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MC-07-1784BUILDING PERMIT APPLICATION1444� FBC 2004 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 2-2—d Olti^ Mk 2 2 mg Permit No. W-01 _ nc q Master Permit No. Permit Type: Mechanical Owner's Name (Fee Simple Titleholder) ez-V{ r� Phone # $ - SB--Q_ Owner's Address 1 - City 1 1, Vii State °F L_ Tenant/Lessee Name E- MAIL: Job Address (where the work is being done) 3'0 1 /1/4)-C— OL42,4 City Miami Shores Village County Miami -Dade FOLIO / PARCEL # �, 3� ®� 1> Zip °.ai 4 3 'e Phone # Zip 3 `� Is Building Historically Designated YES NO Contractor's Company Name �— Phone # s— p 6 &2 20 Contractor's Address (,k) 6-k._ City }'l.\ Q Z State -F-,.L Zip 15 4 Qualifier Name lv'C\ '1---0-‘.2-0-6, t j /,, Phone # .3r.,5 —S c — .&9....2� State Certificate or Registration No. CAC_. ., y lL-- 32. IS, , Certificate of Competency No. E -MAIL: Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ Square / Linear Footage Of Work: Type of Work: ElAddition ['Alteration ❑New J Repair /Replace ❑ Demolition Describe Work: L 0---X 1 h , Q. A/ C e -t- ********* ** * * * ** * * ** * * * * * * * * * * * * * * * * * *Fe ************* ** * * * * * * * * * * * * * * * * * * * * * ** * * *x** Submittal Fee $ Permit Fee $ F I O V CCF $ 42-0 CO /CC Notary $ Training /Education Fee $ 1 • i.J Technology Fee $ 5 -ko Scanning $ 6129 Radon $ DPBR $ Zoning $ Double Fee $ ?M 010 6 2. Total Fee Now Due $ 2 IS. '. See Reverse side ---> Bond $ Code Enforcement $ Structural Review. $ 043 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 abse ce of s posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature wner or Agent The foregoing instrument was acknowledged before me this day of ,20_,by who is personally known to me or who has produced • As identification and who did take an oath. NOT MILAGROS MIRANDA MY COMMISSION # DD638596 - ` o" p+TIRES: February I I, 20I I S'. Prin a f%1 My Commission Expires: Signature actor The foregoing instrument was ac nowledged before me this day of ,20,by who is personally known to me or who has produced as identification and who did take an oath. NOT MILAGROS MIRANDA= MY COMMISSION # DD638596, EXPIRES: February 11, 2011- tut Assoc. Co. Print: My Commission Expires: ** *Sc,4****xxdex **xxxz9exxxx**** &feu **** ****eY************ xxsYxx**** xs4***dr **************** &*&xxx &xxxo **as xxx****xx APPLICATION APPROVED BY: (Revised•02 /08/06) Plans Examiner Engineer Zoning AN ADPLI CAT ION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM, IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT S.} PLUMBING ELECTRICAL ( MECHANICAL ITEM 3ATH TLS UNIT FEE ITEM 1TE SWITCH CUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE 31DET LIGHT OUTLETS CENTRAL HEATIN G k.) OA) 3ISHWASHER RECEPTACLES A/C (WIND) )ISPOSAL SERVICE TEMPORARY A/C (CENTRAL) 173,N JRINKING•FCUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR MAIN SERVICE REPAIR/METER CHANGE REFRIGERATION GREASE TRAP APPLIANCE CUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TCP UNDERGROUND TANKS LAVATORY OVEN ABOVE GROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 HP STEAM BOILERS SHOWER MOTORS OVER 1- 3 HP HOT WATER BOILERS SINK, POT /3 COMP. MOTORS OVER 3- 5 If MECHANICAL VENTILATION SINK, RESIDENCE _ MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES SINK, SLOP MRJTCRS OVER 8- 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE'SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET • MJTCRS OVER 100 HP VIOLATION INDIRECT WASTES A/C WINDOW RELNSFECTJON WATER SUPPLY TO: AIR CONDITIONERS A/C UNIT STRIP HEATER FIRE SPRINKLER 'HEATER-NEW GENERATORS TRANSFORMERS INST. GENERATORS-TRANSFORMERS HEATER - REPLACE . GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIMMING POOL OUTLETS COI4iERCIAL WATER SERVICE - SIGN TUBES EWER CONNECTIONS (NMI-SEWER ,,SIGN TRANSFORMERS IT SIGH TIME CLOCK I L I TY -WATER EPT F I XT1 RES I C TANK ELAY •ANT ER1A . TELEVISION OUTLETS RAINFIELD, 4" TILE/RES. UM') VIOLATION & ABANDON SEPTIC TANK DAKAGE REINSPECTION PIT CU. FT. ATCH BASIN ISCHARGE WELL OM+ISTIC WELL 3EA DRAIN )OF 1 INLET , )LAR WATER HEATER 'RE STANDPIPE IOL I PIPING ,WN SPRINKLER SYSTEM: I ` S RANGE TER SET (GAS) ' ( ! S PIPIN f P . Ag opos Customer Name MO tosizes-vAZ 'Sem cw-e-e, Date Address C- °Oa-Sit% 4S1— e^' Ot—zE - - izc Work Order # City VICA, State F Zip Home Ph. (305 ) 4 6-53 Zi3 3 "IL Work Ph. (30 5) 336 - kagEmail Use eiisting-diOt1006t;',• [i]Rebate New circuit fro,n1:0NOrige Auta- deptive SY NM :,TON INCLUDES All labor ✓ Performance Control Center 0 Standard 0 Electronic 1424ogrammable All required permits • Removal and proper disposal of old equipment • Check entire system for safety and efficiency J Check and reseal minor leaks in exposed ducts One year sc zter rti t.a SPECIAL AIR TMENT PRODUCTS FOR New Relocate EaY 4.ccessailet circutt-frOrn: exlsttg fl NeVv wir .rottt Roans. :9Addsu ROVING ME OU MicroGuardian. Air Scrubber 0 Quantum 254. UV Sterilizer 0 OxyPure. Air Enrichment System 0 OxyQuantum. Combination System 0 Micro PowerGuard. Air Cleaner 0 ToraVac. Source Removal System y years on parts and labor IC> years on compressor eXPlained on the reverse si ons ex-Ohenger COO -tio*rust_raq011 No Surprises The nvestment quoi iswatyou pay 4;00,014 Respect. Our technicians will 19*0.000biY4W000eqiiii*W-'- ie$irttr'cohten*iht leave ur home aeat installation will comp1ywifli ale ing4 cpdes Drtg Pies Yourwork will associates. Satisfactkm We ' uaraNte4Jiat ,00rsYst06ii09$:' F.41' tz crts-1-1 * We hereby propose to complete work as specified above for the sum of: r•LI1004 Back • ducvtdle _ . Payment terms: Financed* 25% de Company approval by Customer approval by Customer approval by *Subject to approval by finance company. Certain restrictions apply ©2001 Venvest, Inc. All Rights Reserved sit. Balance due upon installation D..- .';■.7M.‘WA,;.. • /.-/-z41 Date Finance .cptton* Monthly investmelif Buyer hereby declares that buyer holds title to propettron which merchandise is being installed and has legal author to order the work outlined above. The seller retains title to all materials and property listed herein until payments have been made in full. Accounts not paid within 30 days of invoice receipt are in default and subject to a late payment charge of 1-1/2% per month or 18% annually. Buyer agrees to any reasonable attorney's and/or collection fees incurred by seller to secure payment of this contract.