ME2003-196 MIAMI SHORES VILLAGE
BUff:bI SIG DEPARTMEN
305-795-2204
Building Inspection Request -�
Date 1 ( 610 -4
Type Insp'n �4 f' Yvf0 6`
Permit No.
Name f' l� /tom
Address
Company eleP
Phone# f 55,4
Inspection Date �rz`t 0
Approved �� A, /•o
Correction ❑
Re-Insp'n Fee ❑
y
E IEWE® PERMIT APPLICATION
OCT 17 20 Master Permit No. _
Wr ® WM Subsidiary Permit No, - �O
sst.csss �,
The following (eps must be uiken to obUihi a permit from Ilie klii n1i Shores
Step 1. Complete the attached permit'application which must be sigged by the=V= and WmUfn Both sismaMm must_be notarized. Please
print or type to allow for a more accurate processing of your application. If roofing work will be done,a roofing application must be submit-
ted along with this permit application.
Step 2. Submit the completed armlication 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.
Job Address: 1 IIS Nk- ►03 ST, M14m S Roma 33116
Address Apt. City date Zip
Folio Number 11" Z2YZ" 031'a01 D Description of Work &101Q-SVN 1t'
Lot Block
Subdivision PB PG Zoning Linear Feet
Current Use of Property i DEVACE Square Feet Units Floors
Proposed Use of Property Value of Work _ L 2 Bldg Value
Tenant Information' Tax Assessed/Appraised Value
° Flood Zone Base Floor Elev.
PERMT TYPE (✓) VKRMIT CHANGE (✓ TYPE OF MANAGEMENT (✓
Bullldft Chg.Contractor New Conshmxflon Enclosure
Electrical Renewal Alteration Exterior Re
Mechanical Revision Alteration Interior Demolish
Plumbing Extension Relocation of Strncture Shell Only
LPG% suoplentent Foundation Only Add'I Attachment
Rooft Other Add'1 Detachment
Fence Other
Other
ARCHITECT ENGINEER
Name Nacre
License Na License No.
Address Address
Telephone Telephone
Fax Fax
e . -
PROPERTY OWNERCONTRA�CTOR
Name b AtAt4C O \SG�E .. Name COOL,-&,EF-?:E A/c COM.
Address `113 t4c. 103 ST. License No. CACUz43,v-
hNAs11 5W6fts, T-L 3313$ Ad's Nizo SW 130'0
Home Tekphm 1'IAtl), ft TIM,
Business Telephone Telephone 22(.,','S.� Fax
Fax Qualifier Name .t—A r
Page 2 '
PERNff APPLICATION
1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT 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 am.to 6:00 pm.and Sattaday 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 MAINTAINED IN A CLEAN,NEAT AND SANITARY CONDITION free from construction debris.
3. STREETS AND NEIGHBORING PROPERTIES SHALL,BE KEPT FREE FROM DIRT AND DEBRIS.
4.. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES,AND MAY NOT BE USED FOR STORAGE. A bond is
required far work in or near the street/sidewalk.
5. CONSTRUCTION TRAILERS 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(50%) 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 the replacement cost of the structure,then the entire structure must
conform to the current code requirements of the Building Code.
WARNING 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, 11,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 FLORIDCOUNTY OF MIAMI-DADE ST COUNTY OF MIAMI-DADE
Sigaatnoe of Owner gignature.of Contractor/"dier
D 4%.."V\$ R1 S C 1/
Print Name Print Name
Swann to and subscribed before me this a1 AA day of Sworn to and subsimbed before me this
dQ03• �-Oe3 ,
Si of N -State of Florida 0goanae c-S
ADDt786BB
SEAI: KWoy 881M.11@L SEAL DeoNba
• PabumbMan
• CMM*"ODOPM
�'aw�F Sept 18,
Personally known OR,Produced Identification Personally known OR,Produced Identification
Type of Identification Produced: Type of Identification Produced
Page 3 ,.=.
PERMIT APPLICATION
INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies)in the space provided below.
Minimum Fee Dryer Outlet,Appliance Service Repair
A/C Central 1-3 Ton Fan Outlet,Wall Service,Temporary _
A/C Central 4-7 Ton FlrePump Outlet,Switch Signs
A/C Central 5-15 Ton Fixdue-Fluorescent oven Space Heater(kw)
A/C Central 16-20 Ton Future Light I Parking Lot Lights Spas/Hot Tabs
A/C Central 20+Ton FloodLights Plugmold/Strip Subfeeds,No.of Amps
A/C Window FPL-Load Central Posts Swim Pool,Commercial
Air Conditioners Garbage Disposal Range/Range Top Swim Pool,Residential
Chiller Generators,etc. Receptacles Switchboards
Clear Violations Heat Recovery Refrigerator,Comm-(p/PH) Temp Serv.,Construction
Compactor Low-volt,Burglar Refrigerator,Domestic Temp for Test-30 days
Deep Freezer Low-volt,Fire Renew-Temp Service
Demolition Low-volt,IntercOHkf leph- Repair Circuits
Dishwasher Low-volt,Television Service,Number of Amps
M --
Minimum Fee Condensate Drain Generator Refrigeration,Tons
A/C Central,Tons Cooling Tower Heating Strips,each Vent Hood,Cost
A/C Wall/Win.Tons Dryer Vents,Number of Paint Booth Ventilation,Cost
Air Handler,Tons Ductwork,Cost of A V= Piping,Flammable Liquid Periodic Inspections
Barbecue Fire Sprinkler System Proceaftessure Piping
Bath Fan-Vented,# Fire Number of Pressure Vessel
A/C Condensate Drains,Roof NBsceltaneous Fixture Soakage Pit
Bath lbb Fountain Miscellaneous Repairs Solar Water Heater
Bidet Filter Replace Pool Piping Sprinkler Repair
Ca -Fixture Fountain Puinp and Abandon S er
Ca -Water Gas+Appliance Punip,Domestic Su.Wy,AC Well
Ca -Sewer Gas-Natural Pun ,Fire Stand Teinporary Tollet
Catch Basin Gas.Propane Pump,Re-circulate Temporary Water Closet
Clothes Washer Gas ELpdM Pump,Replace-Pool Urinal
Dental Chair 2MLe Trap Pump,Sprinkler Utility-Sewer
ffiwharge Well Ice Maker Pump,Snm U -Water
Dishwasher Indirect Wastes Relay Reim& Vacuum Pum
Disposal Interceptor Roof Inlet Water Closet
Domestic Well Laundry Tray Septic Connection Water Heater
Drainfield,4"UdPtes. Lavatory Septic Tank Water Heater New
Drains,Area M Set(Gas) Sewer Connection Water Reipe
-
Drains,Floor Mhnimum Fee Shower Water Service
Drains,French Miscellaneous Equipment Sink Well,Supply
RECEIVED AND REVIEWED BY: DATE:
I
i
Page 4 • .
PERMIT APPLICATION
OFFICE USE ONLY
I
i
❑ OWNER-BUILDER FORM ❑ PROOF OF OWNERSHIP ❑ CONDO ASSOCIATION APPROVAL
(Attach) (Attach) (Attach)
i
❑ FIRE DEPARTMENT ❑ HRS/DERM APPROVAL ❑ BPR APPROVAL(Restaurants)
APPROVAL(Commercial/ (Septic/Sewer)
multi-family)
❑ CONCURRENCY ❑ IMPACT FEE ❑ CONTRACTOR REGISTRATION
(New Construction) (New Construction) (On File)
1
❑ OTHER ❑ OTHER
(Specify&Attach) (Specify&Attach)
1
$3.00 per Page(Scanning Fee) $
OJI
Miami Shores Village
i
Bond $
Metropolitan Dade County (C.C.F.) $ (sgft¢.60)=x/1000
71 x
Inspector State Educational Fund $ v (¢.005/sqA)
State DCA(Radon) $ (¢.01/sqA)
Code Enforcement Fine $
Zoning Review $
Notary $
TOTAL $
REVIEWED AND PREPARED BY: DATE:
SECTION BY DATE
Zoning CONI).1410!N, 0F.APPIZOVAL
Electrical
Mechanical 7x o t-
Plumbing
Fire {
Public Works
Structural
Building Official
Revised July 2001
10050 N.E.2-AVE.,MIAMI SHORES,FL• (305) 795-2207 •FAX(305)756-8972• http://www.miamishoresvillage.com
i
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
• 305-795-2204
Building Inspection Request
Date Time
Type Insp'n -I n aS WJ11Aa.,LU 6a-e--,
Permit No. (D
Namev�/aJ�
Address
Company {
Phone# 3�� z18 �P�2So
For Inspector: t v 3 Name&Date
Approved ❑
Correction ❑
Re-Insp'n Fee ❑