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PAINTPERMIT APPLICATION Master Permit No. Subsidiary Permit No. g2Wa . INSTRUCTIONS - The following steps must be taken o obtain Step 1. Complete the attached permit application which must besigned by the proparty owner and qualifier, Both sianntur-csus he 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 submitted along with this permit application. Step 2. Submit the completed application 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. APPLICATION Job Address: /Z�d Address Apt. City State Zip Folio Number Lot Block Subdivision PB PG Current Use of Property Proposed Use of Property Tenant Information I PERMIT TYPE (✓ ) [ Electrical Mechanical LPGX Roofin Fence Other_ ARCHITECT Name License No. Address Telephone Fax Zoning a a W Lftear Yeet Square Feet Value of Work Units Floors Zee Bldg Value Tax Assessed/Appraised Value Flood Zone PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension PROPERTY OWNER Name Address Home Telephone \ 7 S Business Telephone J II Fax Base Floor Elev TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'l Attachment Other Add'I Detachment Other ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name r i • License No. Address ///7K i'VF 13U 1,71pwr-r FC `—3-340' Telephonepr/�� Fax rJr•Y23'�6(y� Qualifier Name,yy�U J M Page 2 PERMIT APPLICATION IMPORTANT I. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying fora 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 a.m. 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 for work in or near the streettsidewalk. 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. Departmcnt 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. AFFIDAVIT, Application is here y made to obtain a permit to qo work and installation as indicated. I, the OWNER of the property, certify that all work will be per f edi the st ds of iaw.s r guiat' g construction in this jurisdiction. I understand that separate permits are required for E CTRICAL# P�� + MNq OL, �IOR 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 OWIVER: 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 $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1" Floor, (305) 679-1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713-35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. STATE O FLOIDA, COUNTY OF IAMI-DADE Signature of Owner Print Name /n Srrw��o,r,nnqto and subscribed before me this �_ day of AIt Signature of Notary SEAL: Expires April 10, 2006 Bonded Thm Adel 14 Banding a),. M= Personally known 'r OR, Produced Identification STATE OF FL0,RIDXf COUjqTY'OF MIAMI-DADE Signature of Print Name L Sworn to and subscribed before me ti i/. of � ti ignaturc o NotaryAu De of Florida SEAL: Personally known L_,<�'OR, Produced Identification Type of Identification Produced: Type of Identification Produced: 39. vO n1 m 0 _a c :3_a U) S 7 ? S CL 7 S fD S 0 y N O N 61 h CD O 7 a 7 y. 3v y. � (ODo�ia m m �cya �yo�yfD 4 w a ym�aa3 to m =: 01 co � 5 �0 2 �c S in a1 0 a mtnCD 0o0o=a a A y N y j N m o 0 0 c 30 a 3 65 a ® CD 3 3 0 O N j>> o 3mo •<�. &a0 o y o m 5-0� i,a �C O N (0 0 d 3 01 1 CD w N 0 ErS� N M (D C1 O C O 0 S S w 70� a m y o m > y =' N 3 y a 61 C _ @ __ 7 39 p � f/i W CD sn aC _ c� 3 �a) CD CD m m r. o- ao Z cr'3rn< �< m m m EpC m sN vo 0 n m o 0 :° CD � 0 0 3 O cD CD m < n m m x c o m m m 0 oo CL �0? �x T ~►T R EOBN 51FET'—EA 0 oELUIIE Evo-m m at Q'3 " x If 03� 3 u0� r "N 0 0-d�s� AM -0 i LW m� p C' �o N ]] � . r � o ,.a a =000� Dcn�OW 5 r �$ Tv2� ; �r2Dm r - m 03 Y W z L Z Ln N W Z r Q m ` r � + W W � o r m� ru W m O a p N 0 r �i1 X" o i CD • 11 y '* 40 O � 0 N' O n O C � N p� CD W 61 O CD CD CL vi 0 O CDo CD 3 O (D `o' Q d N 7 O � O o at aci 0 CD o -a 0 mCD < n 1 3 c f Co 0 * -u 3 C r � m y D Z 6o D D_ Z < Q O O� rl CD _ 3 m x O d m O N 0 0 N fa N O 0 0 O -n -n -nm m m m m N N N M 000•• N N CN N N N W N � 0 o 0 co 0 Y 0 _ cD T EL - cc n -n CD <D cD CD N 0 n� N O m CD CD D cyitflbarn 3 c� cn 0 0 hi O N O= oOoo� 0 0 n (D. -n CD /1 y -v 1 c� W N O CA O W CO O 0 r CD co v 0 N n O 4 D Cn O N m Cn m C-) w 0o O 6 V r O 1 Cn v 90 00 CA r 00 r O i Cn N m ;Cl ZJ m G7 C_ r D r 0 0 0 �D W O Cn 00 O Cn W (') 00 7 n� 0 0 0 ic r m m 0 9 m D Z Z C) n 0 wO W O N cD. Q N N v CA Z m w 0 X m m T*'c O W J D 5 �• v v Cl) Cl) G) D G) N CA O ID C, N 0 O N m co (7) ' CD 3 cn m Z � r 3 D G) G LIE N CD 40 co EA OF-01 M", ou rr� r i CL mo CD rur■ rh Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. ' 'ELECTRICAL Minimum Fee QTY. TYPE Dryer QTY. TYPE Outlet, Appliance QTY. TYPE 1 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 Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subreeds, 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, Intercom/Teleph. Repair Circuits Dishwasher Low -volt, Television Service, Number of Amps MECHANICAL TYPE Minimum Fee QTY. TYPE QTY. Condensate Drain TYPE QTY. Generator TYPE 1 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 Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Bath Fan -Vented, # Fireplaces, Number of Pressure Vessel PLUMBING TYPE A/C Condensate QTY. TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. TYPE Soakage Pit QrY. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic i Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re -circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry 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, Supply RECEIVED AND REVIEWED BY: DATE: Page 4 PERMIT APPLICATION OFFICE USE ONLY CHECKLIST —1 ❑ OWNER - BUILDER FORM ❑ PROOF OF OWNERSHIP ❑ CONDO ASSOCIATION APPROVAL (Attach) (Attach) (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi -family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) PERMIT FEES $3.00 per page (Scanning Fee) Miami Shores Village Bond Metropolitan Dade County (C.C.R) Inspector State Educational Fund State DCA (Radon) Code Enforcement Fine Zoning Review REVIEWED AND PREPARED BY: ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) $ f $ + (sq.ft. = x/1000 x 0.60) $ (¢.005/sq.ft.) $ (¢.01/sq.ft.) SECTION BY DATE Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL DATE: Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795-2207 • FAX (305) 756-8972 • http://www.miamishoresvillage.com Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795-2204 Fax: (305)756-8972 Permit Permit Status: APPROVED Issue Date: 4/12/2006 Expires: 04/10/2007 Permit Number: PT-4-06-920 Owner's Name: GUSTAVO ARTUNDUAGA one: 3 7 7-073 Permit Type: Paint Work Classification: New Job Address: 1250 96 Street NE Miami Shores Village, FL 33138- Contractor(s) Phone Primary Contractor HOME OWNER Yes Comments-, EXTERIOR PAINT Additional Information Type of Work: Exterior Color: INVITING IVORY, TORCHLIGHT Additional Info: Classification: Residential In consideration of the issuance to me of this permit, I aqree 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 responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. Parcel #: 1132060143900 Block: Lot: Section: PB: Total Square Feet: 0 Total Valuation: $ 700.00 Final Fees Due Amount Invoice Number Amt Due Amt Paid CCF $0.60 PT-4.06-24422 )67.30 Education Surcharge $0.20 Total: O�Asv Notary Fee $5.00 Permit Fee $60.00 WR 2 PAID Technology Fee $1.50 Total: $67.30 Building Dep nt File Copy NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the - public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. Applicant Signature yOREr y' �to, Bell, �� yus to ,ORI Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-14499 V. Inspection Date: 04/20/2006 Inspector: Grande, Claudio Owner: ARTUNDUAGA, GUSTAVO Job Address: 1250 96 Street NE Permit Number: PT-4-06-920 Permit Type: Paint Inspection Type: Final Work Classification: New Miami Shores Village, FL 33138- Phone Number 305 757-0735 Project: <NONE> Parcel Number 1132060143900 Block: Lot: Contractor: HOME OWNER Building Department Comments Inspector Comments Passed Failed E:I_ Correction Needed Re -Inspection Fee ($75) No Additional Inspections can be scheduled until re -inspection fee is paid. Wednesday, April 19, 2006 Page 1 of 2 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795,2204 Fax: (305) 756.8972 APR 1 a 2006 B Y. _A.;. 22_._.---- BUILDING 10 j Zc( Permit No. AX s -[ PERMIT APPLICATION FBC 2004 Permit Type (circle): Building Electrical Owner's Name (Fee Simple Titleholder)y S I ec, + ,. e. Owner's Address z 6O ,T1 City Yr q fr`i I 5Al2 4 r e-f 1/$tate Ar L 'GTenant/Lessee Name Job Address (where the work is being done) Master Permit No. Plumbiog N echanical Roofing Iq 1370 N ,l, o� 3 4 2 s' a N F Zip -3-313 8 _- Phone # _ c7G S 7. City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES Contractor's Company Name _ d W �7 4F, Y '? -9 Contractor's Address City Qualifier Name State Certificate or Registration N Architect/Engineer's Name (if applicable) Value of Work For this Permit $ State Type of Work: ❑Addition ❑Alteration Describe Work: P_ �C�G Y' r 0 t-- Submittal Fee $ Permit Fee $ u CCF $ CO/CC Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ l0 Structural Review. S _ Total Fee Now Due $ NO X Phone #_ Zip_ Phone # Certificate of Competency No. _ Phone # _ Square / Linear Footage Of Work: New ❑ ReRair/Replace ❑ Demolition See Reverse&f+30 ,onding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS. TANKS and 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 subj • t to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first ins Betio which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the i�zspei to rll. of approved and a reinspection fee will be charged. TAY of t7-Y7f/x, Y. c:lr/ r pf- Signature. Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of t. _20 (,Y, , byasrte Vj Q�1J(p&. day of .20 by who is personally known to me or who has producedf L_2LIgLLbC who is personally known to me or who has produced I If-DAs identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC Sign:�!!Cp�[jSSD1gL Sign: Print: q { It " =•:Y MY COMMISSION # DD 483995 Rirl 9ctol-D g Print: '' S°ndedThruNolaryPibllcUndefwriters My Commission Expires:My Commission Expires: APPLICATION APPROVED BY: (� Plans Examiner f HvV (Revised 02/08/06) Engineer Zoning Miami Shores Village Paint Color Approval and Agreement Date �7— V D 6' �' ! �t �I'/ $/f� v �. �1' /ej d� d ei F1 b r4 Phone# Owner's Name ,.+ Owner's Address Z® [ G /alr'�S ►f% State C 0 vI 4� Zip 13 City lAY+ti� S`a Job Address (wliere the work is being done) City f A Yw/Mimni Shores Villa +r County Miami -Dade Zip — — Is Building Historically Designated YES NO� Phone#-3gsf�� Contractor's Company Name (if applicable) O M "e ' All elements nn the site must be listed and indicate the color to be ainted Wallst� 3 2 Fascia l� �•�e' c''L,PJ l � — Drip Cap/drip Edge Soffit Roof W f 4t, ,4s Flower bins Shutters S Awnings Chimney Doors and door jams Garage doorsL�ti I 4r, �� ? 7 e H Railings Fences Decorative metal All brick (simulated or regular) Stucco ban Any other stucco features Accessory Buildings Other - OWNER'S apphcsTf'ff SW 6372 Invihing Ivory . ti �'IuTCC+lS , Torchlight I certify that all the foregoing information is accurate and that all work will be done in compliance witli all %,4ALR n and zoning. APPLICATION APPROVED BY: .,,, B 0- D K' Vvner or ent -- P& Z Official Date Date C/l r v / (,-- dic 6/18/03