PAINT PERMIT 2002 • • PERNIIT APPLICATION
e
• Mester No.
SU159A*� t No.
�IORIDp' • •
• • • • • • • •••
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Step 1. Complete the attached permit application which shadby VetmoRot owlier and qualifier Both signs must be notarized Please
print or type to allow r a more accurate
processing o iya;r cl�tid�!jf ipofin: irk will be done,a roofing application must be submitted
along with this permit
Step 2. Submit the com leted V t „on with all necessary documents to the Building,Planning and Zoning Department for processing. During the
processing of your application,you may be asked to submit additional information.
Xe*Job Address: I"I 3 i • 6 • 1-03 rQ UI IANI I S WO MES FL_ 3313
Address Apt. City State Zip
Folio Number Description of Work 2P "
��-e /y 4 . .►
Lot Block
Subdivision PB PG Zoning Linear Feet
Current Use of PropertySquare Feet Units Floors
Proposed Use of Property Value of Work Z/f - Bldg Value
Tenant Information Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
PERMIT TYPE ✓ PERMIT CHANGE ✓ TYPE OF MANAGEMENT
Buil • .Contractor New Construction Enclosure
Electrical Renewal Alteration Exterior Repair
Mechanical RevWon Alteration Interior Demolish
Plumbling Extension Relocation of Structure Shell Only
LPGX Su lement Foundation Only Add'1 Attachment
Roofing Re on Other Add'1 Detachment
Fence Other
Other
ARCHITECT ENGINEER
None , Name
License No. License No.
Address Address
Telephone Telephone
Fax Fax
PROPERTY OWNER CONTRACTOR
Name A wd t4 E h15 C N E 12..... Name
Q
Address I. 5-�-' License No.
Address
�1ys
Home Telephone
ftdness Telephone 3 6!;-- x14
Fax Quallfler Nam
f e
r'
- • • • •
Pape 2 : :•• • • •
• PERMIT APPLICATION
... . . . . ... . .
1. DO NOT BEGIN ANY WORK WITHOUT HAvnq@'cRF.( &ED*y0eAmAm Parr AND PERMIT CARD. Applying for a permit does not grant
the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m.to 6:00 p.m.,and Saturday from 8:00 am.
to 5:00 p.m. No inspections will be conducted on weekends or holidays.
2. All construction of demolition areas MUST BE MADA%NEH 3N kOT EAKN,W.AT AND SANITARY CONDITION fire from construction debris.
3. STREETS AND NEIGHBORING PROPERTIES SHA^BE t "F A F&OkIDIRT.QVD DEBRIS.
4. SWALES MUST BE PROTECTED FROM BEING DAM• •••AGED 10 LQV (*VEHICLES,AND MAY NOT BE USED FOR STORAGE. A bond is
required for work in or near the street/sidewalk. • • • • • ••
5. CONSTRUCTION TRAMERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer
which requires a separate permit.
6. PORTABLE TOILETS for a construction site require a separate permit.
7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building,Planning and Zoning Department
8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement
9. Department of Health and Rehabilitative Services(HRS)approval is required for applications involving septic tanks. Department of Environmental Resources
Management(DERM)and/or Miami-Dade Water and Sewer Department(MDWASD)approval is required for applications involving sewers.
Application is hereby made to obtain a permit to do work and installation as indicated. I,the OWNER of the property,certify that all
work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits
are required for ELECTRICAL, PLUMBING, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY,
ROOFING and SIGNS and there may be additional permits required from other governmental agencies.
I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve
months to the Building Official. Further,I am fully aware that if the cumulative cost of work to my home or business under this and
any other permit equals or exceeds fifty percent (509o') of the fair market value of the structure, the entire structure must meet the
present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business
under this and any other permit exceeds fifty percent(50%)of thereplacement cost of the structure,then the entire structure must
conform to the current code requirements of the Building Code.
WAANIN[' TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for
improvements to your property. If you are spending more than$2,500 or intend to obtain financing,you may wish to consult with
your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at:
22 N.W. 1st Street, l•Floor,(305)679-1078. Once recorded,the Notice of Commencement must be POSTED AT THE JOB SITE in
accordance with Section 713-35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and
Choosing a Contractor.
STATE OF FLORIDA,CO -DAD
STATE OF FLORIDA,Cn OF MIAMI-DARE
Signature of Owner Signature Oftractor/Qualifier
Afu&.L5 / 0 49
Print Name6ev- Print Name
Swam to and ss 'bed before me thrs' da of /tl - Swan to and subscribed before me day of ,
%at 'r _
6
Si of Notary Public;.State of f Florida � b 4Si #o Notary blit-Stalfo6fiidie
SEAL. Vcn SEAL: ,etaAMM M to1
+r� Nh►
�w�°" Novi 16.80116
Personally known OR,Produced Identification Personally lmowl OR,Produced Identification
Type of Identification Produced: Type of Identification Produced
KATiiE M LIoTERD
.j W COMMOM a cc 825420
ft.EXPIRES:lira 12,2�3
Page 3 : ' : : :•
. . ... . . . . ...
PERMIT APPLICATION
.. . . . . . . . . .
INSTRUCTIONS: Please indicate the type ol:worf being jieifVmed*Wd 1pantity(ies)in the space provided below.
. .
Minimum Fee Dryer • • buil Service Repair
A/C Central 1-3 Ton Fan Outlet,Wall Service,Temporary
A/C Central 4-7 Ton Fire Pump Outlet,Switch Signs
A/C Central 8-15 Ton Fixture-Fluorescent Oven Space Heater(kw)
A/C Central 16-20 Ton Fixture Light Parking Lot Lights SpasMot Tubs
A/C Central 20+Ton Flood Lights Plugmold/Strip SuMeeds,No.of Amps
A/C Window FPL-Load Central Posts Swim Pool,Commercial
Air Conditioners Garbage Disposal Rangedlanp Top Swhn Pool,Residential
Chiller Generators,etc- Receptacles Switchboards
Clear Violations Heat Recovery Refrigerator,Comm,WM Temp Se",Conshu gm
Compactor Low-volt,Burglar Refrigerator,Domestic TeW for Test-30 days
Deep Freezer Low-volt,Fire Renew-Twp Service
Demolition Low-volt,IntercomMeph. Repair Circuits
Dishwasher Low-volt,Television Service,Number`iif Amps
Minimum Fee Condensate Drain Generator Rdrigeration,Tons
A/C Central,Tons Cooling Tower Heating Strips,each Vent Hood,Cost
A/C WaWWhL Tons Dryer Vents,Number d Paint Booth Ventilation,Cost
Air Handler,Tons Ductwork,Cost of PiphM Flammable Liquid Periodic Inspections
Barbecue Fire SpdWder System Proceafflressure Piping
Bath Fan-Vented,# Fireplaces,Number of Pressure Vessel
A/C Condensate Drains,Roof Miscellaneous Fixture Pit
Bath Tub Drinking Fountain Miscameons Repairs Solar Water Heater
Bidet Filter ce Pool"ping Sprinider
Ca -Fixture ° Fountain Pump and Abandon S ninkler system
Ca -Water Gas-Appliance Pump,Domestic Supply,AC Weft
Cap-Sewer Gas-Natural Pmup,Fire Stand Tem Toilet
Catch Basin Gas-Propane. Pump,Re-circulate lnemrax7 Water Closet
Clothes Washer Gas Piping Pump,Replace-Pool Urinal
Dental Chair Grease Trap Pmnp,S rinmer Utili -Sewer
Disdutrge Well Ice Maker pmp,Sum Utility-Water
Dishwasher Indirect Wastes Relay Re Vacuum Pum
DisVosal Interceptor Roof Inlet Water Closet
Domestic Well Lawn Tray Septic Connection Water Heater
Drainfield,4"Tile/Res. Lavatory Septic Tank Water Heater New
Drains,Area Meter Set(Gas) Sewer Connection Water Re-pipe
Drains,Floor Minimum Fee Shower Water Service
Drains,French Miscellaneous Equipment Sink Well,Su I
RECEIVED AND REVIEWED BY: DATE:
Page 4 • • • • •
'•' ' ' ' ' ••• PERMIT APPLICATION
OFFICE USE ONLY ... •
. . . . ..
WN H
❑ OWNER-BUILDER FORM ❑ PROOF OF OWNERSHIP ❑ CONDO ASSOCIATION APPROVAL
(Attach) OK'a" .': .'. 0 ; ••• (Attach)
❑ FIRE DEPARTMENT ❑ I.1$$/I ;*40VAL. ❑ BPR APPROVAL(Restaurants)
APPROVAL(Commercial/ (Septic/Sewer)
multi-family)
❑ CONCURRENCY ❑ IMPACT FEE ❑ CONTRACTOR REGISTRATION
(New Construction) (New Construction) (On File)
❑ OTHER ❑ .OTHER
(Specify&Attach) (Specify&Attach)
$3.00 per page(Scanning Fee) $
� 0
Miami Shores Village $
Bond $
Metropolitan Dade County (C.C.F.) $ - (sq.ft.=x/1000
x 0.60)
Inspector State Educational Fund $ (0-005/sq-ft-)
State DCA(Radon) $ (¢.01/sgft.)
Code Enforcement Fine $
Zoning Review $
TOTAL $ 0
ISSUING OFFICIAi-
� e
REVIEWED AND PREPARED BY: DATE:
SECTION BY DATE CONDITION 0FAI1PIZ0VXI_
Zoning3
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Build*ng Official
Revised July 2001
10050 N.E. 2-AVE.,MIAMI SHORES,FL• (305)795-2207 •FAX(305)756-8972•http://www.miamishoresvillage.com
MIA I SHORES VILLAGE
0 * gee
Paint Color 4lyb rriI!kle-ibfidlAgreement
. . . ... . . . .
DATE: ///Z v/O Z_ ... 66
OWNER'S NAME: PRONE: -7f P..3
ADDRESS: //7 :S '+' •••
ADDRESS OF SITE: //73 • : :hU. S¢
CONTRACTOR& LICENSE Sif •p i' dile): : : . .••'. .
COMPANY NAME: E (Y —PHONE: 74 es-93
All Elements on the site must be listed and indicate the color to-be painted.
Walls
f
Fascia 9+40
Drip Cap/Drip Edge ,a
Soffit W k °o
Roof !�
Flower Bins`W
ro
Shutters
Awnings
Chimney
Doors and door jams
Garage Doors .9 D .
Railings
r�
Fences Av /0'
Decorative Metal w /f!
All brick-(simulated or regular) o �'elo
Stucco Banding ty /# .
Any other stucco features
Accessory Buildings
Other t�,C- : (Qc0A% 6w qMeA ®r ;i�; "(ar
in ew�my
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. I authorize the above-named contractor, if applicable, to
do the work stated. Furthermore , the paint colors will be as per the attached
samples. • Ile _Z_
�. 7k-�/7
Signature of Owner Date Signature of Contract Date
APPROVED: Ca-'WHEN PAINTING IS FINISHED,
(� CALL FOR FINAL INSPECTION
— 6%"!
Od'
Building OfficW Date 4/23/01