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574 NE 102 StIssue Date: 9/18/2006 Owner's Name: CARLOS GONCALVES Permit Type: Residential Construction Work Classification: Garage Door Job Address: 574 102 Contractor(s) Phone AUTOMATED HOME SERVICES INC (305)594 -3810 Yes Primary Contractor Comments: GARAGE DOOR Additional Information Miami Shores Village, FL Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Expires: 03/17/2007 Type of Construction: Occupancy: Stories: Exterior: Front Setback: Rear Setback: Left Setback: Right Setback: Bedrooms: Bathrooms: Plans Submitted: Certificate Status: Certificate Date: Additional Info: 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. Building Department File Copy Applicant Signature Parcel #: Block: Section: Permit Status: APPROVED Permit Number: RC -9 -06 -2331 Phone: 305/754 -5840 1132060171030 Lot: PB: Total Square Feet: 68 Total Valuation: $ 1,533.00 Re • uired Ins • ections Final Fees Due Amount CCF $1.20 Education Surcharge $0.40 Permit Fee - New Construction $110.00 Scanning Fee $6.00 Technology Fee $2.75 Total: $120.35 Invoice Number RC -9 -06 -26177 Total: GY Amt Due $120.35 Amt Paid aEP 22P NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. FOLIO / PARCEL # BUILDING PERMIT APPLICATION FBC 2004 Permit Type (circle): Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Job Address (where the work is being done) Is Building Historically Designated YES NO X Value of Work For this Permit $ ) S Q (V Type of Work: ['Addition ❑Alteration Describe Work: Miami Shores Village ao 19W IECIEEM11 Permit No C) . C3 — a5 1 Electrical Plumbing Mechanical Roofing Owner's Name (Fee Simp older) C-Or` S l5 0 hCA IJ L S Phone # 3 V� 76 - •S0 2 /0 Owner's Address nt-s ? �c (7- /021 -- City M1 (St�v1: �Y) oC(j State Ft- Zip 3 3) 3 r Tenant/Lessee Name N Phone # kJ S Mc /0 City Miami Shores Village County Miami -Dade Zip 3 3)3g Contractor's Company Name AP-16 rylic - C 4 ge('ylCe;:S Phone # 35 s7 - ?j' e1v Contractor's Address jaI o jjr 4) 7 A Oc-- City Net, L State Pt, Zip 3 3/ V Qualifier Name 4 n0 IC , IA Lw 1 S Phone # State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # Square / Linear Footage Of Work: 6 Master Permit No. Notary $ Training/Education Fee $ l 40 Technology Fee $ •95 Scanning $ G Radon $ DPBR $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ !2f 5 See Reverse side -4 Repair/Replace ❑ Demolition *************************************** s ******************************************** Submittal Fee $ Permit Fee $ 116 CCF $ 1 CO /CC Zoning $ 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. Signature Signature Owner or Agent Contractor 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: Sign: Sign: Print: Print: My Commission Expires: ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: (Revised 02/08/06) NOTARY PUBLIC: My Commission Expires: G �/ Plans Examiner Engineer Zoning BUILDING PERMIT APPLICATION FBC 2001 Miami Shores Village Building Department fo050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit Type (circle): Building Electrical Plumbing Mechanical Roofing Owner's Name (Fee Simple Titleholder) C Pi- IVES Phone # ad5 7. S&(O Owner's Address 511 uE l °t AD sr City 1-1.4,441' 5 Mot OS state FG Zip 93/36 Tenant/Lessee Name /(! /4 Phone # /v /iq Job Address (where the work is being done) 51q 44' sr City Miami Shores Village County Muni -Dade Zip 93138 Is Building Historically Designated YES NO 1C Contractor's Company Name ari9AaTe) lio,nr &LI Phone # 5935/4/34/6 Contractor's Address ;U � /vl") 9,f- 4v Cit State F 4.- Zip 3 317a - Qualifier eiu A-6 . LzZJ/ $ Value of Work For this Permit 4 /535. eg- Permit No. Master Permit No. Architect/Engineer's Name (if applicable) Phone # Square Footage Of Work: 6S Type of Work: ['Addition ['Alteration ❑New ❑ Repair/Replace ❑ Demolition Describe Work: Fees Submittal Fee $ Permit Fee $ CCF $ Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ Bond $ Code Enforcement $ Structural Plan Review. $ Total Fee Now Due $ (Continued on opposite side) 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 is In the absence o such posted notice, the inspection will not be , p oved and a reinspection fee will be charged. Signature `Ci' • The foreg day of Chc 10/14/03 Owner or Agent mg instrument was acknowledged before me this /R- 200� by ( d I! /a'4LEs who is personally known to me or- o.as- preditF NOTARY P LIC: Sign: Print: ei/e° ti My Commission Expires: APPLICATION APPROVED BY: As iden tification and who did take an oath. PENCE I IUNT COMMISSION #DD176535 EXPIRES: JAN 08, 2007 Bonded through Advantage Notary (Certificate of Competency Holder) Signature - -- Contractor The foregoing instrument was acknowledged before me this day of 3eP i 20 Q6 by at V 4i .D 6) . �Q.a/ who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: �r9tt/LE�s' .I : P ,' i D176535 a .. , m 07 : Bonded through Advantage Notary My Commissio State Certificate or Registration No. Certificate of Competency No. Plans Examiner Engineer Zoning IMCMEWMI SEP 1 s 2006 !J 617 < ( 1 Inspector Comments Passed Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until I nspection Number INSP -26712 Inspection Date: 11/30/2006 Inspector: Grande, Claudio Owner: GONCALVES, CARLOS Job Address: 574 102 Project: <NONE> Miami Shores Village, FL Contractor: AUTOMATED HOME SERVICES INC Building Department Comments Wednesday, November 29, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Block: Permit Type: Residential Construction Inspection Type: Final Work Classification: Garage Door Phone Number 305/754 -5840 Parcel Number 1132060171030 Lot: Phone: (305)594 -3810 Page 1 of 2 BUILDING CODE COMPLIANCE OFFICE (BCCO) PRODUCT CONTROL DIVISION NOTICE OF ACCEPTANCE (NOA) Raynor GarageDoors. 1101 East River Road Dixon IL 61021 SCOPE: This NOA is being issued under the appli documentation submitted has been reviewed by Rules and Appeals (BORA) to be used in Miami Jurisdiction (AHJ). • • • •• •• - • • • •• - • • • • • • • • • • • • • • • • -• • • • • • • • • • • • • • • • • • • •• • • - • • • • • - • • • • • •• - • • • ••• • • • • • • • • • ••• • • • • • • • • • • • • • • •• • • • • •- • • • • •• - • 03 -- • • • • • • 5/6tr MIAMI METR 140 WEST FLAGLER S TECMTIF NOA No 03 -0805.01 Expiration Date: August 21, 2008 Approval Date: November 27, 2003 Page 1 G 1603 Ivl];FL� •_m: (14 (305) 375 -2901 F _ (305) 375 -2908 governing the use of construction materials. The Control Division and accepted by the Board of where allowed by the Authority Having This NOA shall not be valid after the expiration ` � ' o` ` ' e := -Dade County Product Control Division (In Miami Dade County) and/or the AHJ (in areas o ade o, ty) 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 AHJ 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: Sectional Garage Door 9'- 0" Wide. APPROVAL DOCUMENT: Drawing No. P -1276, titled "Spec. Windload Decade Series 9' 0" Wide (Max) ", dated 11/09/93 with last revision on 07/02/03, sheets 1 of 1, prepared by Raynor Garage Doors, signed and sealed by H. Farooq, P.E., bearing the Miami -Dade County Product Control Renewal 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 -Dade 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. LIMITATION: This approval requires the manufacturer to do testing of all coils used to fabricate door panels under this Notice of Acceptance. A minimum of 2 specimens shall be cut from each coil and tensile tested according to ASTM E -8 by a Dade County approved laboratory selected and paid by the manufacturer. Every 3 months, four times a year, the manufacturer shall mail to this office: a copy of the tested reports with confirmation that the specimen were selected from coils at the manufacturer production facilities. And a notarized statement from the manufacturer that only coils with yield strength of 33000 psi or more shall be used to make door panels for Dade County under this Notice of Acceptance 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 and renews NOA # 00 -0804.02 and consists of this page, evidence page as well as the approval document mentioned above. • • ••• • • • • • - • The submitted documentation was ityieweitby • - ° nt 7E. isizioppr Raynor Garage Doors. NOTICE OF ACCEPTANCE: EVIDENCE PAGE A. DRAWINGS 1. Drawing prepared by Raynor Garage Doors, titled "SPEC. WINDLOAD DECADE SERIES 9' 0" WIDE (M4X) ", Drawing No. P1276, dated 11/09/93, with last revision on 07/02/03, sheets 1 of 1, signed and sealed by H. Farooq, PE. B. TESTS I. Test report of large missile impact test per PA 201 and cyclic wind pressure test per PA 203 on `Decade I/II 9' wide x 8" high", prepared by Hurricane Engineering & Testing, Inc., report No. HETI 94 -33, dated 04/13/94, signed and sealed by A. Vgar, PE. 2. Test report of niform static air pressure test per PA 202 on a "Decade I/II 9' wide x 8" high" prepared by Hurricane Engineering & Testing, Inc., report No. HETI 94- 30, dated 04/12/94, signed and sealed by A. Vigar, PE. C. CALCULATIONS 1. Calculations dated 06/01/94; pages 1 through 2, prepared by AI- Farooq Corp., signed and sealed by H. Farooq, PE. D. QUALITY ASSURANCE. 1. Miami Dade County Product Control Approval. E. MATERIAL CERTIFICATIONS F. STATEMENTS. 1. Letter confirming that Raynor Garage Doors, Decade Series have not changed on any item or design since its previous approval, issued by Raynor Garage Door on 07/11/2000 signed by G. Wedekind 2. Letter confirming that H. Farooq is still practicing engineering, issued by Al Farooq Corporation on 07/26/2000, signed and sealed by H. Farooq, PE. 3. No change letter issued by Raynor Garage Doors on 10/21/03 signed by G. Wedekind and notarized by S. M Salsbury. 4. Tensile test report & affidavit of minimum yield issued by Heti & Raynor Garage Doors on 10/21/03 & 09 /18 /03and signed & sealed by R. E. Droz -Seda. • ....... • .. .. • • • • • • • • .. ... .. • .. • • • . • • • • • • • • • • • • .... • • .. .. .. • • • • • • • • • • • • • • .. ... • • E -1 ... • • • ... • • • • • • • • • • • ... • • • • • • • • • • . . . ... • • ... • • Candido F. Font, PE. Senior Product Control Division NOA No 03 -0805.01 Expiration Date: August 21, 2008 Approval Date: November 27, 2003 MIAMI SHORES VILLAGE f t7� BUILDING 4EPARTMENT 305- 795 -2204 Building Inspection Request Date Type Insp'n �� Pb ®0 e Permit No. �/ Name ,, Address 5? LLL A/E /0 ? Company CC Phone # C 2 05 ) /7 � A o Inspection Date Approved Correction Re- Insp'n Fee ro fo V BUILDING Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. ►APO/ f L/ /`I PERMIT APPLICATION Master Permit No. FBC 2001 Building Electrical , Plumbing Mechanical Roofing Owner's Name (Fee Simple Titl 1 -42105 Go4X.41iE5 Phone # ' Permit Type (circle): Owner's Address S1`'i N 1` 1O2 O City NIA w .% s 4462E11 State Ft. City Miami Shores Village County Miami -Dade Job Address (where the work is being done) 51 P E IMP ST Is Building Historically Designated YES NO v Zip 33 Tenant/Lessee Name Phone # Zip 33138 Contractor's Company Name i'exi4E OWt+EA. CA . Z . ''CAW ES Phone # ''S 1S'-( . S S � Contractor's Address 51 4 ktE t02 Sr City I" SMtbW State Ft- Zip 3 3 t3 S 30 2 ? Qualifier State Certificate or Registration No. t Certificate of Competency No. v/A. Architect/Engineer's Name (if applicable) ti1A Phone # W l A $ Value of Work For this Permit ISO°. 0 Square Footage Of Work: Type of Work: ❑Addition ❑Alteration Describe Work: VEpIAc EO 4QoNT pcc2 Total Fee Now Due $ (Continued on opposite side) ❑ New no mo ne Submittal Fee $ Permit Fee $ ! � - CCF $ . d C CO /CC Notary $ Training/Education Fee $ � 7L7 Technology Fee $ CV/ 3 Scanning $ � � Radon $ Zoning �— Bond $ Code Enforcement $ Structural Plan Review. $ * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * ** * * * * * * * * * * * * * * * * * * * * ** 1 5, 1 0 Er Repair/Replace ❑ Demolition Bonding Company's Name (if applicable) Bonding. Company's Address Cit) 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. 1 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 inspec ' which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will t be a proved and a reinspection fee will be charged. Signatu Owner or Agent Th foregoing instrument was a owl dged before me this off, ounc. la day of , 20 by who is personally kn NOTARY PUBI. Sign: Print: My Commissio Expires: * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Chu: 05 to me or who has produced Signature Contractor The fo going instrument was acknowledged before me this day f , 20 , by who is personally known to me or who has produced identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: gas ommission . ;DD2331984 Ex ires: Jul 1.h, 2007 * * * * * * ** , - ** ** *wooded , ********************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ‘. roa loodiflg(o Inc My Conunission Expires: ******************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * ** **Aft * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: Plans Examiner Engineer Zoning BUILDING DEPARTMENT OWNER BUILDER DISCLOSURE STATEMENT VILLAGE OF MIAMI SHORES I '(.r}4LoG 6 ProcitAv S being the legal property owner, for the property Located at: 5 14 Fie •107 �t / !tt 4vt ∎ bite , FL 331 Legally described as , Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S. 489.103(7),And I have read and understand the following disclosure.' Statement, which entitles me td 3,rork as my own contractor, I further understand that I as the owner must appear in person to complete all applications. Proof of ownership provided ( ) DISCLOSURE STATEMENT State law requires construction to be done by licensed contractors. You have applied for a permit under an exemption to that law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the constT uction yourself. You may build or improve a one - family or two-family residence or a farm out - building. You may also build or improve a commercial building at a cost of $25,000.00 or less. The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is completed, the law will presume that you built it for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as your contractor. It is your responsibility to make sure that people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A. and with- holding tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, building codes and zoning regulations. initial of reviewing clerk. The foregoing instrument Was acknowledged before me this day of 20 0`I By a i eiCOCPICTh who is personally known to me or who has Produced as identific . on and who did take an oath. Not gas sevc+u � " ommission #D 3, 2007 =...0..:.-. Bonded Th U InC ,,,,,, , Atlantic Bonding Co • 51.35iq ooT5 o E OoT 50L2 l-zo Se- - om F T £T E PopQ 3 ii s is De fivosE- MIAMI - COUNTY BUILDING CODE COMPLIANCE OFFICE PRODUCT CONTROL DIVISION PRODUCT CONTROL APPLICATION FOR HOURLY RATE SERVICES This application is required to request the issuance of a one -time Notice of Acceptance (NOA), Review of a Proposal, Association Product Submittal, and any other special service provided by our office. Please type or print all the information requested and sign the application in the space provided. APPLICANT'S INFORMATION 4.2-LOC 6a AKA tvE -5 (1) Legal Name of Applicant: (2) Mailing Address: (3) City, State, Zip Code: (4) Name & Title of Contact Person: (5)Telephone / Fax Number: (6) Email address(es): (7) Check only one applicable box (Please see back of application for definitions) ❑ One -Time NOA Address where product will be installed: Name of product or system: Name of product's manufacturer: Manufacturing Location(s): City, State, Zip Code: Telephone / Fax Number. ❑ Proposal Name of produc of s evaluate;, ❑ Associatio � ucub ` tal Name of (The name of the applicant must be the legal name. Trade or D/B/A names are not allowed) Sly NE IDauo sT- t1t'4 tut' SFFaeEB Ft 33( 3 649.105 Zogx4 v g 49. 51 1.909 /givc,E u Ta/2. 3 el7to . 7ssz s Y ?( : i$ 2 5 /.:Hur(G _ 40,x41 e5 e 6RP. Gam PURPOSE OF APPLICATION siq NE /02Nd $T Fee/4J r furPg z€ Ivor 4v4'/44x g - Tk v r bTBIt.+E wgarfi een oR ,✓ /q MIAMI -DADE COUNTY, FLORIDA METRO -DADE FLAGLER BUILDING 140 WEST FLAGLER STREET, SUITE 1603 MIAMI, FLORIDA 33130 -1563 TELEPHONE (305) 375 -2902 FAX (305) 372 -6339 ❑ Additional Review for file No. 0 Group Testing (Product) ❑ Other (Specify) (8) Fees: Initial payment is not required when application is filed. An invoice will be generated upon completion of review requested. When invoice is received, make check payable to "Miami -Dade County Building Code Compliance Office." The legal name of the applicant must be printed on the check. THIS SPACE IS FOR 1HE USE OF THE BUILDING CODE COMPLIANCE OFFICE ONLY Application Number: Date Received: PC .002 Rev. July 2004 Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 11/2/2004 Applicant: CARLOS Owner: GONCALVES JOB ADDRESS: 574 Contractor Local Phone: Parcel # 1132060171030 NE 102 Legal Description: Building Permit Permit Number: BP2004 -1414 GONCALVES CARLOS ST Contractor's Address: Fees: FEE2004 -10763 FEE2004 -10764 FEE2004 -10765 FEE2004 -10766 FEE2004 -10767 Description Building Fee CCF Training and Education Fee Technology Fee Scanning Fee Total Fees: Amount $100.00 $1.20 $0.40 $2.50 $9.00 $113.10 Total Fees: $113.10 Total Receipts: $0.00 Permit Status: APPROVED Permit Expiration: 4/25/2005 Construction Value: $1,500.00 Work: DOOR FRONT Signed: (INSPECTOR) Signed: (Contractor or Builder) BY: Page 1 of 1 PB 15 -14 MIAMI SHORES SEC 4 AMD PLAT LOT 3 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. BLK 94