PAINTPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date I�1 Job Address " ` Tax
Legal Description
Owner / Lessee /
Master Permit 4 _a 4V'
Owner's Address �( ( � ��_ i I Phone
Contracting Co. 1,' I I - Address �� 1 V
Qualifier �SSaf-- Phone
State # P I-�' Municipal IF Competency # Ins.Go.
Architect/Engineer.
Bonding Company,
Addres
Add
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION '\i C7
Square Ft
Estimated Cost(value)-A__ —_
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO
SO 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).
Application is hereby made to obtain a permit to do work and installation as indicated above, and
on the attached addendum (if applicable). I 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, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will
be done in com liance with all applicable laws regulating construction and zoning. Furthermore, I
authori h i ove-na ed c tractor to do the work stated.
Signature o owner or C ndo President Signature of Contractor r Owner Builder
Date: Date: /f
Notary er and/or Condo President N-olaiy-as to Contractor or Owner -Builder
My Co on Ex My C n Ex&RMAL SEAL
b*8� L SEAL
d ELAINE BLACK j�; ELAINE BLACK
• ; My Commission Expires My Commission Expires , p� es
** t ` • *March 1j 1997 * *r * * * i *March 1*, 1997
•i'ss '1 C 7 NA.—�C 266222 G d ice. rE dr. Comm. No. CC 266222 S r%
FBES:` 7IT s1/ RADON C.C.P. /•' NOTARY TOTAL DUE
APPROVED
0
Mechan
Electri
Plumbing/ Enginee
PERMIT APPLICATION FOR MIAMI SHORES VILI A--
Datea� Job Address Talc Folio - -
Legal Description Historically Designated: Yes No
Owner/I.essee / Tenant FF /t 1 c pw Master Permit # _ 3
Owner's Address �Z -3 1y Phone VV — & 3
Contracting Co. n (��/y Address
Qualifier 1.5 !/ % � -/t// SS# -,W—hone
State # Municipal if Competency #
Architect/Engineer Address
Bonding Company
Mortgagor
Address
Ins. Co.
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
Square Ft.
Estimated Cost (value) q , T O D.
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO 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.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I
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, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
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. Furthermore, I authorize the above -named contractor to do the work stated.
iof owner n r Condo President Date Ignatur Contractor or Ow - uiYder Date
Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner -Builder Date
My Commission Expires: My Commission Expires:
T �J
FEES: PERMIT LSD RADON C.C.F. SL NOTARY u ' TOTAL DUE
Zoning
Building j Electrical
Mechanical Plumbing Engineering
Miami Shores Village
70050 NE 2nd Avenue
Phone: 305-795-2204
Printed: 3/12/2003
Applicant: JOSEFINA FARMER/
Owner: FORCHION
JOB ADDRESS: 1-60 NW 101
Contractor
Local Phone:
Building Permit
Permit Number: BP2003-399
CRISTOBAL VALECILLOS
GUY
ST
Contractor's Address:
Page 1 of 1
Parcel # 1131010230200 Legal Description: BONMAR PK ADD A RE -SUB PB 24-71 LOT 10 & W1/2 LOT 11 BLK 3 LOT SIZE
Fees: Description Amount
FEE2003-1487 Building Permit Application Fee $60.00 Total Fees: $65.60
FEE2003-1488 CCF $0.60
- - -� FEE2003-1489 Notary Fee $5.00 Total Receipts: $0.00
Total Fees: $65.60
Permit Status: Approved Permit Expiration: 9/8/2003 Construction Value: $200.00
Work: EXTERIOR PAINTING AS PER AGREEMENT
If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re -inspection
fee is $50.00, which must be paid in advance before calling for another inspection.
This Permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described In the application herefor In strict compliance with all
ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to
and approved by the proper municipal authorities. This Permit may be revoked at any time if the work Is not done in compliance with such ordinances or if the plans are changed without
authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the
ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or In the statements or specifications and that he assumes responsibility for work done
by his agents, servants or employees.
Signed: (INSPECTOR) BY:
In consideration of the issuance to me of this permit, I agree 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 1 assume responisibility for all work done by either
mvself_ my anent_ servants nr emnlevaa0o"
Signed:
(Contractor or Builder) BY:
RAG COl
031403 1504 001 005495 CASH $35.6
-
✓r
PERMIT APPLICATION
MaatPr'PttrmiAATn••• _
•:• o3-3a
Subsidiary ferroSt NSo:
Step 1. Complete the attached permit application which must be shmed by the propgUow;or!njQm . Please
print or type to for a more accurate processing of your application. If rotg'ing work will to Qo*•aroo ,ng application must be submit-
ted 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.
Job Address: b v A �0I st , 4 atlum 540� T L >3150
Address Apt. / City Sta e. /, Zip
Folio Number Descripfion of Work �i -/' G4, Vl��t% A
Lot Block
Subdivision PB PG
Linear Feet
Current Use of Property Squ/ars Feet Units
Proposed Use of Property he of Work 2 Bldg Value
Tenant Information
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
ARCHITECT
Name
License No.
Address
Telephone
Fax
Tax Assessed/Appraised Value
Flood Zone
I Renewal I I
I Extension I I
�ifiOPERTY OWNER
Namc fR jt Q.t/yy'IXAk sa.,/a 'U
Address
16-0 �) uJ /Q/ S f tv-� - S uv4
Home Telephone ZA _ 736 C0 9
6
Business Telephone 75�W/
Fax YM _7/�Y Wo
Base Floor
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'1 Attachment
Other
Add'1 Detachment
Other
ENGINEER
Name
License No.
Address
Telephone
Fax
CONTRACTOR
Name
License No.
Address
Telephone Fax
Qualifier Name
Page 2
PERMIT APPLICATION
1. DO NOT BEGIN ANY WORK W 1THOU? HANG RELINED 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 a.m. to 6:00 p.m., and Saturday from 8:00 a.m.
to 5:00 p.m. No inspections Iyill beg o nducted on weekends or holidays.
2. All construction of demolitio trees MU4f11F M I N1NED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris.
3. STREETS AND NEIGHB(:RING PNOIrfi*IV JHRhb BE4&PT FREE FROM DIRT AND DEBRIS.
4. SWALES MUST BE PROTRCOPBD IRDNC Bt((90 ®A# &ED 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 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 (FIRS) 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.
AFFIDAVITr
Application is hereby made to obtain a permit to do work and installation as indicated. 1, 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, la 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
Print Name
Sworn to and subscribed before me this o
3
ture of No ry Public - S to of Florida
SEAL: Angela M Becker
STATE OF FLORIDA, COUNTY OF MIAMI-DARE
Signature of Contractor / Qualifier
Print Name
Sworn to and subscribed before me this day of
Signature of Notary Public - State of Florida
SEAL:
+� • My Commission DD15OD48
vn, pdB Expires November 15. 2006
Personally known OR,
/I Produced
/ Identificatio(n� (/ / 1' Personally known OR, Produced Identification
Type of Identification Prolucedffa L V t-"`r V —g/�41 3 y 6Ape of Identification Produced:
Page 4 • • • - ,
PERMIT APPLICATION
OFFICE USE OD iLy :I ; • ; • ;
❑ OWNER -BUILDER FORM • •• ❑ PROOF OF OWNERSHIP
(Attach) .• .'. {Attach)
❑ FIRE DEPARTMENT • • ' • • ' •'❑; W,4 ( PERM APPROVAL
APPROVAL (Commercial / (Septic / Sewer)
multi -family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
PERMIT FEES
❑ IMPACT FEE
(New Construction)
$3.00 per page (Scanning Fee) $ Miami Shores Village $ `� //�
O
Bond $
Metropolitan Dade County (C.C.F.) $
Inspector State Educational Fund $
State DCA (Radon) $
Code Enforcement Fine $
Zoning Review $
Notary $ S
ISSUING OFFICIAL
REVIEWED AND PREPARED BY:
(Specify & Attach)
SECTION
BY
TE
Zonin
3 2
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
s
(s .ft. x/1000
(¢.005/sq.R)
(Q.01/sq.rt)
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ 6 S _ 6 U
Revised Iuly 2001
10050 N.E. 2- AVE., MIAMI SHORES, FL • (305) 795-2207 • FAX (305) 756-8972 • http://www.miamishoresvillage.com
MIAMI SHORES VJLL,A GE
Paint Color Approval an•3•Agtdei ient
ATE:
AWNER'S NAME: at et L P.I`IC+I>JE: 8 2-36 S'a Y 6
L�DDRESS: 160 W /Ol sty v��n inys 33/sr�
DDRESS OF SITE: 5 t
CONTRACTOR & LICENSE (if applicable) -
COMPANY NAME: PHONE:
All Elements on the sit must be listed and indicate the color to be painted.
Walls ✓
ascia J
lip Cap/Drip Edge
S ffit
R of
F ower Bins
hutters �Q o
Awnings
Chimney
Doors and door jams
Garage Doors
Railings C l `
Fences ✓ U,)U:: C
Decorative Metal
All brick (simulated or regular)
Stucco Banding
Any other stucco features
Accessory Buildings v
Other w
"
0
r
0
z
x
r
en
En
H
H
x
z
C
a
to
En
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 st�ted.furt4ermore , the paint colors will be as per the attached
-a>
0 0,3 .
ignature9f-erAer Daie gnatuCeontractqr" Date
APPROVED: WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
/emu 3
Building Official Date 4/23/01