EL-06-1743Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel
BUILDING J�
PERMIT APPLICATION BY:
FBC 2004
Permit Type (circle): Building Electrical
Owner's Name (Fee Simple Titleholder) 5150. h A to r
Owner's Address 1 a-3y NF a at .
.E 756.8972
o. ' � n's-S , Permit N V�
_ Master Permit No. 06' \ 'i
&dO6 -esog----
Mechanical Roofing
ne # -JDs
L 2 0 2006
City (V1 icJt..rY11 Sko (2.S State
Zip
Tenant/Lessee Name Phone #
Job Address (where the work is being done) )-34 NJ E 5+ •
City Miami Shores Vill. e County . Miami -Dade Zip 33 l % $
FOLIO / PARCEL # 1 l '' -2Jai„0(p — 0141 331 30
Is Building Historically Designated YES NO
Contractor's Company Name Pip elude f(tirn,b /Nq NC., Phone # ?,s4/ - 6go -'/ jj
Contractor's Address -P. O, R., x 5 313-9 9 J
City r" / c'-l) ii,,,,. a State Ft_ Zip 33 / ,5 -3
Qualifier Name `„f -e F1 ThSS 0) Phone#
State Certificate or Registration No. C. F c. ®.5 a f,. ,T S Certificate of Competency No.
Architect/Engineer's Name (if applicable)
Phone #
Value of Work For this Permit $ 3 So - Q ® Square / Linear Footage Of Work:
Type of Work: ❑Addition
Describe Work:
New
❑ Repair/Replace
❑ Demolition
*** *** * * * * * * * * * * * * * * *** ** *** * ** *** * ** Fc46* jy*********** * ** *** * * * * * * ** * * * **** * * ** ** ** **
Submittal Fee $
Permit Fee $
Notary $ Training/Education Fee $
Scanning $ Radon $ DPBR $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $
CCF $
COICC
Technology Fee $
Zoning $
Total Fee Now Due $
See Reverse side -+
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable) '{
Mortgage Lender's Address PO 7t 78 ) q
1
City P kb e, 1 State ft" 2, Zip sW 6 0 b ,4 ° 9 1
Application is hereby made to obtain a permit to clothe 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 MR 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 ; of be approved and a reinspection fee will be charged.
Signature Signature
��' � �- � -- � ,-- Si gn
Owner or Agent
The foregoing : nstrument was acknowledged before me+ is / .. The foregoing instrument was acknowledged before me this
i
day of by -�� day of , 20 , by
who is so ly known to me or who has produced J� �d who is personally known to me or who has produced
As identifies ' e� ®�� ho e an oath. ation and who did take an oath.
NOTARY _ �,lr x
��}� e1 NOTARY Pas
c LI t
C: YSSIO�} Fns ��tiurrri
F�
Y�I11(A:..x_• UZ�FfI� i� 9��/i l' .,d
`WU4Y(Y(n n rift
Sign: ��' wpm Sign:
Print: Print:
My Com ission Expires: My Co
* * * * * * *'. * * * * * * * * * * * * ** * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
(Revised 02/08/06)
Plans Examiner
Engineer
Zoning
AN AL'PLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B.
OBT/ NED" THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ELECTRICAL
MECHANICAL
ITEM
3ATH TLB
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
3IDET
LIGHT OUTLETS
CENTRAL HEATING
3ISHWASHER
RECEPTACLES
A/C (With)
)ISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL)
DRINKING FOUNTAIN
• SERVICE SIZE IN AMP'S
DUCT WORK
FLOOR DRAIN
SERVICE REPAIR/METER CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE CUTLETS
PROCESS AND PRESS PIPING
I HTERCEPTOR
RANGE TOP
UhDERGROUND TANKS
LAVATORY
OVEN
ABOVE GROUIC TANKS
LAUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
MOTORS 0- 1 P
STEAM BOILERS
SHOWER
MJTCRS OVER 1- 3 FP
HOT WATER BOILERS
SINK, POT /3 COMP.
MOTORS OVER 3- 5 FP
MECHANICAL VENTILATION
SINK, RESIDENCE
MJTCRS OVER 5- 8 FP
TRANSPORTING ASSE& LIES
SINK,• SLIP
MJTCRS OVER 8- 10 FP
ELEVATORS/ESCALATORS
TE1PDRARY WATER CLOSET
MJTCRS OVER 10- 25 HP
FIRE SPRINKLER SYSTEMS
URINAL
MOTORS OVER 25-100 FE'
COOLING TOWERS
WATER CLOSET
MJTCRS OVER 100 FP
VIOLATION
INDIRECT WASTES
A/C WINDOW
REI,NSPECTJON
WATER SUPPLY TO:
AIR CONDITIONERS
A/C UNIT
STRIP HEATER
FIRE SPRINKLER
GENERATORS TRANSFORMERS
HEATER -NEW INST.
GENERATORS.TRANSFORMERS
HEATER - REPLACE
GENERATORS TRANSFORMERS
LAWN SPRINKLER -WELL
SPECIAL PURPOSE
SWI13AING POOL
OUTLETS COMMERCIAL
WATER. SERVICE
SIGN TUBES
SEWER CONNECTIONS
...SIGN TRANSFORMERS
UTILITY -SEWER
SIGN TIME CLOCK
UTILITY -WATER
FIXTURES
SEPTIC TANK
RELAY
ANTENNA
)RAIHFIELD,
TELEVISION OUTLETS
4" TILE/RES.
'lh,P
VIOLATION
& ABANDON SEPTIC TANK
OAKAGE
RE I NSPECT ION
PIT CU. FT.
:ATCH
BASIN
)ISCNARGE WELL
)OMESTIC WELL
•
AREA. DRAIN
00F INLET
OLAR WATER HEATER
IRE
j
STANDPIPE
DOL
I
PIPING
AWN SPRINKLER SYSTEM
AS
•
I
RANGE
STEP, SET (GAS)
AS PIPIK: