PL2004-121Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 4/19/2004
Applicant: AQUALIFE
Owner: USA
JOB ADDRESS: 175
Contractor
Local Phone:
Parcel # 1121360030170
NW 109
Signed: (INSPECTOR)
Signed: (Contractor or Builder)
Plumbing Permit
Permit Number: PL2004 -121
USA
AQUALIFE
ST
Contractor's Address: 1021 S, W, 134 AVE.
Legal Description: MIAMI SHORES EXT PB 43-40 LOT 17
Permit Status: APPROVED Permit Expiration: 10/16/2004 Construction Value: $350.00
Work: CAP SANITARY LINE TO EXISTING PATIO
BY:
Page 1 of 1
BLK 219 LOT SIZE 104.900 X
Fees:
FEE2004 -4034
FEE2004 -4035
FEE2004 -4036
FEE2004 -4037
FEE2004 -4038
Description
Building Fee
CCF
Notary Fee
Training and Education Fee
Technology Fee
Total Fees:
Amount
$120.00
$0.60
$5.00
$0.20
$3.00
$128.80
Total Fees: $
Total Receipts: $d.00
z
APR 1 9 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.
ITEM
BATH TUB
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS
CENTRAL HEATING
DISHWASHER
RECEPTACLES
A/C (WIND)
DISPOSAL
SERVICE TEMPORARY
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 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 COWERCIAL
WATER SERVICE
SIGN TUBES
SEWER CONNECTIONS
SIGN TRANSFORMERS
UTILITY -SEWER
SIGN TIME CLOCK
UTILITY -WATER
FIXTURES
SEPTIC TANK
ANTENNA
RELAY
TELEVISION OUTLETS
DRAINFIELD, 4' TILE/RES.
VIOLATION
PUMP & 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
_
A,041, Ge..c.cose
' 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
ELECTRICAL
MECHANICAL
Bonding Company's Name (if applicable)
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 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 1/63s3.-C)
Owner or Agent Con
The foregoing instrument was acknowledged before me this J (/j The foregoing instrument was acknowledged before me this t
day of A ill , 20 fl g by •D-e, Onn 13e l s 3 .S () • day of / d 1 , 20 , by - .So L.-3 CFa ,
who is personally known to me or who has producedct GI.Q) • who is personally known to me or who has produced PRAI) {ll
As identification and who did take an oath.
l � Vnbv.I. as identification and who did take an oath.
NOTARY PUBLIC:
IARY PI; 1.1 My Commission Expires: - -4ti? , ,,,
S: ; (1f,. lb , a OoS
Bonding Co , Inc MY co • II N U h p . -13 C.,:af irAN. : 2040 . 6
(Certificate of Competency Holder)
State Certificate or Registration No. eACe.../' 2 56 21 Certificate of Competency No.
NOTARY I :
Sign:
Print: t�.
APPLICATION APPROVED BY:
Chc 12/15/03
Signa
******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** **** **** r, �k ************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Plans Examiner
Engineer
Zoning
BUILDING
PERMIT APPLICATION
FBC 2001
$ Value of Work For this Permit )( 4 35 , c
kola
Total Fee Now Due $ I Z)
(Continued on opposite side)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Job Address (where the work is being done) 1 7 5 /0 lx 1 09 5 i .
City Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES NO
Permit Type (circle): Building A Electrical Plumbing' > Mechanical Roofing
Owner's Name (Fee Simple Titleholder) A Oki /k (. ( F E USA / Eachone # ( 305 TS
Owner's Address .7) ST .
Tenant/Lessee Name Phone #
Qualifier So 1 CT- F C Ft;, j `7 Z 56 31
Contractor's Company NameA - 1 ► � <- o°J l�� .� ,-, ...- 7-.1C- Phone #
Contractor's Address /0 ?_ 51,.) (3 Ave
City - Dery State FC__. Zip 3 3 3 Z
Architect/Engineer's Name (if applicable) Phone #
Permit No. Pt D-ook-k - 12 1
Master Permit No.
Square Footage Of Work:
9�r!- Z75 — _ /
* * * * * * * * * * * * * * * * * * * * ** * * * ** F ees *** * * * * * * * * * * * * * * * * * * * * * * * * * **
aiECEPVED
APR 1 9 2004
Type of Work: DAddition ❑Alteration ['New ❑ Repair/Replace `Demolition
Describe Work: C,4- _,A,,,■ 1-1.2 y Z,,,,e % E , s peg %
Submittal Fee $ 5() -(D Permit Fee $ / q (.9 5.„ CCF $ + 6 0 C CC
Notary $5, D D Training/Education Fee $ . '0 Technology Fee $ 3,0
Scanning $ Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $