REV-17-1063 �ECEiv
Miami Shores Village
Building Department APR 177,r
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(3 05)762-4949
FBC 2014
BUILDING ter Permit No.gt-C-3 -(7- (; 3 I
PERMIT APPLICATIO Sub Permit No.zf_y r-7-- (UPS
❑BUILDING Eg ELECTRIC OF REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
P,40 �'l CONTRACTOR DRAWINGS
JOB ADDRESS: _
City: Miami Shores County: Miami Dade Zio• X14 1
Folio/Parcel#: Is the Building Historically Designated:Yes NO Y
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): L&92=V (f N l if CcQ S( %Y Phone#: :� 10 - OC- 3 L(Z
l- Tom'
Address: '�6 6 AJ r= _2� AAF
City: Maml cSNC)f2E 5 State: (`— Zip: 3
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: (?-4P)— J AJ� T OC_, Phone#: ®S - Cj J -t( r o
Address:_ t 1 7 S N( _ ( Z I I*f -a ;.
City: AJ6 [V%f(�Kk State: F4— Zip: 33 IA-Z
Qualifier Name: ,R_6)_pTP ' 1L "� (\j i7VL�Lj Phone#: so- -8t(-100c?
State Certification or Registration#: L=�5 000 o (� G Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: 5Q Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:8 D D(Pte(,- 12Cj,y A-L L® /-J Q. F C In V_
e K_
Specify color f color thru tile:
Submittal Fee$ Permit Fee$ Xr01 f0 CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ v
(ReAsed02/24/2014)
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 ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES,BOILERS,HEATERS,TANKS,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 Signature
"instrumentwas
NT CONTRA6&
The fore ledged before me this The foregoing instrument w s acknowledged before me this
U�day of/���601 L, .201' by day of 1� 20 /I ,by
,16qh MIA V whams personally known to who is personally known to
me or who has produced as me
identification and who did take an oath. id R nd who did take an oath.
NOTARY PUB IC: NOTARY PUBLIC:
Sign: J� Sign:
Print: y irl Print:
fn
DEBORAH SA GHI
Se ��x wry public State of Florida Seal: r � NOTARY PUBLIC
Jeffry J Yap —STATE OF FLORIDA
� s �C�Comm/s�18 1seae� Comm#FF171409
APPROVED BY � �.� l Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
RECEIVE®
Barry SPMB 107 t f7078.8 APR 171017
Equipment to structure and cable
Manufacturer Model Quantity Cost Description
Draper Profile 2 $3,026.00 Wall mounted projection screen
Crestron GLS-OIR-C-CN 1 $125.00 Room sensor for turning off equipment
Chief SYSUAB 2 $612.00 Ceiling tile mount w/safety wire
Chief MCM1U 1 $184.00 Adjustable ceiling mount kit
Chief CMS018024 1 $90.00 Pipe from ceiling mount to projector mount
Chief CMA330 1 $41.00 Offset ceiling plate
FSR DR-PCB-H15M 1 $251.00 Plenum rated 50' HDMI cable
FSR DR-PCB-H10M 1 $194.00 Plenum rated 33' HDMI cable
Belden 1213F 250ft $200.00 CATS Plenum cable to room sensor and projector
Belden 63000E 250ft $100.00 18/2 Plenum cable to speakers
Belden 9451P 250ft $50.00 22/2 Plenum cable
Belden 1695A 250ft $198.00 RG6 Plenum rated coax cable
Nuetrik NE8FDY-C6-B 2 $50.00 Wall plate RJ45 connector
Nuetrik NL4MP-2 2 $6.00 Wall plate Speakon connector
Nuetrik NCSFD-L-B-1 21 15.50 Wall plate XLR connector
Custom lWall Plate 1 2 $14.00 Aluminum wall plate
$5,156.50
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4/10/2017 NC5FD-L-B-1-Neutrik
NC5FD-L-B-1
5 pole female receptacle,solder cups,black metal housing, gold contacts
Universal D-size metal body XLR panel mount series.UL recognized component.
Features&Benefits
• Robust"D"metal shell
• Standardized D sized 24 mm panel cutout
• Solder cups on 3-7 pole version
Technical Information show
Accessories
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Certificate of Compliance
Certificate tiuintler 20100108-E135070 �,anc--1 of 2
Repoit Reierence E135070. 1997 Septeniber 18
issue;gate 2010 January 8 Underwriters
U '
0 Laboratories Inc,;.
Issued to: NEUTRIK AG
IM ALTEN R1ET 143 SCHAAN
9494 LIECHTENSTEIN
This is to certifj•that CONNECTORS FOR USE IN DATA SIGNAL,
representative samples of CONTROL AND POWER APPLICATIONS.
See Addendum Page
Hare been irrnestigaterl by Underwriters Laboratories Inc. (UL)or anji blrldVized
licensee of L'L in accordance with the Slantlard(s)indieta k om 11siv Cerltticate. •,:
Standard(s)for Safgy: UL 1977 - STANDARD FOR COMPONENT CONNECVO*A§' •OR IN �•�••
DATA, SIGNAL, CONTROL AND POWER APPLICATIQV. -Edij on ;••••
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Additional Information: See UL On-Line Certification Directory at wvtwv.UL.co11jf0%;fjditiona1 ••
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infonn •ation s••••
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only those products bearing the UL Recognized Component :Mark should be
Considered as being covered by UL's Recognition and Follow-Up Service.
Llie UL. Recc:gniiud Coinionent Mark generally consists of the manedicturcr's i,ienlificaiic.n :n;.i
n:I,he,, iron cl n.ul„ber or other product desirmation as Specified i1ri e, tcirh;n; r:r �l,u
p:irii,ui:n Rc.c:ognitiou as published in the appropriate UL Directory. As a skill pirtuentar: niutti5 oil
id util�ii:;< products that have been oroduced under UU., (.component Rccognit :_a
Recoenizcd C. ^ip::nuni Mih': 911, miry be used in ii}njuction x ith tlae rec3ui cd Rcev,nir; l ,larks
'Liar: . res;uirid when specified in the Ul. three€,n,
rtiii;L.C.I. 1�••,)1 :;CT 1 i kli1t5 lti Jig individual recc-nitions.
Look feat” >he UL Rocognized Component Mark on the product
� a;r'th _ inerican Q:tr =rta irri t°ltrrts
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inc,
Certificate of Compliance
e. ii;;ate 20100108-E135070 :; 2 of 2
R j,otlRdi:';ercf, E135070, 1997 September 18
ksuie Dat@ 2010 January 8 Underwriters
UOL Laboratofles Inc...
f
This is to verify that representative samples of the product as specified on this certificate were tested
according to the current UL requirements.
Component Connectors, Series DL, Series DLX, Series RX, Series XX
and Series X, Cat. Nos. with prefix NC followed by 3, 4, 5, 6 or 7 followed
by F or M, may be followed by S, followed by D for DL series or D-LX for
DLX series or followed by X for X series or XX for XX series or followed by
RX for RX series, may be followed by -M3, -H, -V CAU, -B, -BAG, -HE, -HA ,
-L-1 or -0. For RX, X and XX series only: -HD, -14, -CRYSTAL or -SPEC.
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