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,. I Hid 0
HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number: 5744- 002 - 4015 -6)
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
PART II - SITE PLAN
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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? +
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318 NE 102- 5
MIAMI
GGREsIs
. . .. : : .' . • : . .
•
• • o •• ••••• •
•
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f -toR FL 33 t3
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• • • • • ••. •• . • • 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.