EL2004-113•
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Buildin
Owner's Name (Fee Simple Titleholder)
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Owner's Address �1 ; &■
City I) I . , "# ti 1.4 C> State r'L%
Tenant/Lessee Name
$ Value of Work For this Permit ' e/ (1
Total Fee Now Due $ O ,,. 3
(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
_Elect+;eftt -- - Plumbing
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Job Address (where the work is being clone) r C . K. j - ri t, - i ` ' #
City Miami Shores Village County Miami -Dade
Is Building Historically Designated YES NO
Contractor's Company Name i l L. �:� 1 t . r t/'■;1 iZ- -Phone #
Contractor's Address d G III J 1, ;� 4 ! ,# ' s
City 1 �►It �, State
Qualifier .' i' l l 1
Zip
Architect/Engineer's Name (if applicable) Phone #
Type of Work: ❑Addition EAlteration ❑New a Repair/Replace El Demolition
Describe Work: Ll.i J j l . F . I / f' '` ! _-
Master Permit No.
Phone #
Permit No. Lc
Mechanical
Zip
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Roofing
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Square Footage Of Work:
** *** ***,v * * * * * * * * * * * * * * * **** F ees * * ** * * * * * * * * * * * * * * *** * ** ******
Submittal Fee $ Permit Fee $ , /t''t' t CCF CO /CC
Notary $ Training/Education Fee $ , 0 Technology Fee $ c
Scanning $ Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
Bonding Company's Name (if applicable)
Bonding Company's Address
City _
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City
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,Signature
The fore fling instrument as acknowled
day of / �� , 2014: by a_
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whose pt v f." ., . _
for the first inspection which occurs seven (7) days aper
inspection will not be approved and a reinspection fee will be charged.
edbefore me this
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY P
Sign: � ,� �� t
Print:
My Commission Expires:
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
State Certificate or Registration No. Certificate of Competency No.
***************** * * * * * * * * * * * * *** * ** ** * * ** * ** * * **
APPLICATION APPROVED BYi-
Chc 12/15/03
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(Certificate of Competency Holder)
Signature
Contractor
instrument was ailmowledged before me thi
20 `f" b 3(-1- L /` 1. i ;j
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
* ************ **************************** **** *****
Plans Examiner
Engineer
Zoning
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Sign:
Print:
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My Commission Expires:
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ITEM
BATH 1U8
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE°
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS
CENTRAL HEATING
�!
DISHWASHER
_
DISPOSAL
■■
SERV TEMPORARY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN AMPS
DUCT WORK
FLOOR ORION
SERVICE REPAIR/METER CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TOP
UNDERGROUND TANKS
LAVATORY
OVEN
ABOVE (MOUND 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
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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 If
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 ,;_, Y,
A/C UNIT
STRIP HEATER VII
''
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 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
ARE,', DRAIN
ROOF INLET
SOLAR WATER HEATER
FIRE STANDPIPE
POOL PIPING
° �
LAWN SPRINKLER SYSTEM
GAS RANGE
all
METER SET (GAS)
Ell
GAS PIPING
PLUMBING
ADDENDUM TO BUILDING PERMIT APPLICATION
(AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A RASTER PERMIT HAS B.
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
MECHANICAL
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 5/4/2004
Applicant: LEROY JACKSON
Owner: JACKSON LEROY
JOB ADDRESS: 755 NE 91 ST 3F
Parcel # 1132060440300
Signed: (INSPECTOR)
Electrical Permit
Permit Number: EL2004 -113
Contractor AFFORDABLE ELECTRICAL CONTRACTORS H Xractor's Address: 515 NE 190 ST
Local Phone: 305 - 940 - 0777
Page 1 of 1
Legal Description: SHORES PLAZA EAST CONDO UNIT 3F - 2ND FLOOR UNDIV .01786% INT IN
Fees: Description Amount
FEE2004 -4547 Building Fee $100.00
FEE2004 -4548 CCF $0.60
FEE2004 -4549 Training and Education Fee $0.20
FEE2004 -4550 Technology Fee $2.50
Total Fees: $103.30
Total Fees: $103.30
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration: 10/30/2004 Construction Value: $500.00
Work: WIRE 1.5 TON A/C W 5KW
NAy 0 6 Pk&
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: