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EL-05-1130Miami Shores Village Building Department 10050 N.E.2nd Avenue . U ' - - a o • a 33138 Tel: (305) • •_; a 'ufNivg 6 8�� 2 BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Owner's Name (Fee Simple Titleholder) Owner's Address /7 Ali" /07 S7L City fl2 i i err..( State Tenant/Lessee Name N/4 Job Address (where the work is being done) / 7 NE /07 x741.04 Permit No. t as er Permit No. Plumbing Mechanical Roofing mivet/4,, Phone # 75' 2W, ° X3..3/ Zip ilib/ Phone # City Miami Shores Village County Miami-Dade Is Building Historically Designated YES NO i! Contractor's Company Name Contractor's Address /Z City State FI Qualifier Phone #:. Zip Zip s State Certificate or Registration No. EC /3002b73 Architect/Engineer's Name (if applicable) $ Value of Work For this Permit Type of Work: Describe Work: 1» Certificate of Competency No. Phone # 500 ['Addition ['Alteration Replace 1/144er c C r ['New R 1 Sec Square Footage Of Work: Repair/Replace ❑ Demolition Submittal Fee $ Notary $ 5. 00 Training/Education Fee $ Scanning $ 3• o Code Enforcement $ * * * * * * * * * * * * * * * * * ** Permit Fee $ * * * * ** *Fees * * * ** ' G CCF $ . �� CO /CC. Technology Fee $ Bond $ * * * * * * * * * * * * ** Radon $ Zoning Total Fee Now Due $ 16-4. '5 Structural Plan Review. $ (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 inspe tion which occurs seven days after the building permit is issued In the absence of such posted notice, the inspection will n be approved a reins. 'ion fee will be charged Signature Thing inst rument was acknowledged before me this da� . , 20 0 , by jet Co7rat.ov , w o is personally known to me or who has produced /Welt's /it. C 2.3( 4g) "65442 -0 As identification and who did take an oath. wner or Agent NOTARY Sign: A d 'i Print: /bbd? /.63 h Z Signature Contractor 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. NOTARY PUBLIC: Sign: Print: My Commission Expires: r?j MONICA LISSETH DIAZ — *:*51 MY COMMISSION # DD 483995 � - o EXPIRES: October 20, 2009 y '07 Bonded Thru Notary Public Undenvdters ** ************* *** + k+ k***# ***#******#*?k** ** *** APPLICATION APPROVED BY• chc 05113/03 My Commission Expires: ecc Plans Examiner Engineer Zoning ADDENDUM I U bUiLU1NEI rCmmi ! hi-r Limon ivy. AN AEPLITCATION 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 APPLICATIONS.) 1 PLUMBING ELECTRICAL MECHANICAL FEE IT SPACE HEATERS UNIT FEE TEM ATH TU3 UNIT FEE ITEM UNIT SWITCH OUTLETS CENTRAL HEATING LIGHT OUTLETS -- IDET A/C (WIND) I RECEPTACLES ISHWASHER A/C (CENTRAL) SERVICE TEMPORARY iISPOSAL DIE WORK SERVICE SIZE IN APS PINKING FOUNTAIN REFRIGERATION __ SERVICE REPA I R/}ETER CHANGE .L OOR DRAIN PRESS PIPING __ APPLIANCE OUTLETS IREASE TRAP UNDERGROUND TANKS I RANGE TOP INTERCEPTOR ABOVE GROUND TANKS OVEN -_ _AVATORY U.F. PRESSURE VESSELS TRAY WATER HEATER _AUNTRY STEAM BOILERS WASHER -_ MOTORS 0- 1 }P :LOTHES HOT WATER BOILERS SOWER MOTORS OVER 1- 3 H' -- MECHANICAL VENTILATION POT /3 COMP. MOTORS OVER 3- 5 If 3INK, TRANSPORTING ASSEMBLIES SINK, RESIDENCE MOTORS OVER 5- E HP ELEVATORS/ESCALATORS __ MOTORS OVER 8- 10 FP ,INK, SLOP - FIRE SPRINKLER SYSTEM TEMPORARY WATER CLOSET __ MOTCRS OVER 10- 25 HP URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET -_ MOTORS OVER 100 i-F VIOLATION ItCIRECT WASTES I A/C WINDOW REINSP.ECTION WATER SUPPLY TO: } AIR CONDITIONERS A/C UNIT STRIP HEATER I FIRE SPRINKLER } GENERATORS TRANSFORMERS I HEATER -NEW INST. } GENERATORS TRANSFORMERS I HEATER - REPLACE __ GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL __ SPECIAL PURPOSE I SWIMMING POOL __ OUTLETS COMMERCIAL WATER SERVICE -_ SIGN TUBES SEWER CONNECTIONS _!'SIGN TRANSFORMERS UTILITY-SEWER SIGN TIME CLOCK UTILITY -WATER FIXTURES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS DRAINFIELD, G' TILE/RES. VIOLATION I RUM' & ABANDON SEPTIC TANK RE INSPECT ION SOAKAGE PIT CU. FT CATCH BASIN DISCHARGE WEL L -_ DOMESTIC WELL AREA DRAIN I I ROOF INLET I I SOLAR WATER HEATER, FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM' GAS RANGE I METER SET (GAS) _I ! I I I I . E I F w I 1. it NOV 14 2005 MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date f(/f©g Type Insp'n c U r4N f lW Waged 6 j Of /Ali( Permit No. rlb — I Name (1L7 + r1�57iatuvec Address l'7 lad SST Company Kc . tleil(( Sot VICO, Phone #5 13'} Inspection Date /1('/65 ® Approved ❑ / l� Correction ry Re- Insp'n Fee ❑