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PL-07-742Date Friday, April 20, 2007 04/20/2007 Check Receipt Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Number: PL -4 -07 -742 Invoice Number: PL -4 -07 -28172 Applicant: HOWARD BERNSTEIN Company Name: Owner Address: 178 NE 111 ST MIAMI SHORES, FL 33161 Job Address: 178 111 Street NE Miami Shores Village, FL 33138- Payment Type Check Number 11062 Amount $168.60 Change $0.00 Total Payment: $168.60 Page 1 of 1 Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795 -2204 Project Address 178 NE 111 Street Miami Shores Village, FL 33138- 1121360040140 Block: Lot HOWARD BERNSTEIN Owner Information HOWARD BERNSTEIN 178 NE 111 ST MIAMI SHORES FL 33161 -7048 Valuation: Total Sq Feet $ 1,800.00 0 Contractor(s) ESSIG POOLS INC Phone 305 - 949 -0000 Cell Phone Type of Work: plumbing Type of Piping: relocation Additional Info: Bond Retum : Classification: Residential Fees Due CCF Education Surcharge Permit Fee - New Construction Scanning Fee Technology Fee Total: Amount 01.20 00.40 $160.00 $3.00 $4.00 $168.60 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, servants, or employes. I understand that separate permits are required for ELECTRICAL PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Tuesday, April 17, 2007 Add itionlAlter ti Status AP PRQ V Expiration: 10 /14/2007 Phone Total I Amt Paid I Amt Due $ 0.00 $ 0.00 Payment Type e / /06Z Available Inspections: Inspection Type: Water Main Top Out Re Pipe Final Main Drain Water Service Underground Rough Heater Lavatory April 17, 2007 Date Cell 1 Tenant/Lessee Name E -MAIL: Job Address (where the work is being done) City Miami Shores Village FOLIO / PARCEL # Is Building Historically Designated YES Contractor's Company Name E CICAS 1 t( 1( 5T Contractor's Address City N YAMM.) Architect/Engineer's Name (if applicable) Value of Work For this Permit $ Type of Work: ['Addition ❑Alteration Describe Work: Submittal Fee $ Permit Fee $ 0 Notary $L Scanning $500-= Miami Shores Village Building Department k 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 x: (305) 756.8972 BUILDING APR 1 0 2007 Permit No. T I 1-11 PERMIT APPLICA FBC 2004 1,$00 a State tvike County FL NO Qualifier Name / State Certificate or Registration No.C C 05 . O. E -MAIL: Training /Education Fee $ 0: ❑New Master Permit No. Permit Type: Plumbing �, Owner's Name (Fee Simple Titleholder) u 1 \OJYA Vt s tit. Phone # Owner's Address 111 I1t g Cit \IO State Zip Phone # Miami -Dade Zip Phone # zip 3 Mt # � q41 •CLOD Certificate of Cpetency No. Phone # Square / Linear Footage Of Work: ❑ Repair /Replace ❑ Demolition 1 (Oc4Te �ac�S SW1 Wl pal prpe * ******at***dz &x &xaYxxxx xxxxxxxxat xa:xFeesxataYic*******xxdoxiraY xxxxxxxxxxxxxxxxxxxxx *was** CCF $ / -0-0 CO /CC Technology Fee $ 4.00 Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ /(OW -00 See Reverse side ---> Bo nding Company's Name (if applicable) r 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: 1 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 properly 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 Signature Owner or Agent The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of , 20 , by , day of , 20 , 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: NOTARY PUBLIC: xxxx xxxxx xxxxxxxe'exxxxxxxxxxxxxxxxxxx xx APPLICATION APPROVED BY: (Revised 02/08/06) Contractor Sign: Sign: Print: Print: My Commission Expires: My Commission Expires: xx xxxxxxxxxxxxxxx it* xxxxxx xxxxxxxxxxxxxicxxeexxxxx Plans Examiner Engineer Zoning Is Building Historically Designated YES NO Architect/Engineer's Name (if applicable) Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING IMICOMEWEI PERMIT APPLICATIO APR 1 6 2007 AI FBC 2004 BY: V- Permit Type (circle): Building Electrical Owner's Name (Fee Simple Titleholder) higid99KO tegle.49Lk Phone # Owner's Address / 7g /ye /l / 6 / • City /14/ /ft,/ State P" Tenant/Lessee Name Ar/i) Zip Permit No. Master Permit No. Phone # Phone # PL Mechanical Roofing Job Address (where the work is being done) / 7 Sr /1/i J/1 City Miami Shores Village County . Miami -Dade Zip FOLIO / PARCEL # � Contractor's Company Name TI' D Ps / /A/ C> Phone # Contractor's Address /got° /rig 4.5/ 57 City /V.d ,4'/ /fin / State - /.: Zip ' 3/e2 Qualifier Name / ;04 s tJ - Phone # 34 5' Y r,- State Certificate or Registration No. cp< ® .S2 .0 5 Certificate of Competency No. Value of Work For this Permit $ / Square / Linear Footage Of Work: ['Alteration ONew Repaivr/R eplace ❑ Demolition Type of Work UAddition escribe Work: obc Ex/ kri z � ` u., %Bl X/1ittx-r u J i' ***** * * ** * * * * * * * * *** * * * *** * * * * * *** ** * * F * * * * * * * * * * * * * * * *:* * * * * * * * ** * *.* Submittal Fee $ Permit Fee $ CCF $ CO /CC Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ See Reverse side -* Bonding Company's Name (if applicable) A/1/9 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 broc whose property is subject to attachment. Also, a certified copy of the recorded notice of commen for the first inspection which occurs seven (7) days after the building permit is issu -d. inspection will not be approved and a reinspection fee will be charged. Signature I Owner or Agent The foregoing instrument was acknowledged before me this The fore omg day of j®/�'i�l , by/ / MM VJ eG ��t / day of /VA who is perso kno 1 . II e or who 1. produced who is personal cation and who did take an oath. Sign: Print: APPLICATION APPROVED BY: {Revised 02/08/06) 1 �2 • 1 1. 1. 5■. a rio a NOTARY PUBLIC NOTARY PUBLI 4 SHERMA Si Print: as identific ure will be delivered to the person ement must be posted at the job site bsence of such posted notice, the Q it 11 ontractor knowledged by f or who has produced efore me this CFC d who did take an oath. HE otary Public, State Of Florida 007 Comm. No. DD182405 My Commission Expires: My Comm. exp. May 24, 2007 My C sion Expires: Comm. No DD182405 Plans Examiner Engineer Zoning ITEM UNIT FEE ITEM UNIT FEE ITEM UNIT FEE BATH TUB SWITCH OUTLETS SPACE HEATERS DISHWASHER LIGHT OUTLETS CENTRAL HEATING DISPOSAL RECEPTACLES NC (WIND) FLOOR DRAIN SERVICE TEMPORARY NC (CENTRAL) GREASE TRAP SERVICE SIZE IN AMPS DUCT WORK INTERCEPTOR SERVICE REPAIR/METER CHANGE REFRIGERATION LAVATORY APPLIANCE OUTLETS PROCESS AND PRESS PIPING LAUNDRY TRAY RANGE TOP UNDERGROUND TANKS CLOTHES WASHER OVEN ABOVE GROUND TANKS SHOWER WATER HEATER U.F. PRESSURE VESSELS SINK. POT /3 COMP. MOTORS 0 -1 HP STEAM BOILERS SINK, RESIDENCE. MOTORS OVER 1 -3 HP HOT WATER BOILERS SINK, SLOP. MOTORS OVER 3 -5 HP MECHANICAL VENTILATION TEMPORARY WATER CLOSET MOTORS OVER 5 -8 HP TRANSPORTING ASSEMBLIES. URINAL MOTORS OVER 8 -10 HP ELEVATORS /ESCALATORS WATER CLOSET MOTORS OVER 10 -25 HP FIRE SPRINKLER SYSTEMS INDIRECT WASTES MOTORS OVER 25 -100 HP COOLING TOWERS WATER SUPPLY TO: MOTORS OVER 100 HP VIOLATION NC UNIT • A/C WINDOW REINSPECTION FIRE SPRINKLER AIR CONDITIONERS HEATER -NEW INST. STRIP HEATER HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL GENERATORS TRANSFORMERS SWIMMING POOL GENERATORS TRANSFORMERS WATER SERVICE SPECIAL PURPOSE SEWER CONNECTIONS OUTLETS COMMERCIAL UTILITY -SEWER SIGN TUBES UTILITY -WATER SIGN TRANSFORMERS SEPTIC TANK SIGN TIME CLOCK RELAY FIXTURES FAINFIELD, 4" TILE/RES. ANTENNA PUMP & ABANDON SEPTIC TANK TELEVISION OUTLETS SOAKAGE PIT CU. FT. VIOLATION _ CATCH BASIN REINSPECTION DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE / POOL PIPING v / 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 BEEN OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS. PLEASE CIRCLE 0 DISCIPLINE APPLIED FOR: PLUMBING ELECTRICAL PERMIT # MECHANICAL • • ••• • • • ••• • •. /� ; *" A ". �'••• , cry jin3417t tha . A U rt i ttn n i e .i. PAVE I: LAND SURVEYORS.. . stsst :'�.ca • el • • • • • • • • •• . • • ievva Desfear .6e SUBJECT TO _� " :1C .)Ufl LZIJK • • • • •• • V�� °" • ficam v • • • • • • • • ••• • • • • • • • • • • • • • • • • • • • • • • • • V ed / • • •M• :• • tt20 ,e5 t?:QCe /CGS LgJ002 /00