MC-05-1244 Miami Shores Village RE-- EPYED
Building Department _
® 1 5 29,5
:10050 N.E2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fag:(305)756.8972
BUILDING Permit No. C IZ-105 ' lz+i_
PERMIT APIPLICATION Master Permit No
FBC 2001
Permit Type(circle): Buildin Electrical Plumbing -)jj!!kanica Roofing
Owner's Name(Fee Simple Titleholder Phone#
Owner's Address H11 KI.E . 91r-T
City M I State Zip
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Tenant/Lessee Name Phone# —~
Job Address(where the work is being done) I 1 ��.�. �S1 aniTgeaT
city Miami Shores Village County Miami-Dade Zip
LT
YES NO__X_
Contractor's Company ame �-T 11 �, �'S. Th�(_�i. Phone#
Contractor's Address 6'® c� 3
City &T " -.2 State ICZ7 Zip ��' �✓
QualifierC..
State Certificate or Regis tion No.�_.� ®� Certificate of Competency No.
Architect/Engineer's Name(if applicable) Phone#
av
Square Footage Of Work:
�Type-o )gAd*fion DAlteration ❑New ❑ Repair/Replace
❑Demolition
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Submittal Fee$ Permit Fee$ � CCF$ Q CO/CC.
Notary$ -,QQ Training/Edu0cation Fee$ Q. Z O Technology Fee$ -Z -
Scanning$ --P% Radon$ Zoning Bond$
Code Enforcement$ Structural Plan Review.$
Total Fee Now Due$ t
(Continued on opposite ide)
II
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 z
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.
MONICALMMIAZ
Sign: Sign: MY eMMSION#DD 48M
Print: Print: 1fW169 7i�, s anN, v u
My Commission Expires: My Commission Expires:
APPLICATION APPROVED BY: Plans Examiner
Engineer
Chc 45/13/03 '
Zoning
i
ADDENDUM TO BUILDING PERMIT APPLICATION
(AN APPLICATION 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.)
PLUMBING ELECTRICAL MECHANICAL
ITEM UNIT FEE ITEM UNIT FEE ITEM UNIT FEE
BATH TUB SWITCH OUTLETS SPACE HEATERS
BIDET LIGHT OUTLETS CENTRAL HEATING
DISHWASIS RECEPTACLES A/C (WIND)
DISPOSAL SERVICE TEMPORARY A/C (CEO)
DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK
FLOOR DRAIN SERVICE REPAIRAJETER CHANGE REFRIGERATION
GREASE TRAP APPLIANCE GMETS PROCESS AND PRESS PIPING
INTERCEPTOR RANGE TOP UNDERGROUND TADS
LAVATORY OVEN ABOVE GROUND TANKS
LgJNDRY 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 HP MECHANICAL VENTILATION
SINK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES
SINK, SLOP MOTORS 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
MATER CLOSET MOTORS OVER 100 HP VIOLATION
INOIRECT WTES A/C WINDOW REINSPECTION
WATER SUPPLY TO: AIR CONDITIONERS
A/C UNIT STRIP HEATER
FIRE SPRINKLER GENERATORS TRANSFORMERS
'HEATER-NEW INST. GENERATORS TRANSFORMERS
HEATER-REPLACE GENERATORS TRANSFaWERS
LAWN SPRINKLER-WELL SPECIAL PURPOSE
SWIMMING PDOL OUTLETS MMMERCIAL
WATER SERVICE SIGN TUBES
SEWER CONNECTIONS SIGN TRANSFORMERS
UTILITY-SEWER SIGN TIME CLOCK
UTILITY-WATER FIXTURES
SEPTIC TANK ANTENNA
RELAY' TELEVISION OUTLETS
DRAINFIELD, 4' TILE/RES. VIOLATION
PUMP 8 ABANDON SEPTIC TANK REINSPECTION
SOAKAGE PIT CU. FT.
CATCH BASIN
DISCHARGE WELL
C0h1ESTIC WELL
AREA DRAIN
ROOF INLET
SOLAR WATER HEATER
FIRE STANDPIPE
POOL PIPIM
LAWN SPRINKLER SYSTEM I
GAS RANGE
METER SET (GAS)
GAC P IP INS
Miami Shores Village
10050 N.E.2nd Avenue
Miami Shores, FL 33138-0000
Phone: (305)795-2204 Fax: (305)756-8972
Permit
Permit Status:APPROVED
Issue Date: 31912006 Expires: 12/1512006 Permit Number: MC-12-05-1244
Owner's Name: JOHN AND ELAINE HAMLET
Phone:
Permit Type: Mechanical-Residential Parcel#: 1132060133310
Work Classification: Addition/Alteration
Block: Lott
Job Address: 117 91 Street NE Section: PB:
Miami Shores Village, FL 33138-
Contractor(s) Phone Primary Contractor
Total Square Feet: 0
A TECH SERVICES INC Yes Total Valuation: $ 250.00
Comments: Re uired Ins ections
BATHROOM FAN Rough
Rough Duct
Ventilation
Smoke Test
Additional Information Hood
Smoke Det Test
Tons: Additional Info:
Final
Classification:Residential
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.
Fees Due Amount Invoice Number Amt Due Amt Paid
CCF $0.60 MC-3-06-24079 $111.30
Education Surcharge $0.20 Total:
Notary Fee $5.00 in 02
Permit Fee-Additions/Alterations $100.00
Scanning Fee $3.00
Technology Fee $2.50 �,Q
Total: $111.30
Building Department File Copy 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.
Applicant Signature
III