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MC-04-133Miami 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 No. Master Permit No. 11p n I �fl o m ®® Permit Type (circle): Building Electrical _ j Plumbing Mecchh ical Roofing Owner's Name (Fee Simple Titleholder) �/ 19 Phone # A / %�l 177 Owner's Address 10,59 612- �] _ _ City. State Zip Tenant/Lessee Name Phone # Job Address (where the work is being done) City Nfiami Shores Village County Miami -Dade Zip % z Is Building Historically Designated YES NO Contractor's Company City Qualifier Phone # 1305 q V) 0-1—n State Certificate or Registration No. OA—W q 'j?" I I � Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone #. $ Value of Work For this Permit c/� Type of Work: ❑Addition ❑Alteration MND Describe Work:) Square Footage Of Work: 0 Repair/Replace (] Demolition Submittal Fee $;50.- Q6 Permit Fee $ /06) L CCF $ l o CO/CC Notary $ Training/Education Fee $ t 190 Technology Fee $ Scanning $ Radon $ Zoning Bond $ Code Enforcement $ Structural Plan Review. $ Total Fee Now Due (Continued on opposite side) 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: 1 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. A�(0�7)0,1�kys certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seve after the building permit is issued. In the absence of such posted notice, thieinspection wi a ap oved and a r • fee gill be charged. Signature Owner or Agent Contractor The forego' ent as acknow jle �dged before methig�il day of 2t , by ?,v' P I/ *='$:k , who is personally own to me or who has produced As identification and who did take an oath NOTARY ' N aO\�p'�j0b�iP Sign. Print: 9 N f@skN� J od AeS� My Commission Expires: The foregoin ent was aelmowledged before me this day of 2�%bY a is kilt WJLA LU LUV r who has produced identification and who did take an oath My Commission Expires: Pii 1 Vl l t:= APPLICATION APPROVED BY: dr _Zf.." Plans Examiner Engineer Zoning Chc 05/13/03 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 ELECTRICALMECHANICAL 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 TEMPORARY A/C (CENTRAL) 1.4 nn DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOG; 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 QVER 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 WATER CLOSET MOTORS OVER 100 HP VIOLATION INDIRECT WASTES- " 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 TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIMMING POOL OUTLETS COMMERCIAL WATER SERVICE SIGN TUBES SEWER CONNECT IONS S I GN 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 DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANOPIPE 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 Mechanical Permit Permit Number: MC2004-133 EPSTEIN PETER ST Contractor AFFORDABLE AIR & HEAT Contractor's Address: 515 N. E. 190 St. Local Phone: 305-940-0777 Parcel # 1132050180330 Legal Description: REV PL MIAMI SHORES SEC 8 Page 1 of 1 PB 43-69 LOT 16 BLK 180 LOT Fees: Description Amount FEE2004-7473 Building Fee $100.00 Total Fees: $104.90 FEE2004-7474 CCF $1.80 Total Receipt: $6&0*-' FEE2004-7475 Technology Fee $2.50 FEE2004-7476 Training and Education Fee $0.60 5496 Total Fees: $104.90 Permit Status: APPROVED Permit Expiration: 1/18/2005 Construction Value: $2,400.00 Work: REPLACE 4 TON AIC W /10 KW HEAT EXISTING 200 AMPS SERVICE Signed: (INSPECTOR) D1 jq®`) 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: