Fillable Miami Shores Village Building Department FBC 20 (Miami Shores Village)

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Miami Shores Village Building Department FBC 20 (Miami Shores Village)

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(Revised02/24/2014)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20
BUILDING Master Permit No.___________________
PERMIT APPLICATION Sub Permit No.___________________
BUILDING
ELECTRIC
ROOFING
REVISION
EXTENSION
RENEWAL
PLUMBING
MECHANICAL
PUBLIC WORKS
CHANGE OF
CONTRACTOR
CANCELLATION
SHOP
DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes ______ NO
Occupancy Type: ________ Load: _________ Construction Type: ___________Flood Zone: ________ BFE: ________ FFE:
OWNER: Name (Fee Simple Titleholder): Phone#:
Address:
City: State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: Phone#:
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration #: 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: Addition Alteration New Repair/Replace Demolition
Description of Work:
Specify color of color thru tile: _____ _______ ___
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
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.
************************************************************************************************************
APPROVED BY _____________________________ Plans Examiner __________________________________ Zoning
_____________________________ Structural Review Clerk
Signature____________________________________________
OWNER or AGENT
The foregoing instrument was acknowledged before me this
_________ day of _____________________, 20 ________, by
___________________________, who is personally known to
me or who has produced ___________________________ as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
Signature____________________________________________
CONTRACTOR
The foregoing instrument was acknowledged before me this
_________ day of _____________________, 20 ________, by
___________________________, who is personally known to
me or who has produced ___________________________ as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
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(Revised02/24/2014)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax:(305) 756.8972
AIR CONDITIONING REPLACEMENT DATA
PERMIT NUMBER: MC _____________
This form must accompany ALL air conditioning replacement permit applications. Each unit change-out must
be on its own data sheet. Multiple units on single sheets are not acceptable.
Job Address (where the work is being done):_______________________________________________________________
City: Miami Shores Village County: Miami Dade Zip Code: ____________________
ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB
ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION
A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS
AHRI DATA SHEET REQUIRED
Change disconnecting means: YES NO ARHI Sheet Attached: YES NO Contract Attached: YES
UNIT BEING REPLACED
DATA
NEW UNIT
MANUFACTURER
AHU or PKG. UNIT MODEL #
COND. UNIT MODEL #
KW HEAT
NOM TONS
AHU CU PKG
1) M.C.A
AHU CU PKG
AHU CU PKG
2) M.O.P
AHU CU PKG
AHU CU PKG
3) VOLTS
AHU CU PKG
PKG UNIT / /
PKG UNIT / /
EER/SEER
YES NO
REPLACING DUCTS
YES NO
YES NO
REPLACING THERMOSTAT
YES NO
YES NO
NEW 4”CONCRETE SLAB
YES NO
YES NO
NEW ROOF STAND
YES NO
YES NO
NEW RETURN PLENUM BOX
YES NO
1. Minimum Circuit Ampacity (Wire Size): ______________________________________________________
2. Maximum Overcurrent Protection (Fuse/Breaker Size): _________________________________________
3. Voltage of Circuit (208/240/480): ___________________________________________________________
4. Size Disconnecting Means: ________________________________________________________________
Contractor’s Company Name: ____________________________________________ Phone: __________________
State Certificate or Registration No._______________________Certificate of Competency No. __________________
Signature _____________________________________Date: _____________________
(Qualifier’s signature)
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Miami Shores Village Building Department FBC 20 (Miami Shores Village)

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Completed 23 September 2021

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