PL-04-207Miami Shores Village RECEPYED
Building Department , JUL 15 2004
10050 N.E.2nd Avenue, Miami Shores, Florida 3313 -
Tel: (305) 795.2204 Fag: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2001
Permit No.1 KA _ 209.
Master Permit No.
Permit Type (circle): Building ElectricalPlumbin MechanicalRoofing
Owner's Name (Fee Simple Titleholder) e- Phone # ®� - % 'S % d CSS
Owner's Address 4o t jU �/" b a fi
City- �e f �� t e � State c_ Zip s .
Tenant/Lessee Name Phone #
Job Address (where the work is being done) 3(o/ " e - / ® C2�: S -J-
City Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES O
Contractor's Company Name
Contractor's Address
City
Qualifier
State
Phone #
Zip,
State Certificate or Registration No. tate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Permit / -G' , Square Footage Of Work: - l(
Type of Work: ❑Addition ❑Alteration ❑New -YRepair/Replace ❑ Demolition
Submittal Fee S 50. CDC) Permit Fee $ % 10 CCF $ CO/CC
Notary $�-0 Training/Education Fee $ � D Technology Fee $ 3.
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 Zip
Mortgage Lender's Name (if applicable) ��-e Q_e ,, 0 is , ^
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 side
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
Owner or Agent Contractor
The foregoing instrument was acknowledF/Iged be re me this i The foregoing instrument was acknowledged before me this
day of I.Lyknown
20 b I ) I ` _ day of 20 by ,
who is perso to me or who has produced -�- CV who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY P I i�iabel argaS NOTARY PUBLIC:
2319.4 Sign:
Sign: mission
Ex MU
Print: = u Thai Print:
,A lantic Bonding Co., nc.
My Commission Expires: My Commission Expires:
APPLICATION APPROVED BY: ams �7 �� / Plans Examiner
Engineer
Zoning
Che 05/13/03
MIAMI SHORES
BUILDING DEPS
305-795-2204
Buy ding Inspection Request
Date D
Type Insp'n !wU I / flornlro
Permit No. 10 -'.;?t/ /
Name bemr� .
Address % / NE '®?— ST
Company 6LI Jl719
Phone # 365 ✓ 7— 5q
®K
Inspection Date 5 [a z An,
Approved
Correction ❑
Re-Insp'n Fee ❑
�% 00
ADDENDUM TO BUILDING PERMIT APPLICATION
(AN APPLICATION F(31.iuILDING 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
BATH TUB
ITEM
SWITCIi OUTLETS
UNIT FEE ITEM UNIT FEE
SPACE HEATERS
BIDET
LIGHT OUTLETS
CENTRAL HEATING
DISMAS ER
RECEPTACLES
A/C (WIND)
DISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN AMPS
DUCT WORK
FLOOR (RAIN
SERVICE REPAIR/METER CHANE
REFRIGERATION
GREASE TRAP
ADPLIANRCE OUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TOP
UNDERGROM TANKS
LAVATORY
OVEN
ABOVE GROUIU 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
MEW I CAL VENT I LAT I ON
SINK, RESIDENCE
MOTORS OVER 5- 8 NP
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTORS OVER 8- 10 HP
ELEVATORS/ESCALATORS
TEWMMY WATER CLOSET
MOTORS OVER 1D- 25 If
FIRE SPRINKLER SYSTEMS
URINAL
MOTORS OVER 25-100 HP
COOLING TOWERS
WATER CLOSET -rO i L E
MOTORS OVER 100 HP
VIOLATION
INDIRECT WASTES-
A/C WINDOW
REINSPECTION
WATER SUPPLY TO:
AIR CONDITIONERS
A/C UNIT
STRIP NEATER
FIRE SPRINKLER
GENERATORS TRANSFORMERS
HEATER -NEW INRST.
GENERATORS TRANSFORMERS
HEATER -REPLACE
GENERATORS TRANSFORMERS
LAWN SPRINKLER -WELL
SPECIAL PURPOSE
SWIMMING POOL
OUTLETS COWOCIAL
WATER SERVICE
SIGN TUBES
SEWER CONNECT 1 ONS
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.
CATDi BASIN
0ISCHARGE WELL
DOMESTIC WELL
AREA DRAIN
ROOF INLET
SOLAR WATER HEATER
FIRE STANDPIPE
POOL PIPING
LAWN SPRINKLER SYSTEM
GAS RANGE
METER. SET (GAS)
GAS PIPING
S h-- e+-� a /0 o e, k —::)
v
�r
2- ep C'c
s
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305-795-2204
Printed: 7/22/2004
Applicant: CONNIE
Owner: BENSON
JOB ADDRESS: 361
Contractor
Local Phone:
Parcel # 1132060135090
NE 102
Plumbing Permit
Permit Number: PL2004-207
BENSON
CONNIE
ST
Contractor's Address:
Page 1 of 1
Legal Description: MIAMI SHORES SEC 1 AMD PB 10-70 E1/2 LOT 19 & LOTS 20 &21 BLK 37 LOT SIZE
Fees:
Description
Amount
FEE2004-7325
Building Fee
$150.00
FEE2004-7326
CCF
$0.60
FEE2004-7327
Notary Fee
$5.00
FEE2004-7328
Training and Education Fee
$0.20
FEE2004-7329
Technology Fee
$3.75
Total Fees:
$159.55
Permit Status: APPROVED Permit Expiration: 1/11/2005 Construction Value: $1,000.00
Work: CHANGE TUB, TOILET AND SINK IN BATHROOM
Signed:
(INSPECTOR)
Total Fees: $19.5
0-0
Total Receipts: 1W.00
Aus 19 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: