- Cc) /',&AJF M4R/L= All/ Owner's Address 3 l /UC /O /00 Contractin Co. L L DY4)- NORP-1 g) Qualifier J0,652 i /a'/ O SS# State # Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING T MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION 1/cl »t1- e7��C4,,tJ/IZLZ Square Ft. 1 /0 - 0 Estimated Cost (value) IA /got, O 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. Notary as to My Commission Expires: of lESTER E. CROCKETT My Comm Exp. 5/20/2001 Bonded By Service Ins No. CC649326 I 1 Personally Known I I Other I.D APPROVED: Zoning Mechanical FEES: PERMIT 3.- RADON Date Plumbing 77/C4 Master Permit # Address Phone .2 61v Jp c ?5Z2 W W MR/ 5T Ooi 57 Phone 'gnat - . 'Contra or o er- Builder .ar fra Notary as to Contr actor My Commission Expires: LESTER E. CROCKETT My Comm Exp. 5/20/2001 Bonded By Service Ins No. CC649326 I 1 Personally Known I 1 Other 1.0 C C.C.F. / ' NOTARY Date Date BOND 3 0'62 — TOTAL DUE 3.3', v Building Electrical Engineering APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PER �- Permit Application Number C U�"`J Notes: r Qy-t c,. 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M M MMMM•M M , lwr••r•w••••w•••sw■•r••••••••w www• w■ '�r•a aaeea■w••aeaaa•••••••••••••w•w• ■ •• w•••• rw•••;•••••• • •s•• r■•••• w•' rsrwrsww•wrswrwr•srwrwwww•w•sww -/•www ••• r■• w•■ w■•,•••■ r•• w•w•■,•rrr■■ ■•r•w•,•w••••••sw■• • w• w•r rw ■ww• ■•`II•wrr••••••• ••••••••••■• • w•••••s• ws w, •• w•••• 11w•w r• rr• rwwrww w• w•• wr wrr•• �•••••• ws••••, rwr ww rr•■rstsr•sww•••••l••••wr•••we. • ■•wti!•ss•swr.•wrws•ri .ax•.•s•srssrarwr•.....•r rs w•. rswa....w a•r ww wss•. .awrwawwr•swwrwrwrrsws•wwsrwra. „ LA-7_ 102_S. rice. of N � rS �(t (%1 Aloc J( /° "' ; % _l� ,-- -■ , ., e Site Plan Submitted by: ? ®-- SIGNATURE C> 0— Ran Approved a By v Not Approved TITLE. Date -2 2- V? County Public Unit ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT Page 2 of 3 STATE OF FLORIDA - DEPARTMENT OF HEALTH .ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC CONSTRUCTION PERMIT FOR: r. New System Ii' , ] Y [A'b ] . Existing System [ �` ) Holding Tank [] Repair (I'J Abandonment [ 'rOther(Specify) APPLICANT: ,-i e-o 4 , , iA /e'> PROPERTY STREET ADDRESS: ° AGENT: /e's • ' (. LOT: 9 , a BLOCK: - SUBDIVISION: PROPERTY ID #: � - e ., �f�n�� [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 1OD -6, FAC. REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER PERMITS EXPIRE ONE YEAR FROM THE DATE OF ISSUE. DEPARTMENT OF HEALTH APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS .WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. SYSTEM DESIGN AND SPECIFICATIONS T A N K D R A I N F I E L D 0 T E R SPECIFICATIONS BY: APPROVED BY: ; ] ([GALLON:S.a/ GPDJt SEPTIC TANK /AEROBIC UNIT CAPACITY ] [GALLONS / GPD J CAPACITY ] GALLONS GREASE INTERCEPTOR CAPACITY ] GALLONS PER „DOSE DOSING TANK CAPACITY [ (-4 a' ](SQUARE FEET PRIMARY DRAINFIELD M SYSTE_) [ ] SQUARE SYSTEM TYPE SYSTEM: [ J STANDARD CONFIGURATION: [ ] TRENCH DATE ISSUED: 2 OH 4016, 10/96 (Replaces HRS -H Form 4016 [page 1] which may be used) (Stock Number: 5744 -001 - 4016 -0) + � r r�% ! d sires �?+ ` ° P [ ] FILLED [ ] MOUND [ [ M ] BED [ 1 /r O 2. 3 TITLE.: TITLE: DDu1-;oD DDL=PQ7dt fiff • PERMIT # • .., 4 _.. DATE PAID' FEE PAID 6 d ' RECEIPT # [ I Temporary /Experimental C MULTI- CHAMBERED /IN SERIES:( ] MULTI- CHAMBERED /IN SERIES:( J [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] DOSE MATE [ ].PER 24 HRS NO. OF PUMPS: [ ] LOCATION OF BENCHMARK: ELEVATION OF PROPOSED SYSTEM SITE [ '® ] F , NC S /FT] (ABOVE /ELO BENCHMARK /REFERENCE POINT: BOTTOM OF DRAINFIELD TO BE [ ��� ,' ][INCHES /FT] [ ABOVE /BELOW1BENCHMARK[REFERENCE POINT FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: [`` -) ] INCHES EXPIRATION DATE: Page 1 of 2 INSTRUCTIONS: PERMIT NUMBER: Permit tracking number by County Health Department. APPLICATION FOR: Check type of permit; if "Other" specify type in blank. APPLICANT: Property owner's full name. TELEPHONE: Telephone number for applicant or agent. AGENT: Property owner's legally authorized representative. MAILING ADDRESS: P.O. box or street mailing address for applicant or agent. LOT, BLOCK, SUBDIVISION or PROPERTY ID #: 27 character ID number for property. (Health Department may require property appraiser ID# or section /township /range /parcel number.) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter 10D -6, FAC. DRAINFIELD: Minimum specifications from Chapter 10D -6, FAC. OTHER: Other specifications, such as operating permit requirements, low - volume flush toilets, variance provisos. SPECIFICATIONS BY: Name of individual providing specifications. If desigriedby a registered engineer must be sealed. APPROVED BY: County Health Department personnel reviewing and approving permit. DATE ISSUED: Date permit is issued by County Health Department. EXPIRATION DATE: One year from date issued if the system has not been installed. Permits for system repairs become void 90 days from the date issued. Permit No Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building 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 work. Nature of Water Supply: City —Well Amount of Permit $ My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTML- APPLICATION FOR PLUMBING Owner's Name and Address ........... ____ Registered Architect and /or Engineer _ _ _ _ __ _ `� Employing Plumber's Name ___ —__ — No._ Location and Legal Description Lot_ .___ __ _____ ____ Block_ — �. Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors) _L_ _____ __ New Building Remodeling_ --------------- ___ -_- Addition_- Size Septic Tank _ Type of Tank Capacity Gals Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Size of Soakage Pit (Signed) No S/ F Plumbing Inspector. 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 com- plied 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 sub- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Date_ ), 6- c Street_ — Street- Subdivision Street -_ .. epairs No. of Stories STATE OF FLORIDA, 1 COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared 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 construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Notary Public, State of Florida Master Plumber. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made 'necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWER6 LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBE URINALS CATCH BASIN FLOOR DRAIN DRINKI NG FOUNT' NS TOTAL FI %TORES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM POOL CoNTR. LIST _ CHECK Permit No Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building 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 work. Nature of Water Supply: City —Well Amount of Permit $ My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTML- APPLICATION FOR PLUMBING Owner's Name and Address ........... ____ Registered Architect and /or Engineer _ _ _ _ __ _ `� Employing Plumber's Name ___ —__ — No._ Location and Legal Description Lot_ .___ __ _____ ____ Block_ — �. Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors) _L_ _____ __ New Building Remodeling_ --------------- ___ -_- Addition_- Size Septic Tank _ Type of Tank Capacity Gals Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Size of Soakage Pit (Signed) No S/ F Plumbing Inspector. 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 com- plied 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 sub- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Date_ ), 6- c Street_ — Street- Subdivision Street -_ .. epairs No. of Stories STATE OF FLORIDA, 1 COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared 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 construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Notary Public, State of Florida Master Plumber. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made 'necessary by improper notice for inspection, or faulty materials and /or workmanship. REQUEST FOR INSPECTION Company `� � U 4 `M Job Address j■? C-a Inspection ` 10 Time Ready ,\ 4) Date Ready��� PHONE A.M. P.M. Vtha of Miami Shores N9 4000 • JOB t ee, Bee ADDRESS INSPECTION 4. TIME READY 3 ' REMARKS INSPECTOR DATE - BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Architect Contractor or Builder Legal Lot Description Address of ; Building X" t MIAMI SHORES VILLAGE. FLORIDA ❑ Work to be performed under this Permit C Y ' - ;CONTRACTOR OR`BUILDER PERMIT 11T° 3429 f J B1 BY Value of Project $ DATE 195 Contractor's License No. Subdi- vision Amount of Permit $ This permit is granted to the contractor or builder named above to construc the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough kRwledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications an4 he assumes responsibility for work done by his agents, servants or employees. Signed a ��F '� a BY INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and re"ations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac- cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. s . AUTHORITY BUILDING ELECTRICAL PLUMBING ROOFING Owner of k Building �• Architect Contractor or Builder Legal Description Address of Building Lot • CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA PERMIT N° 11844 ❑ Work to be performed under this Permit Bl. t Gr Subdi- vision Value of Project $ DATE 195 Contractor's License No This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work ,covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or .employees. Signed • Y INSPECTOR 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 responsibility for all work done by either, myself, my agent, servant or employee. twai Amt. of Permit $ BY AUTHORITY CFN 2005R07137576 OR Bk 23577 F's 1729; (fps) • ° NOTICE OF COMMENCEMENT RECORDED 07/15/2005 15:42 :54 A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION HARVEY RUV'IN r CLERK OF COURT MIAMI --DADE COUNTY, FLORIDA LAST PAGE PERMIT NO. TAX FOLIO NO. STATE OF FLORIDA: COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Legal description of property and street / address: S i n q ( 1- c, M I y i'1 c o'YL4. i � Nrr: t 0 2 Str e. - M i S hore s , 1 L 3 3 3 8' 2. Description of improvement: S4 4-1 yr cif Iv+'+PaG1' win door S CosT ' 1 2 a '7 0, 00 3. Owners name and address: env a n S k .c 1 a e cQ , 3i 8' tJE i s a.Ki Sk'ore,s L.- 33! 3 Interest in property: �+ Name and address of fee simple titleholder: 4. Contractor's name and address: ,Atlorn+Cc. Wrnr)o;. hoddev's }3!Ss 5.w. 3•7 A.veveve M c%vv• F '3 3(76 5. Surety: (Payment bond required by owner from contractor, if any) Name and Address: Amount of bond $ 6. Lender's name and address: 7. Persons within the state of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes. Name and Address: 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and Address: 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date is specified) Signature of • ' ner . Pe4 e- r M Print Owner's Name Sworn to and subscribed before me this Notary Public: Print Notary's Name: My commission expires: STATE OF FLORIDA, COUNTY OF DADE i HEREBY CERTIFY that this is a tiv co e rigrnal file. this offi n day of / " WlTN , A D 20 hand and • ficial al. HAR By 1111 I I IRENE 0. DAKOTA MY COMMISSION # DD 256058 EXPIRES: October 1, 2007 Banded Thru Notary Pudic UndawrItsts B a i t ( PreparecTby day oftl , 20 <.' Address: 5 - I Opening Description of Window Product Acceptance Product Approval Opening Design Pressure RcuLb Opening Size Shutter Required Yes / No I %iuliion'Required Yes / No Impact Yes / No ID or Door or Mullion Number Design Pressure ( +) PSF ( -) PSF ( +) NSF ( - ) PSF 1 C. W /NDOU ) 03 - 06//. OA 57. 67.4 45-X 4 1-g 19x. 38 37x so 14 No No JJo N 17 1% YES YES y Es 2.. 5,1- W FN DOM) 03 -- 051'/•0 / 66,7 go. o 3 1 4)11 4 DOW 03 Os(q.0I 66.7 $0.0 ' C. W 1 A Dog) 05- 0611, oz 70,0 -7s.o 37 le 5o No No yes 5- 64- WINDo141 03- 05'I'i•o1 66.7 66).0 r9 Y 38 No No Yes 6 .4 WIN Pox; 03- 051 '1. o/ 6 6.'7 80.0 37 xco NO ( YES 7 FMS WINDOW 03 0612.66 61.9 6/•• - 3 X 5 0 nip Al YES c d- W/NPOW 03- o&1'1•o/ 66.7 80.0 19 X 5D N0 No YES q . W /NDota 03 - 0$`If.01 b6.7 80.o 19 X So No No y E.s 10 }�S WINDoN) 03- 0612.06 61•g 6/.8 53XS0 No No YES 11 - IA! /IV DOW 03- og 1 '1.o/ 66.7 go.0 37 x So No No YES IL 44 WINDOW 03 -QS t11.0/ 66.7 8'0.o 3'7x• So No rio ye.s 13 - DooA 02. 13 `7's" 75- 33 A x 77 No No Ye.S 1 IA/ /N pat.() 03 -oSi'f- 0/ 66.7 SO.o 37 A So No No Y 6 lc �U- W IN Deo) 03 - 051'F• 66.7' CO-0 37 x5 No No YES 16 R W /141 03- 6s7 . r 66.7 10.0 37 x 39 r.10 - /4 Kb No yes YES ti - J4. WiNt,OW 03 05 66.7 0+.0 37X f • Miami Shores Building Department 1 Product Aanroval Schedule / Comparison Chart Address: Permit No 05- l Z? + • • •• ••• • • 1 • • • • • • • • • • • IT • • •'� • �---a a • • • • • T • • • • • • • • • • • ••• • ••• • • • • ••• • • • • • • • ',•• • • O. •• • • • • • • • • • • • • • • •. • • • • • • • • • • • • -- 318 NE 102- 5 MIAMI GGREsIs . . .. : : .' . • : . . • • • o •• ••••• • • • •• • f -toR FL 33 t3 . • • . .. •�- • . • • . ..... • . . .. . • . • • •.• • • • ••• • • • • • • • •• •• • • • • • • • • • • • • • • ••• • • • • • • • • • • • • • • ••• • • • • • ••• ••• • • • • • • • • • • • • • • • • • • • • • • • • • •• • • c • • • • • ••. •• . • • RU1I DIN( CODE COMPLIANCE OFFICE, (RCCO) PRODUCT CONTROL DIVISION 1'f A, .. •• • • • • • • •• • ••• • •. • ••• • • • • • • NOTICE OF ACC'Nagci ®A) •. •• • • • • • ••• •• DADE COUNTY. FLORIDA 0-DADE FLAGLER BUILDING FLAGLER STREET, SUITE 1603 MIAMI, FLORIDA 33130 -1563 (305) 375 -2901 FAX (305) 375-2908 PGT Industries 1070 Technology Drive Nokomis, FL 34274 SCOPE: This NOA is being issued under the applicable rules and regulations governing the use of construction materials. The documentation submitted has been reviewed by Miami -Dade County Product Control Division and accepted by the Board of Rules and Appeals (BORA) to be used in Miami Dade County and other areas where allowed by the Authority Having Jurisdiction (AHJ). This NOA shall not be valid after the expiration date stated below. The Miami - 1)ade County Product Control Division (Ii Miami Dade County) and/or the AHJ (in areas other than Miami Dade County) reserve the right to have this product or material tested for quality assurance purposes. If this product or material fails to perform in the accepted manner, the manufacturer will incur the expense of such testing and the AHD may immediately revoke, modify, or suspend the use of such product or material within their jurisdiction. BORA reserves the right to revoke this acceptance, if it is determined by Miami -Dade County Product Control Division that this product or material fails to meet the requirements of the applicable building code. This product is approved as described herein, and has been designed to comply with the High Velocity Hurricane Zone of the Florida Building Code. DESCRIPTION: Series C -740 Aluminum Casement Window - Impact APPROVAL DOCUMENT: Drawing No. 7045 -8, titled "Aluminum Casement Window, Impact ", sheets 1 through 12 of 12, dated 12/17/02 with revision C dated 7/10/03, prepared by manufacturer, signed and sealed by Lucas A. Turner, P.F.,., bearing the Miami - Dade County Product Control Revision stamp with the Notice of Acceptance number and expiration date by the Miami -Dade County Product Control Division. MISSILE IMPACT RATING: Large and Small Missile Impact LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and following statement: "Miami -Dadc County Product Control Approved ", unless otherwise noted herein. RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no change in the applicable building code negatively affecting the performance of this product. TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in the materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of any product, for sales, advertising or any other purposes shall automatically terminate this NOA. Failure to comply with any section of this NOA shall be cause for termination and removal of NOA. ADVERTISEMENT: The NOA number preceded by the words Miami -Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, then it shall be done in its entirety. INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at the request of the Building Official. This NOA revises NOA # 02- 1224.02 consists of this page 1 and evidence pages E -1 and E -2, as well as approval document mentioned above. The submitted documentation was reviewed by Manuel Perez, P.E. 00.0611 02 • Cosomenrao ria, 2 NOA No 03- 0611.02 Expiration Date: May 22, 2008 Approval Date: October 9, 2003 Page 1 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._ pie R4 No. . Street Registered Architect and /or Engineer Name and address of licensed contractor____ i /¢4/x ^(.c/ /r 0O "-- e ' I //,' 3 Q0 —" • 9 9 5 T '‘1/'— / Location and legal description of lot to be built on: Lot Block Subdivision 5��� Street and Number where work is to be done N� .2.._ S ? ' S State work to be done and purpose of building (by floors). ."(..A."-r.--/A—OZ-41-"1-4,"> . IS /‘ and for no other purpose. New Building Remodeling Addition Repairs No. of Stories l To be constructed of Kind of ndation Roof Covering Estimated Total cost of improvements $ J n co O 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 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, Pennanent 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 subcgrytractors, on w to performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) STATE OF FLORIDA, COUNTY OF DADE. ss Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared Chairman Member Member Council Approved and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Q Permit No.--_/ T (7r Date /o {�// p - Read, Sworn to and Subscribed before me. Disapproved _- ' _ _ D e_ ( Signed) Building Insp itor to me well known, Notary Public, State of Florida My Commission Expires LANNING BOARD DATE Member Member Member 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 $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.