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BP-02-2097 nj Miami Shores Village 9 Building Permit 10050 NE 2nd Avenue 2097 BP2002 b Permit Number: - Phone: 305-795-2204 P Printed:12/5/2002 Page 1 of 1 Applicant: B KANJI Owner: KANJI B JOB ADDRESS: 588 NE 103 ST ^J Contractor Contractor's Address: Local Phone: Parcel# 1132060170860 Legal Description: MIAMI SHORES SEC 4 AMD PLAT PB 15-14 LOTS 1 &2 BLK 93 Fees: Description Amount FEE2002-6938 Building Permit Application Fee $60.00 Total Fees: $65.60 FEE2002-6939 CCF $0.60 Total Receipts: $0.00 FEE2002-6940 Notary Fee $5.00 1` Total Fees: $65.60 Permit Status: Approved Permit Expiration: 6/2/2003 Construction Value: $500.00 Work: EXTERIOR PAINTING AS PER AGREEMENT If there is no permit package accessible on the job-site for inspectors to verify,there will be no inspections. Re-inspection fee is$50.00,which must be paid in advance before calling for another inspection. This Permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,drawings,statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents,servants or employees. 2 Signed: (INSPECTOR) BY: 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. REG C01 120602 0921 A1C#01 003213 CASH USA Signed: /'Pwj M (Contractor or Builder) BY: Paint Color Approval and Agreement DATE: OWNER'S NAME: PHONE: ADDRESS: ADDRESS OF SITE: CONTRACTOR& LICENSE (if applicable) COMPANY NAME: PHONE: All Elements on the site must be listed and indicate the color to be painted... Walls egrb I I . . . Fascia Drip Cap/Drip Edge r o. , Soffit �l� � 1� � _ . . .•�, Roof Flower Bins (q t-i e7 c "rA Shutters ,°, dry ,,,i •� . Awnings Chimney C�� y Doors and door jams Garage Doors iv ' . • . 3 Railings Fences Cn Decorative Metal All brick (simulated or regular) Ea`z ('k, Stucco Banding . Any other stucco features Accessory`Buildings - Other 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. I authorize the above-named contractor, if applicable, to do the. work stated. Furthermore , the paint colors will be as per the attached samples. Signature of Owner Date Signature of Contractor Date APPROVED: WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION Com' �� G� • . •.._.:. Building Officia Date 4/23/01 PL s� Paint Color Approval and Agreement DATE: 102 ),3 ly �- OWNER'S NAME: ��P..%" Icer PHONE: ADDRESS: Sff�� 1�j F- /y 3 o- ADDRESS OF SITE: S ay C-- l®� �►- CONTRACTOR& LICENSE (if applicable)_ ,� COMPANY NAME: `� PHONE: -. All Elements on the site must be listed and indicate the color to be painted.. Walls Fascia Drip Cap/Drip Edge - • . t., Soffit Roof Cn , Flower Bins ro r Shutters h Cn Awnings Chimney y . Doors and door jams Garage Doors C e Railings Fences Crecy Cn z Decorative Metal All brick (simulated or regular) Stucco Banding . Any other stucco features Accessory`Buildings - Other 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. I authorize the above-named contractor, if applicable, to do the work stated. Furthermore , the paint colors will be as per the attached samples. Signature of Owner Date Signature of Contractor Date APPROVED: WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION Building Official Date 4/23/01 MIAMI SHORES VILLAGE Paint Color Approval and Agreement DATE: el 42JI" OWNER'S NAME: PHONE: 3o - 2 Z C ADDRESS: r� . ADDRESS OF SITE: CONTRACTOR&'LICENSE (if applicable) COMPANY NAME: PHONE: All Elements on the site must be listed and indicate the_color to-be painted. Walls t� Fascia roo Drip Cap/Drip Edge Soffit1 Roof P Flower Bins Shutters Awnings Chimney y Doors and door jams Garage DoorsC. Railings ✓ � �� Fences Decorative Metal P L All brick (simulated or reg lar) Stucco Banding �cw��-� • S , Any other stucco features ,o. o Acce s I Al ^' s ory Buildings Other �`' e'Ae� OWNER'S AFFIDAVIT: I certifythat all the fore oin 'information s accurate g g and that all work will be done in compliance with all applicable laws regulating construction and zoning. I authorize the above-named contractor, if applicable, to do the work stated. Furthermore , the paint colors will be as per the attached samples. Signature of Owner Date Signature of Contractor Date APPROVED: WHEN PAINTING IS FINISHED., CALL FOR FINAL INSPECTION Building Official Date 4/23/01 1V11.H.1V11 311" A E3 V 11LLAUE Paint Color Approval and Agreement DATE: tlI�S��y OWNER'S NAME: i?c��2�ru,.�:.,,, I ►, PHONE: 3�� 2 Z 7 2 ADDRESS: ST& sv 0 3 rt h - ADDRESS OF SITE: Ski oy'F- i 03`''h-. CONTRACTOR&'LICENSE (if applicable) COMPANY NAME: PHONE: All Elements on the site must be listed and indicate the.color to-be painted. Walls v Fasciaram ca o Drip Cap/Drip Edge Soffit Roof Flower Bins Shutters Awnings z Chimney y Doors and door jams v x Garage Doors if�✓ Railings Fences `^' n r t� Decorative Metal All brick (simulated or regular) i/ _1A pe)n Stucco Banding Any other stucco featuresa AccessoryBuildings Other OWNER'S AFFIDAVIT: I certify that all the foregoing`infor information s accurate OW fY and that all work will be done in compliance with all applicable laws regulating construction and zoning. I authorize the above-named contractor, if applicable, to do the work stated. Furthermore , the paint colors will be as per the attached samples. Signature of Owner Date Signature of Contractor Date APPROVED: WHEN PAINTING IS FINISHED., CALL FOR FINAL INSPECTION Building Official Date 4/23/01 se°R. PERMIT APPLICATION Master Permit No. Subsidiary Permit No. �IORiDp' INSTRUCTIONS -The following steps must be taken to obtain a permit from the Miami Shores Step 1. Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done,a roofing application must be submit- ted along with this permit application. Step 2. Submit the completed application with all necessary documents to the Building,Planning and Zoning Department for processing. During the processing of your application,you may be asked to submit additional information. APPLICATION Job Address: 53-S- AI /O J y� - ��i�� .�, d" I Address Apt. City State Zip Folio Number e -RJD 0 1 7 V Description of Work Lot t Block Subdivision PB PG Zoning Linear Feet Current Use of Property R n .1_t' Square Feet Units Floors Proposed Use of Property K alue of Work 0 .5-0 0 Bldg Value Tenant Information Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT TYPE ( ✓) PERMIT CHANGE (✓) TYPE OF MANAGEMENT (✓) Building Chg.Contractor New Construction Enclosure Electrical Renewal Alteration Exterior Repair Mechanical Revision Alteration Interior Demolish Plumbing Extension Relocation of Structure Shell Only LPGX Supplement Foundation Only Add'1 Attachment Roofing Reinspection Other Add'1 Detachment Fence Other Other ARCHITECT ENGINEER Name Name License No. License No. Address Address Telephone Telephone Fax Fax PROPERTY OWNER CONTRACTOR ame/ A Name ff'w Address License No. ® y Address Home Telephone Business Telephone 7 �— 6 , / Telephone Fax Fax Qualifier Name F Page 2 PERMIT APPLICATION IMPORTANT NOTICES I. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m.to 6:00 p.m.,and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN,NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES,AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the streettsidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building,Planning and Zoning Department 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement 9. Department of Health and Rehabilitative Services(HRS)approval is required for applications involving septic tanks. Department of Environmental Resources Management(DERM)and/or Miami-Dade Water and Sewer Department(MDWASD)approval is required for applications involving sewers. AFFIDAVIT Application is hereby made to obtain a permit to do work and installation as indicated. I,the OWNER of the property,certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further,I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50%) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50%) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 111 Floor,(305)679-1078. Once recorded,the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713-35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. TATE OF FLORIDA,COUNTY OF MIAMI-DADE STATE OF FLORIDA,COUNTY OF MIAMI-DADE Si ature of Owner A Signature of Contractor/Qualifier � ;Na-meDPV X J9- A CPriPrint Name subscribed before me this of Sworn to and subscribed before me this day of A D OL ignature of-NCuy of-NPublic State o FI rida Signature of Notary Public-State of Florida Angrily M BedkW SEAL: W,mmfselon p®9�A9913 SEAL: a Expires NoV8Mb@f 1®l Personally knownOR,Produced Identification Personally known OR,Produced Identification Type of Identification Produced: Type of Identification Produced: Page 3 ` PERMIT APPLICATION i INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies)in the space provided below. ELECTRICAL TYPE QTY. TYPE QTY. TYPE QTY. TYPE Q-1-Y. , Minimum Fee Dryer Outlet,Appliance Service Repair A/C Central 1-3 Ton Fan Outlet,Wall Service,Temporary A/C Central 4-7 Ton Fire Pump Outlet,Switch Signs A/C Central 5-15 Ton Fixture-Fluorescent Oven Space Heater(kw) A/C Central 16-20 Ton Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+Ton Flood Lights Plugmold/Strip Sub s,No.of Amps A/C Window FPL-Load Central Posts Swim Pool,Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool,Residential Chiller Generators,etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator,Comm.(p/PH) Temp Serv.,Construction Compactor Low-volt,Burglar Refrigerator,Domestic Temp for Test-30 days Deep Freezer Low-volt,Fire Renew-Temp Service Demolition Low-volt,Intercom/Teleph. Repair Circuits Dishwasher Low-volt,Television Service,Number of Amps MECHANICAL TYPE QTY. TYPE QTY. TYPE QTY. TYPE QTY. Minimum Fee Condensate Drain Generator Refrigeration,Tons A/C Central,Tons Cooling Tower Heating Strips,each Vent Hood,Cost A/C Wall/Win.Tons Dryer Vents,Number of Paint Booth Ventilation,Cost Air Handler,Tons Ductwork,Cost of Piping,Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Bath Fan-Vented,# Fireplaces,Number of Pressure Vessel PLUM13ING TYPE QTY. TYPE QTY. TYPE QTY. TYPE QTY. A/C Condensate Drains,Roof Miscellaneous Fixture Soakage Pit Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap-Fixture Fountain Pump and Abandon Sprinkler System Cap-Water Gas-Appliance Pump,Domestic Supply,AC Well Cap-Sewer Gas-Natural Pump,Fire Stand Temporary Toilet Catch Basin Gas-Propane Pump,Re-circulate Temporary Water Closet Clothes Washer Gas Piping Pump,Replace-Pool Urinal E Dental Chair Grease Trap Pump,Sprinkler Utility-Sewer Discharge Well Ice Maker Pump,Sump Utility-Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield,4"Tile/Res. Lavatory Septic Tank Water Heater New Drains,Area Meter Set(Gas) Sewer Connection Water Re-pipe Drains,Floor Minimum Fee Shower Water Service Drains,French Miscellaneous Equipment Sink Well,Supply RECEIVED AND REVIEWED BY: DATE: i Page 4 PERMIT APPLICATION OFFICE USE ONLY CHECKLIST ❑ OWNER-BUILDER FORM ❑ PROOF OF OWNERSHIP ❑ CONDO ASSOCIATION APPROVAL (Attach) (Attach) (Attach) ❑ FIRE DEPARTMENT ❑ HRS/DERM APPROVAL ❑ BPR APPROVAL(Restaurants) APPROVAL(Commercial/ (Septic/Sewer) multi-family) ❑ CONCURRENCY ❑ IMPACT FEE ❑ CONTRACTOR REGISTRATION (New Construction) (New Construction) (On File) ❑ OTHER ❑ OTHER (Specify&Attach) (Specify&Attach) PERMIT FEES $3.00 per page(Scanning Fee) $ Miami Shores Village $ -s Bond $ Metropolitan Dade County (C.C.F.) $ (sq.ft.=x/1000 x¢.60) Inspector State Educational Fund $ (¢.005/sq.ft.) State DCA(Radon) $ (¢.01/sq.ft.) Code Enforcement Fine $ Zoning Review $ Notary $�„ � / TOTAL' ISSUING OFFICIAL REVIEWED AND PREPARED BY: DATE: SECTION BY DATE, CONDITION OF APPROVAL Zoning ® i Electrical Mechanical Plumbing Fire Public Works Structural Building Official Revised July 2001 10050 N.E. 211D AVE.,MIAMI SHORES, FL• (305) 795-2207 • FAX (305) 756-8972 • http://www.miamishoresvillage.com i I MIAMI SHORES VILLAGE, FLORIDA MILDING ❑ 3LECTRICAL ❑ DATE ""' 1951— ?LUIvIBnvG ❑ PERMIT No 8414 Contractor's License No. 300FING ❑ ❑ Work to be performed under this Permit___ owner of 3uilding — --- --- —-- — architect ,ontractor r Builder __ .egal Lot Bl. Subdi- )escription vision Sq. Ft. address of Value of Amt, of IUilding Project $ Permit $ This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application erefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, rawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any me if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is ranted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations ertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work one by his agents, servants or employees. Signed: BY INSPECTOR 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 ertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. i accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY 17 r ROOF REPORTERS, INC. ew a M"i (561) 434-7555 TAS 106-95 Roof Tile Uplift Test Report Test Date May 3 , 2002 Project 588 NE 103 Street, Miami Shores, Fl. Contractor Bay Contracting Permit# BP 2002 - 629 Roof Pitch 31/2 : 12 Tile Installation Date April 30 , 2002 Attachment Method Poly Foam Tile Type Double Roll All testing is in strict accordance with The-Florida Building Code, Testing Application Standard (TAS) 106 Each Test location was pulled using a Chatillon Force Gauge to a minimum of 35 lbs.. TEST SUMMARY Roof Area Total# of Tests # of Tests Passed % Passed Field & Ridge 25 25 100 % Corner 10 10 100 % Perimeter 10 10 100 % TEST RESUL'T'S. PASSED � See Attached Sketch For Further Details Al Maccagli, RRC #116 -Dade County Certified Testing Agency #99=0615.04 3281 Lake Worth Road ❑ Suite E ❑ Lake Worth ❑ Florida 33461 Roof Consulting & Testing ❑ Visual Surveys & Evaluations ❑ Roof Design s r t * r• T - ,� i � i � � � } f 1 _ i - v � ._.�, .. ! . ; i .., 1. 1.. i +•'_.i. _ } i. s,. _.._ .. vow f 1 _ . I { I I ! d i J, sk Af JL • , t 'JL i . 1. r ; I I � • • I � i j . 1 1 I • Report of Calibration SYwgy Labs. irtc 9831 E Evergreen St. Miami,FL 33157 $88.3462430 UNIT UNDER TEST: CHATILLON DFIS100 DIGITAL FORCE GAUGE Mfr SAN. 839639 Oust S/N: 839539 PROCEDURE NAME, SYN141 PERFORMED ON: 1lMar2002 CALIBRATED BY: Samuel Lago NEXT*CAL OUE`.: 11 Mer2003 P.O.NUMBER: VERBAL TEMPERATURE: 7'2.0°F +l-1 DEG HilMIDiTY: 40% +1-5% SUBMITTED ROOF REPORTERS BY: 3281 LAKE WORTH ROAD LAKE WORTH FL CERTIFICATE NUMBER: 39382:1015842299 Syne tahbra Inc raro$es 8tst a above listed i:tsuttonant meets or elmeeds a speciflrazloas as stated in the referenced prooedtNe a t t8e points tested(unless othorw3se noted} it has btwt ealtb rd using measmaraeat statdards tfa trf the tdatfortat Inst ate of Standards sad Terhnoiog�q CN�1? or to AUST empted iminst stwAyds of maswramem,or derived by the ratio tgrpe of a f-calibratioo tests►itptesThis aalfbtration ootaplies whir ISO Liuida 17025 ant A,1$idNCSL ZS4Q-1-1994. Cal Bart t dww and oda mea nt unwru ter ratios of Inas Chert or ogu Ito 4:1 of the spGciftt ion the unit taul®r tea.wirl►a covatage! of k�Z at a cvnAdarcoe level of 99°l0,unless otherwise acted US repent my not to reproduced exvt in Olt unless petmiseioa far Cho peb111a�ion of an approved abs�aa is oMaittsd in writing from Synergy Labe,Inc REMARKS: Thz wait was found to be in tolerance at the tame of calibration.No sdjusta waU were neessary.. Srt8rttl$rCfF Used TtaGa{3o DsscrlP�st CAL DA CAL M.DATE 9�9tat}2 AMETEX W G-W1 MGHT SET 9 Jim 21 B Jun 200 Signed. Signed. il�irOttOI1 ) ` .� OuallAAAAs6ance REPORT OF CALIBRATION for SERIAL NUMBER: 939539 ��Late assigned ASSET NVMe ER: PRINTED ON- Al Mar 2402 page'-j-of)— IAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby Made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shares Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and of all rules and regulations of the Building Division of Miami Shores Villagshl beco complied with, whether herein specified or not. A copy plans and specifications must be kept at building during progress I� /� Date_. /— ---_— —--•-------•---.,19_11. Owners Name and Address. r! — �?� k! 5�� -- No.s - — Street 1510-1-51.7-------•-- fTA 3 _(d -----•--•----------------—_-----------............--.................................... Registered Architect and/or Engineer---- _ __t_U��-@��5---{�'- Name and address of licensed contractor. Location and legal description of lot to be built on: Lot- T = ----------------- Subdivision------------------- --------------- --- — oc - Street and Number where work is to be done--- --- �-- —� — _----------• —------ "-- - - —�— State work to be done and purpose of building (by floors)_ -- — --d •• `�""' "--_ _ -------- ---------- --- — — - - — ---------------------------and for no other purpose. New Building-____- Remodeling------------•-------_---- Addition-------------------------- Repairs-------------------------- No. of Stories_----------------------- To be constructed of--------------------------- Kind of foundation---------------- -• -------------------------------- Roof Covering-------------------------------------•------ Estimated Total cost of improvements ��-------------------------Amount of Permit $•••. Z: � $____�_.-___.. Zone tubage required---------.--.—---------------------------------------flan Cubage---1`8-� - —t�'��.•F'[ --------------------_----------_-------- - Size of Building Lot------------------------------------------------------_------------- Distance to next nearest building--------------------------- -- ------------- ------- --------------------------- - ----------------------- Maximum live load to be borne by each oor__-___-------------------------------— I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may besent to_---- --•- - ----- ------------------ - — - — — - - ----------------- -----•----- -------- -- -- - - The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966,Compiled General Laws of Florida,Permanent Supplement, him and has complied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed in the work toed performed under this perniit; and will post or cause to be posted for inspection on the site of the work such public notice or noticesas a e e required c n it by the Act. Theres undersigned gned agrees to employ only such subcontractors, on work to be performed der this permit, - - (Signed) _ STATE OF FLORIDA, ! ss. COUNTY OF DADE. J Before me,the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments,personally ap- pear -------------------------- - -------— — - - - -- ------------- --------------------------------__._____to me well known, and who,being by me first duly sworn, upon oath deposes and says that he is the__________ _ - - -•----------------------- -------------•-------•---------------------- of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Permit No. -- Date.----5L_1_� ----------------- Read,Sworn to and Subscribed before me. _ — --- - ----- ---------------- --- -------- Disapproved ------ - — ----— - -f ----------------- - Notary Public,State of Florida (Signed) - --=r---------- - ---- -- ------ -----_----------------- Buildmg I e for - My Commission Expires - PLANNING BOARD------------------•------------------ -—- DATE Chairman -------------------------------------__ —_ Member ---------------------------------------------------------------- •------------- --------- Member -----------------------------------------------------------------------_- •-------- Member -----------------------•---------------------------------Member Member ---------------------------------------------•----------------- - - --- -_-----— — - ----— ---- -------------------- Date Council Approved------------------------------------------------ Date Disapproved -------------------•------------------------------------ - ... ---- NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re-inspection fee of $1.00 will be charged when such re-inspection is made necessary by improper notice for inspection or faulty materials and/or workmanship. e� v e �5 444 Sf!Av-41si i 0 � * L 1� a i b a.s MIAMI SHORES VILLAGE, FLORIDA BUILDING ❑ ELECTRICAL ❑ DATE 195 PLUMBING ❑ PERMIT N? 8421 Contractors License No._ _ ROOFING ❑ ❑ Work to be performed under this Dwner of 3uilding -— — - — - ?architect <- 6 contractor r �.� �` �:�` , Dr Builder -egal Lot II Bl. Subdi- Description _ vision Sq. Ft. ?address of Value of I Amt. of 3uilding Project $ Permit $ This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application Therefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, irawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any :ime if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is ;ranted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations ;ertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work lone by his agents, servants or employees. Signed: BY INSPECTOR 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, servant or employee. d CONTRACTOR OR BUILDER BY AUTHORITY A:,17 -4 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No..1-72-ffv Date..._.._.__.-.___...____.... — Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described.This application b made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida,all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with,whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address.... CL- I AlC -..._. No. Street-... Registered Architect and/or Engineer_--._ _ ._........___..—..... _._........ _...._ Employing Plumber's Name._ .ICS .. . o.,...—..,.,�..�.....,.,�.,,.,..= Location and Legal Description Lot-r -lock —.___. Subdivision..___ Street and Number where work is to be performed—No. _ Street.. ._._.._..._.__._.........--__...-..---_- -- State work to be performeS and purpose of building (By )-------•---•-------___- _ _.__.......----,,.��,�._//—.--'-----.--.------_ ....----------..-._-_.. New Building------- ---...---•---Remodeling .—._.�...._._Addition.-___..... Repairs......./1_7..-._... No. of Stories. . BATH LAVASLOP LAUNDRY CATCH FLOOR DRINKING TOTAL CLOGNTS TUBS SHOWERS TORI[[ SINKS SINK[ TUBS URINALS BASIN DRAIN FOUNT•NG FIXTURES CONTR. LIST CHECK SEPTIC SEWER DRAIN SOAKAGE GREASE' SOLAR DEEP SPRKLR. SWIM-G TANK N. FIELD PIT TRAP HEATER YELL SYSTEM POOL CO . LIST r CHECK Size Septic Tank_. of Tank -_----.-__-.—_____—.__.____..._»__._.Capacity Feet of Drain Tile. '�"� — Dist. Feet of Tank or Drain Field from Nature of Water Supply: City—Well -.-------- of Soakage Pit......._--------_-------__—._—_......... .__.-....._.._...... ---------- .._.-_._........_.. ......... ... ._.. .. — ----------------- -••----- -- — ----- (Signed)- —_._ .... ..... ........... Amount of Permit f----" -E Inspector. pectoe. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligation s an employer of labor under the Florida Workmen's Compensation Act,being Section 5988, Compiled General Laws of Florida Permanent Supplement, and hats com- plied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub-contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. (Signed) Master Plumber. STATE OF FLORIDA, l COUNTY OF DADE. 5 Before me,the undersigned authority,a notary public,duly authorized to administer oaths and take acknowledgments, personally appeared to me well known,and who,being by me first duly sworn,upon oath depom and says that he is the._._-........................» .......___._............... ..._.. of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public,State of �— —— NOTE: A re-inspection fee of $1.00 will be is ma&-necessary by hnproper notice for haPectim or faulty materials and/or workmanship. MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby wade for the approval of the detailed statement of the plans and specifications herewith submitted for the build- inq or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during p�gress of the work. Date. �._... _._..._.__......_.. 19..-L4 Owner's Name and Address..Burdines=Wesche ».............,_,__ No,7504s&ed_N. _Kendall,.Dr. RegisteredArchitect and/or $ngincer..........................................................................,.......... .............................. Name and address of licensed contrpctor....Alid. . _W_5....R491.?-B g__..&... ...Ave.....H..i.e....» Location and legal description of lot to be built on: Lot........................................... Block.................................. Subdivision...................-...._.......... ..................... _....... Street and Number where work is to be done......5 88 N. E. .11310 3t,.— State $t ._.--- State work to be done and purpose of building (by in wall of garage near rear?_ over rear eave of garage wood is _......................__ _ .. .......»...._ ............ ...........»» .»._»...»- rotte�; and where leaking in valley over fr .. porch. and for n® other purpose. New Building............................. Remodeling......................... Addition.......................... Repairi.......X...X........ No. of Stories...._ ......_......_ To be constructed of............................ Kind of foundation....................... .. Roof Covering.W b i t e s h i n g l e t h e Estimated Total cost of improvements $..3...O_.....................»_•_.__....Amount of Permit $x......5_:.0 ».... ...•.---......»_................-_.._. Zonetubage required..............................................................._ ----.._-Plan Cubage....................__...»...._..»..............._--._-_-_ Distanceto next nearest building...........................................»........_.....Size of Building Lot........_-----............_......................................._..... Maximumlive load to be borne by each floor...................•-•-•-----•-----.................--•-•---•-----......------.............._-......---•----••-•-•--.................... . I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to......An.dregs....R.o.o.fing....&....1n p._.--.Co---------43.0.0--.E._....1.1-th...Aue-_-._...H.i-a................. . ......._-.. . ............ The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966,Compiled General Laws of Florida,Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of4he work such public notice or notices as are required by the Act.The undersigned agrees to employ only such su tr� s. oa o be pe ormed under this permit, as are licensed by Miami Shores Village. �' Remarks----------------------------------------- (Signed) . STATE _ .__._ OF FLORIDA, i COUNTY OF DADE. j ss Before me, the undersigned authority, a notary public,duly authorized to administer oaths and take acknowledgments, persorfally ap- peared ---------------------............_..............-- -._._--------------.-.--------.-___.............................»»__..._._...._._ ___..._.-_-...-.......-.............._ -— ---- ----------------_-----------------------------_._..._. ._ _.__._... __ - .» _ _._._........_ _ to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the.................................................................................._......_ of the above described construction, that lie has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Permit No.______�_`� 122 ...... Date......�.•.... ..� _ Read,Sworn to and Subscribed before me. Disapproved D�Ce?_ ..... .... »_..._ ..._. -.__._. -.»» --- -.__.-_..... _... ......r_.__-......._._.». ............................ ...... ...._ Notary Public,State of Florida (Signed) / =.. ••--•---•--••.. -••. ...._._.............. — - _ uilding Insspp for My Commission Expires......._.».__....... _».._... /PLANNING BOARD......._............. ..................._..__.-DATE Chairman ......... ..................- --............-...-------.............._ Member ......._..................._..__..»....».».....___. Mernber ................................-----•-----..».•..— .. __.._...... —_ Member __._...._.._...._..._ » ._._...- Member .. .... ..........---—-------------------- __ ._ _ _._...»_ Member ».- ...__... __. .._ ._._ _-__- Council Approved......-_-_.................................. _-__.._--Date Disapproved ...........................................................................Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning hoard. A re-inspection fee of $1.00 will be charged when such re-inspection is made necessary by improper notice for inspeLtion or faulty materials and/or workmanship. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT r p APPLiCATION FOR PLUMBING PERMIT Permit No.----- .------------ Date__._ !:.[_..�#'L.:�.____...---.-•-•.. - --.-•-. Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida,all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. _ 8pT 105th Street Owner's Name and Address-______,S Cl_?_--_- TYStreet_-_- _ Registered Architect and/or Engineer---------- w__-------------------- 22 Ave Employing Plumber's,Name - --y-+ -� r- -i'- -*-,+r•._ NO.--- r------------------------ Street ----- ------------------------------. 'Location and Legal Description Lot-----------------_----__---- __ Block_-- ------__. Subdivision__.....-......................-_._......... Street and Number where work is to be performed-No. ' =� Street--------------------------------.------------------•-------_--------- State work to be performed and purpose of building (By New Building--------------------------------- Remodeling-----------------------------Addition------------------------- Repairs----------. ---- No. of Stories. BATH LAVA- SLOP LAUNDRY CATCH FLOOR DRINKING TOTAL CLOSETS TUBS SHOWERS TORIES SINKS SINKS TUBS URINALS BASIN DRAIN FOUNT'NS FIXTURES CONTR. LIST CHECK SEPTIC SEWER DRAIN SOAKAGE GREASE SOLAR DEEP SPRKLR. SWIM'G TANK CONN. FIELD PIT TRAP HEATER WELL SYSTEM POOL --- CONTR. 27 -I1 1.1 - LIST CHECK Size Septic Tank---------------- ------- ------Type of Tank------------------------- - - -----Capacity Gals.---------------------- Feet of Drain Tile-------------------------- Feet of Tank or Drain Field from Well---------------------------------------------------------------------------- Nature of Water Supply: City-We1L----- -------------___--______—_---Size of Soakage Pit---------- ----------- ---__ _------------------- ------------------- --- - ---- :- -- --------------------------------------------------------------------- ---- -- - - . - Amount of Permit �- ---------- - - --- (Sed)---- - ••-•------- Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act,being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub-contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. (Signed) - - _�E' --------------------------------•....._.._.._... r Master Pumber. STATE OF FLORIDA, as. i �✓ ( �1fii COUNTY OF DADE. 1 Before me, the undersigned authority, a notary public,duly authorized to administer oaths and take acknowledgments, personally appeared to me well known,and who,being by me first duly sworn,upon oath deposes and says that he is the-----------__-- .__-----------_. -.__ _ ._. . .-_ of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. - ----- ---— -- __— - ---- ------ ------------------------- _ _----- -- - - My Commission Expires Notary Public,State of Florida NOTE: A re-inspection fee of $1.00 will be made when such re-inspection is made-necessary by improper notice for inspe�-tinn, or faulty materials and/or workmanship. PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date VJob Address "�,e, (5 Tax Folio /J `3,Qo �, / 7 OT&0 Legal Description L—® 7— Owner / Lessee Tenant 4,ORU �"� T�/ l Master Permit it 366 9- Owner's Address / ® — Phone�l21 Contracting Co. — Address Qualifier SS# - - Phone State # Municipal # Competency # Ins.Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN WORK DESCRIPTION CI BS "0067ff 7- 00 ,L�� ✓�� /�G Square Ft. Estimated Cost(value) WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO 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) . Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. 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. Furthermore, I authorize the above-named contractor to do the work stated. Signature of owner and/ Condo President Signature of Contr ctgr or Owner-Builder Da te. * /�/ /�� Date• as -*o Omer and or ndo President o ry as to Contracto or Owner-Builder Commission Expires: �' � a a> �S Commission Expires: ,�; A NOTARY PUBLIC STATE OF FL(Wll8 NOTARY PUBLIC STATE OF FLONOX MY COMMISSION EXP. JAN.22.199S MY C ISSION XlP. JAN.22. * * BOOM T cnt! *•+P It* it * * * 00MMMM BOr�nldp �fN,eoi Fes! FEES: PERMIT Id RADON C.C.F.�1� NOTARY TOTAL DUE # " APPROVED: Fire Other Zoning Buildin Electrical Mechanical Plumbing Engineering MIAMI SHORES VILLAGE, FLA. No 26 JOB - ADDRESS 1 INSPECTION TIME READY REMARKS: Orf)L/L i I `�I j INSPECTOR DATEZ- -7-5 -t- t aRirass A" TO A,I„)` 6-sSVF40;0 L.t&R-eatlb0j T44P. 0 SKETCH 1y&�Y: V, V IL Co �p Qum S '� - �. h a om � Q .•� �l' `v' T, j .ra --- '00 KwAy, 0.10 04(K WALK Av, l,�avaVNIan R• r�dv1 Pu-) F` ca- °e ------------ 6rY• 5 TYPE OF SURYEY: 'Q�OV1�ObQ-�"� NOTES: DATE: " ��`� 1. ELEVATIONS WHEN SHOWN REF �7� PREPARED FOR: �y, QVI�tN M�C-� L.TD►J2a �dla� x THIS FIRM HAS WADE NO ATT SCALE: �Iti-^ GV ,J�Q UNLESS OTHERWISE NOTED. REV I S(DN5 & THE LAWS SHOWN HEREON HA JOB ORDER: MATTERS OF INTEREST by 01 FLOOD ZONE:)( o1�.20-`� 4. TTHHISRSURVEY WAS PS. REPARED 1 NO I CATER NEREON AND Ili N • F. Q. 2 P6. 3 !S ALL BOUMDARY LIMIT INDICJ D THE BOUNDARY LIMITS ESTAI FILE NO, R DESCRIPTION PROVIDED By 1 SHEET OF ,' . ,- SURVEY X50 POjZI�O1ti�..C1p C=C.(JC7toI. (; jc wQL5N1p .5.s.5ac .- .-. W-4 Al(5-,L . -j . el%Y or m i1 M I: Y d,D6-, COW 1 Y, ptLol?10 d 3 `T t+l 12 1> to q v � �, s 4 25 9�. 13 14 15 le. 11 If,tot ?o it -A 14 �(A� 1� t -- 1=tEs�'. UIJtoN �bT1o1.3J�1. rbbN�- o� �►.U�I Dl� �� p � Cc�Mµo�tUE�L�'N LI}u� �(l'CC.!✓ II-�.jP.bUr,� GbN.PbN`�' r n w dopla- duo kl-E l Q/ pp. _'&,&DRUDIN Z, Y-W31 WC) WlbLt lGS0LYQN �5, -Y-& ZI ) „o LEGAL DESCRIPTION + LOT e(.ocK . 1� '`1 _�M�NC�O__PLD�_a�_l--tl�►.-t1_sl_bP-�s___��__G�to�J _I.�=-------------- OF n ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT 800K __L°_'-�._ AT PAGE ---____ .1 OF','THE PUBL I C"RECORDS OF ------ COUNTY, "FLORIDA. ' LEGEND: FIP - FOUND IRON PIPES 2�s � SURVEYOR' S CERTIFICATE GIP - GET IRON PIPE �� t3u� IND - FOUND NAIL AND DISC ME HEAESY CERTIFY THAT THIS SURVEY 18 TRUE AND CORRECT TO THE BEST W OUR SND - SET NAIL AMC DISC KNOMLE08ff AND BELIEF AS REGTLY SURYEYEp AND NMM Ut1t0ER OUR DIRECTION CENTER LINE AND MEETS THE MINIMUM TECHNICAL STANDARDS SE TH BY THE FLORIDA STATE �dL G�I6 E BLOCK, STUCCO, BOARD OF LAND SURVEYORS IN CHAPTER 21H 6 i ADNINIS CODE, tl:,CONCREoTE, RIGHTKAY PURSUANT TO SECTION 472.027 FLORIDA S UTE . - CHAIN LINK FENCE ,N I FH C F IRE CONCRETE P INS RVE.YO fhjo pIZF 1 l(. VLC- MN - MANHOLE .--/ µi•?0 ~.PVT - PAVEMENT AUTHENTIC COPIES OF TH I - SRlC s8 - SOUTHERN BELL SURVEY SHALL BEAR THE FPL - FLOCABLE T POWERLEVIS AND LIGHT RAISED SEAL OF THE NESTOR G. ODRIG E - P 1lo CTY - CABLE TELEY1810N 7�vd LK K. WN - NATER METER ATTESTING REGISTERED REGISTERED LAND SUR Y • 4277 ay EAS - EASEMENT LAND SURVEYOR STATE OF FLORIDA ' _..... ._UtIL_-.UTILITY tONAT10NAL GEODETIC VERTICAL DATUM IONS(NOVOPEN j INSULA LAND SUAVEYDAS f TO LOCATE FOOTINGS AND/OR FOUNDATIONS S N C O IOT BEEN ABSTRACTED BY, THIS FIRM F40AR0I14 LAND DEVELOPMENT CONSULTANTS PARTIES, SUCH AS EASEMENTS, RIGHTS W MAY SURVEYORS PLANNERS AND FERABCERTIFIED TO THE PARTY(IES) CONSTRUCTION LAYOUT I SET BY THIS FILE OR RM ARE #T D RL8 . 4277. 585 EAST 49TH STREET. 'ED ON THIS SURVEY ARE BASED ON THE LEGAL SUITE 8 CLIENT OR IT8 REPRESENTATIVE. H I ALEAH. FLORIDA 33013 + PHONE ( 305) 687-9191 FAX ( 305) 687- . 9190 e r BUILDING 91 MIAMI SHORES VILLAGE, FLORIDA ,"; ELECTRICAL ❑ Date-_ �! _ t PLUMBING ❑ PERMIT N? 9951 Contractor's # ROOFING ❑ License No. ❑ Work to be performed under this Permit ,. Owner of J � � Building dz4 Architect — i Contractor / or Builder i k_ t r; :., ,, r _ �, 4 , c. . :. — ---- Legal Lox Subdi- rf Description i I Bl, _ vision Address ofr / Sq.Ft. r �" fry— Value o n - Amount of Building __.�?/ Project $ Permit $ _ This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the applica- tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown qn the plans or drawings or in the statements or specifications and that he assumes respon- sibility for work done by his agents, servants or aemployees. Signed 4- `i z INSPECTOR) BY In consideration of the issuance to me of this permitI a to perform the work covered hereunder in compliance with all ordi ances a pertaining thereto and in strict conformity with the plans, draw' statements or specifications submitted to the proper authoritigs of iami Shores In accepting this permit I assume responsibility for all work e by either, myself, my agent, servant or employee. CONTRACTOR or BUILDER BY AUTHORITY = PERMIT APPLICATION FOR MIAMI SHORES VILLAGE 10050 E.2nd Avenue•Miami Shores,Florida 33138•Phone: 305-795-2204• Fax:305- Date_ Job Address 15 57Tax Folio JUN 1 6 2003 Legal Description Historically Designated: Yes No 10VV/_wnerQ.ess w/Tenet P A JAZ1417�'l+,l' IS ,'"1 A A �� 1-'7 r" Master Permit# aaa Owner's Address 6 S Phone Contracting Co. LU c' V Address ;z Qualifier SS# e 3 0j 7 S— 6 -2 State# C Municipal# Competency# Ins.Co. IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY, THERE WILL BE NO INSPECTION.RE-INSPECTION FEE IS $50.00 AND MUST BE PAID IN ADVANCE BEFORE CALLING FOR ANOTHER INSPECTION. .r; Permit Type (circle one): B IN ELECTRICAL PLUMBING MECHANICAL ROOFING WORK DESCRIPTION: lJy CLQ ! C�- ., Square Ft. �� Estimated Cost(value) v C1 WARNING TO OWNER:YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY(IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR ANY ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.) Application is hereby made to obtain a permit to do work and installation as indicated above,and on the attached addendum(if applicable).I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction.I understand that separate permits are required for all disciplines. 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.Furthermore,I authorize the above named contractor to do the work stated. /Z/>1 i,,'('-z r � 3 gn ure of owner and/or Condo President Date Signature of Contractor or Owner Builder Date 1<5��_p 6�-V/- 1, ��'� �. ICwL;O;TAEAL _ /dam®� �1DNotary 'to Own u:'and/or on SER Date Notary as to Contractor or Owner Builder Date My Commission�k"ix�s .°1Y COMMISSION EXPIRES My Commission Expires _--_ RNAR.1,2006 .01 FEES:PERMIT RADON C.C.F NOTARY 5 BOND APPROVED: TOTAL DUE—4 ( Q ? Zoning ' r Building Electrical Mechanical Plumbing Structural Engineer r �, .^ d n