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MC-06-2957 IZecelpt Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795-2204 Fax: (305)756-8972 Permit Number: MC-12-06-2957 Owner Address: Invoice Number: MC-12-06-27136 9942 NE 4 AVE RD Applicant: DONNA WILSON MIAMI SHORES, FL 33138• Company Name: Job Address: 9942 4 AVE Street Miami Shores Village, FL Date Payment Type Check Number Amount Change Thursday,January 18, 2007 01/18/2007 Credit Card $157.55 $0.00 Total Payment: $157.55 Page 1 of 1 ` . ` ADDENDUM TO BUILDING PERMIT APPLICATION ' AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM.IF A MASTER PERMIT HAS BEEN OBTAINED,THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS. PLEASE CIRCLE O DISCIPLINE APPLIED FOR: PERMIT# PLUMBING ELECTRICAL MECHANICAL ITEM UNIT FEE ITEM UNIT FEE ITEM UNIT FEE BATH TUB SWITCH OUTLETS SPACE HEATERS DISHWASHER ILIGHTOUTLETS CENTRAL HEATING DISPOSAL IRECEPTACLES A/C (WIND) FLOOR DRAIN ISERVICE TEMPORARY IAIC(CENTRAL) GREASE TRAP ISERVICE SIZE IN AMPS DUCT WORK INTERCEPTOR I SERVICE REPAIR/METER CHANGE REFRIGERATION LAVATORY JAPPLIANCE OUTLETS PROCESS AND PRESS PIPING LAUNDRY TRAY RANGE TOP UNDERGROUND TANKS CLOTHES WASHER JOVEN ABOVE GROUND TANKS SHOWER IWATER HEATER U.F.PRESSURE VESSELS SINK.POT/3 COMP. IMOTORS 0-1 HP ISTEAM BOILERS SINK,RESIDENCE. IMOTORS OVER 1-3 HP I HOT WATER BOILERS SINK,SLOP. I MOTORS OVER 3-5 HP IMECHANICAL VENTILATION TEMPORARY WATER CLOSET IMOTORS OVER 5-8 HP TRANSPORTING ASSEMBLIES URINAL MOTORS OVER 8-10 HP ELEVATORS/ESCALATORS WATER CLOSET MOTORS OVER 10-25 HP FIRE SPRINKLER SYSTEMS INDIRECT WASTES MOTORS OVER 25-100 HP COOLING TOWERS WATER SUPPLY TO: MOTORS OVER 100 HP VIOLATION A/C UNIT A/C WINDOW REINSPECTION FIRE SPRINKLER JAIR CONDITIONERS HEATER-NEW INST. ISTRIP HEATER HEATER-REPLACE IGENERATORS TRANSFORMERS LAWN SPRINKLER-WELL IGENERATORS TRANSFORMERS SWIMMING POOL IGENERATORS TRANSFORMERS WATER SERVICE ISPECIAL PURPOSE SEWER CONNECTIONS JOUTLETS COMMERCIAL UTILITY-SEWER ISIGN TUBES UTILITY-WATER ISIGN TRANSFORMERS SEPTIC TANK SIGN TIME CLOCK RELAY FIXTURES FAINFIELD,4"TILEIRES. ANTENNA PUMP&ABANDON SEPTIC TANK TELEVISION OUTLETS SOAKAGE PIT CU.FT. VIOLATION CATCH BASIN IREINSPECTION 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 TMIMiami Shores Village D DEC 10 ,2006M O TO Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 B Y.- Tel: °Tel:(305)795.2204 Fax:(305)756.8972 0 1 10ki U-1:1 Permit No. PERMIT APPLICATION Master Permit No. FBC 2004 Permit Type(circle): Building Electrical Plumbing Mechanical Roofing Owner's Name(Fee Simple Titleholder)/*4 fZ f i4N f (,U t �,5 p A­� Phone# m, Owner's Address rF, d City/ A l Awt,,: 5t�00/Le S State — Zip Z,3/3 Tenant/Lessee Name Phone# Job Address(where the work is being done) City Miami Shores Village County . Miami-Dade Zip FOLIO/PARCEL# Is Building Historically Designated YES NO Contractor's Company Name �� Phone# &®5 &6? 7 4/3,/ Contractor's Address /lam - ?— `HJT City State._,: t/J� Qualifier Name /2&&K5/-X� ±9z4,-1 +t_ Phone# State Certificate or Registration No. 00�" XP13 C13 ® Certificate of Competency Architect/Engineer's Name(if applicable) Phone# 00 Value of Work For this Permit.$: Square/Linear Footage Of Work: Type_of.Work: ❑Addition , []Alteration ❑New ❑ Repair/Replace ❑Demolition DescribeWork: S `! �i� .��G'Y_'��®�2� ReLo c x 4-e o Submittal Fee$ Permit Fee$ CCF$ o(0 D CO/CC Notary$ Training/Education Fee$ Technology Fee$ Scanning$ Radon$ DPBR$ Zoning$ Bond$ Code Enforcement$ Double Fee$ Structural Review.$ Total Fee Now bue•$t I��• , See Reverse side-� Bonding Company's Name(if applicable) , c Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the fast inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of ,20_,by day of. .20 fie,by who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. PFA g:,,.ci �Ges identification.and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: P 0 A Sign: Sign: _ 1 :. MAY( { M#DD3856r, Print: Print: c� R� t My Commission Expires: My Commission Expires: APPLICATION APPROVED BY: I �I Plans Examiner Engineer Zoning (Revised 02/08/06) I Miami Shores Village r �� ,s Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fax:(305)756.8972 BUILDING r Permit No. D b z q PERMIT APPLICATION UEC 20a� Master Permit No. �C. — N2-7 FBC 2004 eo Permit Type(circle): Building Electrical Plumbing Mechanical Roofing Owner's Name(Fee Simple Titleholder) y�'��}(�5 ��� hone# Q�® Owner's Address City State . Zip 'J Tenant/Lessee Name Phone# Job Address(where the work is being done) City Miami Shores Village County Miami-Dade Zip FOLIO/PARCEL# Is Building Historically Designated YES NO Contractor's Company Name �(,(���le.. U 11 QA--) Phone# Contractor's Address City State r Qualifier Name 0 W State Certificate or Registration No. Certificate o Competency No- Architect/Engineer's Name(if applicable) Phone# Value of Work For this Permit$ / Square/Linear Footage Of Work: Type of Work: []Addition 4teration ❑New ❑ Repair/Replace ❑Demolition Describe Work: 2 (_5 yyl A Submittal Fee$ Permit Fee$ CCF$ Notary$ Training/Education Fee$ Techn4 Fee Q Scanning$ Radon$ DPBR$ Zoning$ Bond$ Code Enforcement$ Double Fee$ Structural Review.$ Total Fee Now Due$ See Reverse side—� Bonding Company's Name(if applicable) Bonding Company's Address City State Zip u Mortgage Lender's Name(if applicable) 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 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 reinspection fee will be charged Signature Ja",— /?, Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of kern./rev,20&,by 1Jd J'✓M La 11111,564 day of .20_,by who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take oath. as identification and who did take an oath. uni�y NOTARY PUBLIC: ���;� , CUP '''�,, NOTARY PUBLIC: 512412010AQ �� Sign WPM_ = Sign: Print Fr%n T 6y✓Ar7 = 6ammissiaa l Prinr. My Commissioni es Exp �� �/m .,�1,��••.. ....O��O My Commission Expires: Se4edrt44�t4r+kic�le#�ea�Cieie�Sr�t4+t�inkirinYde�Y+S+k4;nkfr�k,trat+Y*4�Y�ir'a7Eg �fah�9���A1F�iY�Y�Yk�Yat,tt aY*aY,taY*ir�r�Tr�r,r�Y,taY*�t�rir�isir#r�C,r�ir*itt�Y,a�lr�rt f�e�Y�r*ar�it�C*�efr*akat �llllllllll APPLICATION APPROVED BY: Plans Examiner Engineer Zoning (Revised t12tO8/o6) Miami Shores Village / VI 10050 N.E. 2nd Avenue 1 Miami Shores, FL 33138-0000 Phone: (305)795-2204 Fax: (305)756-8972 Permit Permit Status: APPROVED Issue Date: 12/29/2006 Expires: 06127/2007 Permit Number: MC-12-06-2957 Owner's Name: DONNA WILSON one: Permit Type: Mechanical - Residential Parcel#: 1132060171220 Work Classification: Addition/Alteration Block: Lot: Job Address: 9942 4 AVE Street Section: PB: Miami Shores Village, FL Contractor(s) Phone Primary Contractor Total Square Feet: 0 ALFRESCO AIR INC Yes Total Valuation: $ 380.00 Re uired Inspections Additional Information Rough Tons: Additional Info: Rough DuctVentilation Classification:Residential Smoke Test Hood Smoke Det Test Final 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, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. 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. Futhermore, I authorize the above-named contractor to do the work stated. Fees Due Amount Invoice Number Amt Due Amt Paid CCF $0.60 MC-12-06-27136 $157.55 Education Surcharge $0.20 Total: Permit Fee-Additions/Alterations $150.00 F410 Scanning Fee $3.00 Technology Fee $3.75 Vf 3�t VZci Total: $157.55 B ilding D partment File Copy NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS,STATE AGENCIES,OR FEDERAL AGENCIES. Applicant Signature MECHANICA L