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CC-13-1548, 311Miami Shores Village �I f Building Department OCT 2013 J 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 7. Tel: (305) 795.2204 Fag: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 FBC 20. BUILDING Permit No. PERMIT APPLIC r Permit No. CC l 3 e -Y1-W Permit Type: BUILDING ROOFING ,TOB ADDRESS: 9999 NE 2 Ave. suite 311A City: Miami Shores County: NFiiami Dade ; 33138 Folio(ParceW Is the Building Historically Designated: Yes NO no FloW Zone: OWNER: Name (Fee Simple Titleholder): Alex Edelman Phone#: 786.290.0565 Address: 9999 NE 2 Ave City. Miami S/g / ^r 5 State: ti Z;p; 33138 Tenant&essee Name: Dr. Jay Stein Phone#. 305.751.2850 �LGt �-G-@ -) - 3- �? LN --2-7 CONTRACTOR: Company Nara: Art, Design and Construction Inc phonet 305.461.3590 Address: 3075 NW South River Drive city: Miami Ste. FL gip; 33142 Qualifier Name: Bruno Ramos Phone#: 305.461.3590 State Certification or Registration #: 033989 Certificate of Competency #: Contact Phone# 305.461.3590 Email Address: adrlan @bea.com DESIGNER: Arcli tectlEngineer: Phones Value of Work for this Permit: $ '�"t9a . Footage of Work: Type of Work: ❑Addition ❑Alteration o]New URepair/Replace LIDerolition Description of Work: office space build out new interior walls Color thru tile: Submittal Fee $ Permit Fee $ CCF $ MCC -$ Scanning Fee $ Radon Fee $ DBPR $ Bond. $ Notary $ TraiuWEducation Fee $ Doable Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $--A- 4 Bonding: Company's Name (if applicable) Bonding Company's Address city State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City zip State I 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 commended 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 CONDdENCEMENT:" 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 caminencement 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 rewspection fee will be charged X Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing ' insUungnt was acknowledged before me this I day of 20 by day of 20 L &, by r3 �- . C who is personally known to me or who has produced- who is personally known to me or who has produced As identifcation and who did take an oath. _as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: APPROVED BY NOTARY Plans Examiner FRANCHESKA LAM W COMMISWN # EE117340 EXPIRES July 31, 2015 b11tS zoning Structural Review Clerk (Revised 3 /12/2012XRevised 07 /10WXRevised 06/1=009XRevised 3/15189) -. Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 November 4, 2013 Permit No: CC13 -1546 Building Critique Review 11 -04 -13 FIRE APPROVAL REQUIRED. Ismael Naranjo Building Official Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RECEIPT PERMIT #: 6!� 13 %f Wb DATE: J / "�- l Ae/ ele, ntractor • Owner • Architect Picked up 2 sets of plans and (other) Address: From the building department on this date in order to have corrections done to plans And /or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Building Department to continue permitting process. Acknowledged by: PERMIT CLERK INITIAL: RESUBMITTED DATE: 4c- PERMIT CLERK INITIAL: 1" NOTE: ALL SHEET MUST BE REVIEWED MIAMI -DADE COUNtY DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES Herbert S. Saffir Permitting and Inspection Center 11805 SW 26th Street (Coral Way) • Miami, Florida 33175 -2474 • (786) 315 -2000 APPLICATION FOR MUNICIPAL PERMIT APPLICANTS THAT REQUIRE PLAN REVIEW FROM MIAMI -DADE FIRE RESCUE AND /OR ENVIRONMENTAL SERVICES PROVIDE MUNICIPAL PROCESS NUMBER HERE 6 VF Job Address �� :3114 Contractor No. LL� o w Folio ( o�� ! �-I-- �z o o — Last four (4) digits of Qualifier o2 Lot Block Contractor Name �-� °C Qualifier Name o no Subdivision PBpg v z Address City State _Zip Metes and bounds [ ] New Construction on [ ] Demolish �,� Current use of properly 96C ��'� v� Vacant Land [ ] Shell Only Z o [ Alteration Interior [ ]Addition Attached 5176(y r w [ ] Alteration Exterior [ ] Addition Detached Description of Work l2 po [ ] Relocation of Structure [ ] Re -Roof [ ]Enclosure [ ] Foundation Only Sq. Ft. Units Floors _ [ ] Repair [ ] Repair Due to Fire [ ]Tent Value of Work 09 a �� [ 1'] MBLD' [ ] Chg. Contractor Owner 4 zelolm �-A Address �'9 ,yrs C4 Ike Uj Category N [ ] Re -Issue W Q [ ] MELE N [ ] Re -Stamp y City State Zip [ ] MLPG [ ]Revision z Phone Last four (4) digits of cc a [ ] MMEC [ ] Not Applicable for $ FIRE ¢ Fire o Owner's Social Security No. OZ Name / 6 �� Owner Address 9ce z / 15 4'y d ,7 V a Ewa `�� / �3 Address X5 a F z , City fir" State Zip e � City State _Zip W Y v a IL s Phone 3- Z �� Y � ? ,c � �d W Phone I am requesting a Special Request Plan Review (SRI) to be scheduled as soon as possible at the rate of $190 for the first hour and $65 per each additional hour in addition to the review fees. Minimum charge one -hour vat L"-, 1- Request: Date: LLW E 2- Request: YDate: cc 34 Request: Date: I am requesting Optional Plan Review (OPR) to be scheduled as soon as possible at the rate of $75 for each discipline. a a Additional review fees may apply. 0 o f= 1111 Request: Date: _ o 2 "d Request: Date: LU31' Request: Date: 123 01- 192 6/13 BUILDING PERMIT CATEGORIES CATEGORY DESCRIPTION PERMIT TYPE BUILDING 01 GENERAL BUILDING - COMMERCIAL MBLD 02 SUB- GENERAL BUILDING - RESIDENTIAL MBLD 08 CANVAS AWNING MBLD 10 COMMUNICATION TOWER MBLD 15 DEMOLITION MBLD 29 METAL AWNING & STORM SHUTTER MBLD 48 SCREEN ENCLOSURES MBLD 55 SWIMMING POOL MBLD 56 TENNIS COURTS (SURFACE PAVING) MBLD 86 TRAILER TIE DOWN MBLD 88 WALK -IN COOLER MBLD 91 MARINAS MBLD 92 LOW SLOPE APPLICATIONS (GRAVEL, SMOOTH MODIFIED, SINGLE PLY) MBLD 95 SHINGLES (ASPHALT, FIBERGLASS) MBLD 96 SHINGLES (METAL ROOFS/WOOD SHINGLES & SHAKE) MBLD 97 STAGE 2 VAPOR RECOVERY SYSTEM MBLD 99 SOIL IMPROVEMENT MBLD 0100 BULK STORAGE PROP�NE TANK MBLD 0101 REMOVABLE STORM PANELS MBLD 0107 TILE ROOF MBLD 0110 WATER MAIN MBLD 0111 SITE PLAN MBLD 0112 INDOOR EVENT /EXHIBIT MBLD ELECTRICAL 04 FIRE ALARM SPECIALTY MELE 16 SPECIALTY WIRING MELE 38 GENERATORS MELE LPGX 01 LIQUEFIED PETROLEUM GAS MLPG 02 MISCELLANEOUS MLPG 04 LIQUEFIED PETROL. GAS /STATE MLPG MECHANICAL 09 ABOVE/BELOW GROUND TANKS /PUMPS & POLLUTANT STORAGE SYSTEM MMEC 38 COMMERCIAL HOODS MMEC 43 FIRE CHEMICAL MMEC 46 SPRAY BOOTHS MMEC 48 SMOKE CONTROL MMEC 52 RESIDENTIAL ELEVATOR MMEC FIRE 32 FIRE SPRINKLER FIRE Effective and easy to insW, 3M —Fire Barrier Sealant CP 25WB+ is part of a family of 3M Fire Protection Products that offers affordable, long - lasting solutions for a variety of commercial, industrial and residential applications— brought to you by 3M, the #1 brand preferred by firestop contractors. Features and Benefits • Versatile for use in multiple firestoppmg applications • Listed systems for ratings up to 4 hours • Water - based and paintable • More than 600 UL and Intertek listings • Easy to identify red color • Easy to apply • Meets the intent of LEED11 VOC guidehries* • Minimizes noise transfer --STC- Rating of 54 when tested with STC 54 -rated wall assembly Applications • HVAC Ducts and Vents • Metal Pipe • Plastic Pipe`* • Blank Openings • Cable Trays • Insulated Pipe • rnpc dilu udune INTuuynl- rtansuduundb • Busways • Construction Joints • Combos • Concrete Floors • Static Construction Joints *Helps reduce the quality of indoor air contaminants that may be odorous, irritating and harmful to the comfort and well -being of the installers and occupants. <250 gfL VOC contents (less H2O and exempt solvents). * *Check UL directory. Not approved far use with CPVC pipes made using NoveonA resins. Ordering Information E� specifications 3M'" Fire Barrier Sealant CP 25WB+ shall be a -c ready -use, v: gun- grade, latex -based intumescent firestoa seal c Y f a nPiw of 3 times its dried volume when exposed to to e F The material shall be thixotropic and shall be ap icable the d, erti horizontal firestops. The sealant shall be listed by ind t test allencies as UL, intertek or FM. 3M' Fire Barrier Sealant CP 15 be d up to hours in accordance with the criteria of ASTM E 814 (Li and T t M for R Tests of Penetration Firestop Systems, ASTM E 1966 ( %4tarw etlnc for Fire Resistive Joint Systems and CANtULC S115 Sunda Metho of ests of Firestop Systems. 3M'° Fire Barrier Sealant CP 25WB -4 m a}th IBC, IRC, AFC, IPC, IMC, NFPA 5000, NEC (NFP 741,,�t NF A 1 is W tt 0 Z > 0 NE 3M" Fire Barrier Sealant CP 25WB+ 10.111. o7. Cartridge 000- 51115 - 11636-4 :O 12 27 ft. oz. Camft 000- 51115 - 11641 -4 6 98040053623 20 ft. oz. Sausage 000- 51115- 11642 -1 10 98040053631 2 Gallon Pail 000 - 51115.11639 -1 1 98040053807 5 Galion Pail 000- 51115- 11640 -7 1 98040053815 LISTED ,■■,fi�ee.. ■w NpSstNO, LMM �6A ode FIf1 U V SOUND BARRIER o'i,� �/ vONA10 P` Us SURJECT TOTW CONDIigNS OF APPROVAL LISTED FlU vow ORCAVITYMATMAL csw Intertek AS WALL & FLOOR PE ETRATHM FOR USE w lntertek tRESPOPSYSTEMS FRESTOPW IEN NSTALED AS DESCRIBED Fan vow OR CAmY (#;ESTOP SYSTEMS FURESTOP SYSTEMS SEE NTERTECDIRECTORY LATHE CURRENT EDITION OF THE FMRC MWEIIAtS SEE UL FBA RESISTANCE D907ORY SEE WTERTEK DIRECTORY APPROVAL GLIDE 9DG9 9OG9 Building and Comffeereiai 3M Cuter Bull ft 223 -2N -21 SL Pad, MIN 55144-1000 804 -328 -1687 www3M.com/firestop www.3M.com /fireprW Warranty and Limited Remedy Warranty and Limited Remedy: 3M warrants that each 3M Fire Protection Product will be free from defer in material and manufacture for 90 days from the date of pimhase from 3M's auWized distributor. 3M MAKES NO OTHER S(PRESS OR IMPLIED WARRANTIES, INCLUDING ANY IMPLIED WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE If a 3M product does not dxxdann to this 112ramy, ft SOIe and exclusive remedy is, at 3M's option, replacement of the 3M M OCt or refund in the prctase price. LisdUtiou of LW W. Except where prohibited by haw, 3M will not be liable for any Ioss or damage arising from the 3M p-04 whetter direct, i ndrecL special, incidenFd of consequential, regardless of the legal theory asserted. CO F g \� W W cc U CL CL L) U (� p R.i w i� © 3M 2011. All rights reserved. 3M is a trademark of 3M. AA other trademarks Printed in U.S.A. 98- 0213- 4638 -6 Please recycle. are the property of their respective owners. System No. W L-1Q96 April 24, 2002 F Rating -2 Hr T Rating -0 Hr SECTION A —A C m U) L Q v U_ NL P r M N N Q N W z M t� tr� 1. Wall Assembly —The fire rated gypsum wallboard/stud wall assembly shall be constructed ofthe materials and in she manner described in the individual U300 or U400 ScricsWall or Partition Designs intheULYneResistanoeDirectoryandshall include the following construction features: A. Studs —Wall framing may consist of eithawood studs or steel channel studs. Wood studs to consist of nom 2 by in. limber spaced 16 in. OC with nom 2 by in, lumber end plates and cross braces. Steel studs to be min 3-5 /8 in. wide by 1 -3/8 in deep channels spaced max 24 in. OC. B. Gypsum Board* — Two layers of nom 5/8 in. thick gypsum wallboard, as specified in the individual Wall and Partition Design. Max diam of opening cut in gypsum wallboard layers is 3-9/16 in. C. Farmers —When wood stud frammg is employed, gypsum wallboard attached to studs with cement-coated nails as specified in the individual Wall orPartition Design. When steel channel stud framing is employed, gypsum wallboard attached to studs withType S self - drilling, self- tapping bugle -head steel screws as specified in the individual Wall or Partition Design. Dian of cacnlarthroughopening cutthrough both layers ofgypsum wallboardon each side ofwall assembly to be min 1/4 in. to max 11/16 in. largerthan outside diam of flexible metal piping (1tem2) installed in through opening. Side edge of circular opening to be min 3 in. ftm nearest stud in wall cavity. 2 Through Penetr,$ting Product* — Flexible Metal Piping Nam 2 in. diam (or smaller) steel ficcible metal piping. Max one flexible metal piping to be mstaRednear center of circular opening in gypsum wallboard layers. Flexible metal piping to be rigidly meted on both sides of wall assembly. Plastic covering on piping shall be removed for a distance of 2 ft on loth sides of wall assembly. WARD MFG INC 3. Fd1,Yoid or Cavity Material* — Caulk — Caulk fill material forced into annular space around entire circumference of through penetrating product to completely fill nom 1 -1/4 in. deep opening in gypsum wallboard layers on each side ofthe wall assembly. 3M COMPANY —CP 25WB+ *Bearing the UL Classification Mark h C A O C 11 AD O L .0 ,C • 3 to CL U =WW wo aftaled rind dtottti by ZA Fire howft hafink ftm® In 2W eft in of 16 UL No dlitetlary.. emw 3N Fibre Protection Products dhn rs�artli t-dlf -3i tbsl www.I.CM/ W +1096.1 of 1 Gmeolift4forFAXORM 111 3 O C tt3 s co sv 3 O �N tri -ll O W t0 W D (0 0) 0) Z D, M N U) W 1 s System No. W L-12% February 14, 2008 F Ratings -1 and 2 Hr (See Item 1) T Ratings -0 and 1/4 Hr (See Item 1) SECTION A-A 1. Wall Assembly -The I or 2 hr fire rated gypsum board/studwall assembly shalt be constructed of the materials and in the manner described m die individual U300, U400 or V400 Series Wall and Partition Design m the UL Fire Resistance Directory and shall incMdetbe following construction features: A. Studs -Wall flaming may consist of either wood studs or steel channel studs. Wood steads to consist ofnom 2by4 m. (51 by 102 mm) lumber spaced 16 in. (406 mm) OC. Steel studs to be min 3-1/2 in. (89 mm) wide spaced max 24 in. (610 mm) OC. R Gypsum Board* -The gypsuna board type, thidiawss, mamba of layers, fastenertype and sleet orientation shall be as specified mthe p individual U300, U400 orV400 Series Design in the UL Fare Resistance Directory. Max diam of opening is 10-518 in. (270 mm). p C. Sim Sleeve - (Optional, Not Shown) - Cylindrical sleeve fabricated from min 0.019 in. Brick (0.48 mm) gals sheet steel andbaving a mint in. (51 mm) lap along the longitudinal scam. Length of steel sleeve to be equal to thickness ofwall. Sleeve installed by coiling y the sheet steel to a diam smaller than the thmugb opening, inserting the coil through the openings and releasing the cog to let ituncod tp again&t the circular cutouts in the gypsum wallhoard layers. • The hourlyF Rating ofthe flrestop system is equal to the hoiuty fire rating ofthewall assembly iR which his installed. �+ The hourlyT Rating is 0 and 114 Hr for 1 and 2 Hr rated assemblies, respectively. 2. Through Penetrants -One metallic pipe, conduit, tubing or flexible metal pipe installed concentrically or eccentrically within opening. Annular space between penetrant and periphery of opening to be min 0 in. (0 mm point contact) to max 2 in. (51 mm). Penetrant to be rigidly marked on both sides of walk. The following types and sizes afpenetrants may be used: A. Steel Pip -Nom 8 in. (203 mm) diam (or smaller) Schedule 5 (or heavier) steel pipe. B. Iron Pipe -Nom 8 in. (203 mm) diam (orsmaller) castor ductile iron pipe. C. Conduit-Nom 4 in. (102 mm) diem (or smaller) steel electrical metallic tubing (EMT) ornom 6 in. (152 mm) rigid steel conduit. D CopperTahing -Nom 4 in. (102 mm) diam (or smaller) Type L (orheavier) copper tubing. E. Copper Pipe -Nom 4 in. (102 mm) diam (or smaller) Regular (orheavier) copperpipe. E Through Penetrating Product*- Flexible Metal Piling -The following "a of steel flexible metal gasp" maybe used: 1. Nom2 in. (51 nun) diem (or smaller) steel flexible metal gas piping. Plastic covering on piping mayor may not be removed on both sides offloor orwall assembly. OMEGA FLEX INC 2. Nom I in. (25 mm) diam (or smaller) steel flexible metal gas piping. Plastic covering on piping may or may not be removed on both sides of floror wall assembly GASTITE,DIV OFTITEFLF,X 3. Nom I in. (25 trim) diam (or smaller) steel flexible metal gas piping. Plastic covering on piping may or may not be removed on both sides of floor or wall assembly. WARD MFG INC 3. Fill, Void or Cavity Material* - Can* or Sealant -Mm 5/8 in. (16imn) thicknness of caulk applied within armolus, flush with both s W&M ofwalt Min 1/4 in. (6 mm) diam bead of caulk applied to gypsum board*uctugg interface at point contact location. on both sides ofwall. 3M COMPANY -IC 15WB +, CP 25WB +caulk or]cB -3000 WT aka rd *Bearing the UL Classification Mark ft material was extracted and drawn by 31I1 Fire Protection Products ham dw M eftm of dm R lire Raddante ►. a -- 3M Fire Protection PMdnct as o t t- hoe - -t68ifi 122 rw►.3w=/ W -t- 12969 1 of 1 Chomopfim4forWOMMS TYPE 'S' Scmwa (MIN. 2 PER SECTION) 44OLES OVER 3" DIA.— 3" CENTERLM OF STIES 3" MIN. MIN. r � ' A OVER -SIZED WOL.£ ($£'POND) CNI EXIST. PARTITION TYM 'O' SCREIM (MIN. 2 'FAR SEC_'t'tON) +a A r fi WOLES LIP TO 3" DIA- -- .0 �/e" 1'"fi°E 'X' Cs.WB r � ............... ................j.. ... l j " • a tc SCREW -SEE NOTES �`� F ,O. JOMT GOh1POl.pJD nt EXIST. MTL. V 3" 3" 3" S= # C-am. MIN. MIN. MIN. MIN. OWUMS = A i� 1. �3�I7"iER L6ACiC SIDE OF PATC -4 4 M4 JONT N,T 8 CA2111-OUND OR GYfISL" Flies WALT SEALANT 2. LEAVE ALL - OACMWS EXPOSED BLOW -= PATC�-1 @ PENETRAT�3NS SCALE: N.T.S. Project: Dr. Stein 9999 NE 2 Ave, suite 311 A Miarni Shores, R. 3M Fire Protection Products 3MTm Fire Barritr Sealant GP 25WB+ Project: Dr. Stein 9999 NE 2 Ave, Suite 311A Miami Shores, FL Our #1 Selling Fire Barrier Sealant for Through- Penetrations 3M— Fire Barrier Sealant CP 25WB+ is a high performance fire barrier sealant ideal for use on walls, floors and ceilings. Utilizing powerful intumescent technology, it provides up to a 4 -hour F- rating in through - penetrations. When properly installed, this one -part intumescent latex cures upon exposure to the atmosphere to help control the spread of fire, smoke and noxious gasses before, during and after exposure to a fire. Versatile 3M" Fire Barrier Sealant CP 25WB+ meets the intent of LEEDO VOC guidelines and is approved for use in more than 600 combined UL and Intertek listings for the most demanding firestop requirements. I I � 4 1'1-nicir�A In?p No. �'2�3 -------- --- - MUNIMPAL NSFECTiON REQUIKL*f,�."-° RECORD CARD AT TH;E Th,,�JE 0 JA Fikt- by ECT17N- 111111111111111111111111 0000860444 �A 2-0140012 ?�() NOTE: ALL SHEETS MUST BE REVIEWED MIAMI -DADE COUNTY BUILDING DEPARTMENT Herbert S. Saffir Permitting and Inspection Center 11805 SW 26th Street (Coral Way), - Miami, Florida 33175 -2474 - (786) 315 -2100 APPLICATION FOR MUNICIPAL PERMIT APPLICANTS THAT REQUIRE PLAN REVIEW FROM MIAMI -DADE FIRE RESCUE AND /OR DEPARTMENT OF ENVIRONMENTAL RESOURCES MANAGEMENT PROVIDE MUNICIPAL PROCESS NUMBER HERE e ���/ 2'We 5,' /t Job Address T Contractor No. z z Last four (4) digits of Qualifier No. zFolio P Contractor Name d F Lot Block Qualifier Name o a C U Address J 2 Metes and. bounds City State ZIP [ ] New Construction on [ ] Demolish [ ] Shell Only Current use of property '90C�o/ -�,'�� z Vacant Land Alteration Interior [ ] Addition Attached Work W c Alteration Exterior [ ] Addition Detached Description of w Relocation of Structure [ ] Re -Roof [ ] Foundation Only a z [ ] Enclosure Sq. Ft Units Floors Repair Value of Work *,Zoo [ ] Repair Due to Fire 1 1 I { ] MBLD * [ ] Chg. Contractor Owner 14/ex X-47-17,177 W Category W [ ] Re -Issue W Address Vf f A467 2 ,4veR W [ ] MELE 9 [ ] Re -stam p z city ��► s� ®��� State �Z Zip � [ ] MLPG �' PhoneVie-?`�� [ iTMMEC V8 [ ] Revision Last four (4) digits of [FIRE ] [ ] Not Applicable for Owner's Social Security No. Fire W Name P4 6qe./ ` ®�//� �� Name Z Address 20 ?/ �/� 1`147 lG7_ 3 W z Address x City State Zap n City State ZIP IL a Phone a 2 y V 2290c, Phone l am requesting a Special Request Plan Review (SRO to be scheduled as soon as possible at the rate of $190 for the first hour and $65 per each addition hour in addition to the review fees. Minimum charge one -hour. nde It W 1't Request: Date: ul o 2 "d Request: Date: LL 3"d Request: Date: l am requesting Optional Plan Review (OPR) to be scheduled as soon as possible at the rate of $75 for each discipline. Additional a review fees may apply. 0 c 1s' Request: Date: 2"d Request Date: 0 3b Request: Date: Y:1Put =01M4ftd.*P- mtAMAW=d a