The URL can be used to link to this page

EL-04-210.Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Owner's Name (Fee Simple Titleholder) Owner's Address City State RECTI WED JU 2 2 2094 Permit No. (A.- Master Permit No. W t C4 —133 Plumbing Mechanical Roofing Zip Tenant/Lessee Name Phone # Job Address (where the work is being done) City Miami Shores Village County Miami -Dade Zip Is Building Historically Designated YES NO Contractor's Company Name Contractor's Address State Certificate or Registration No. l / t L4-0 Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # S Value of Work For this Permit 100 - V® Square Footage Of Work: Type of Work: ❑Addition ❑Alteration []New C?!f Repair/Replace ❑ Demolition , Describe Work: 41601 Submittal Fee $ Permit Fee S CCF S CO/CC Notary S Training/Education Fee S o 1.0 Technology Fee $ 2 ✓" Scanning $ Radon $ Zoning . Code Enforcement Structural Plan Review. $ Total Fee Now Due S (Continued on opposite side) Bond S Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's -Name (if applicable) .Mortgage Lender's Address City State Zip 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certifted copy of the recorded notice of commencement must he posted at the job site for the first inspectio hich occurs seven (7) jVs after the building permit is issued. Ina abs nce such posted notice, the inspection will,p6ne app oved and a reins gofee will be charged. Owner or Irg-f Contractor The forego' g ' ent cknowledged before me this The forego ng ' ent w cknowledged befof e�me this day of 20 ®, y- / da of CJ� 2t� b V/✓) Y Y who is personalli known to me or who has produced who is personaiW known to me or who has produced As identification and who did take an oath. NOT. Print: V t L'�ten�a My Commission LkWayNOISSIWW00 AN 00IS T SOMA APPLICATION APPROVED BY: Chc 05/13/03 identification and who did take an oath NOTARY PUBLIC: , �- Sign: BB9�N8$ BB 8 8 p rbc Print: jam �* my �I. P* TN Ei0 IA °•yen �10� Plans Examiner Engineer Zoning t 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 MECHANICAL ITEM BATH TUB UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM UNIT FEE SPACE HEATERS BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES A/C (WIND) DISPOSAL SERVICE TEM111MY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/METER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP 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 HP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 HP TRAWMTING ASSEMBLIES SINK, SLOP MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS TEMPARY WATER CLOSET MOTORS OVER 10- 25 If FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 If COOLING TOWERS WATER CLOSET MOTORS OVER 100 HP VIOLATION INDIRECT WASTES-• A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS r9 A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER -REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIMMING POOL OUTLETS COWAERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS FSIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTURES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS ORAINFIELD, 4' TILE/RES. VIOLATION PUhP & ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER. SET (GAS) GAS PIPING Miami Shores Village 10050 NE 2nd Avenue Phone: 305-795-2204 Printed: 7/26/2004 Applicant: PETER Owner: EPSTEIN JOB ADDRESS: 1058 NE 98 Electrical Permit Permit Number: EL2004-210 EPSTEIN PETER ST Contractor AFFORDABLE AIR & HEAT INC Contractor's Address: 515 NE 190 STREET Local Phone: Parcel # 1132050180330 Legal Description: REV PL MIAMI SHORES SEC 8 Fees: Description Amount FEE2004-7477 Building Fee $100.00 FEE2004-7478 CCF $0.60 FEE2004-7479 Training and Education Fee $0.20 FEE2004-7480 Technology Fee $2.50 Total Fees: $103.30 Permit Status: APPLIED Permit Expiration: 1/18/2005 Construction Value: $100.00 Work: REPLACE 4 TON A/C HOOK UP FOR A/C Signed: (INSPECTOR) Page 1 of 1 PB 43-69 LOT 16 BLK 180 LOT Total Fees: $103.30 Total Receipts: $$ 0� SZ.�d 'JUL 2 7 PAID 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 responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: