EL-03-222 MIAMI SHORES VILLAGE 1\
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
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Date 7 [ is — Time
Type Insp'n t tffj` Raw
a w.
Permit No. ` 0 " 2�`„
Name -,��(.
Address "1 � t F 0-
Company WQ i
Phone #
For Inspector: I Nam ate
Approved 1 L7
Correction ❑ `�� 3
Re- Insp'n Fee ❑
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Page 4
PERMIT APPLICATION .5r y�� E E- PERNIIT APPLICATION
F OFFICE USE ONLY . ... u "' � UN Master Permit No. �� D P4 1 .3
P t N . Subsidi ermi o ORmp' p
❑ OWNER - BUILDER FORM ❑ PROOF OF OWNERSHIP ❑ CONDO ASSOCIATION APPROVAL e
INSTRUCTIONS - The follwoein- steps must be taken to obtaina permit from the Miami Shores Village:
(Attach) (Attach) (Attach)
Step 1. Complete the attached permit application which must be signed by the prop�i y owner and qualifier. Both signadues must be notarized. Please
• FIRE DEPARTMENT ❑ FIRS / DERM APPROVAL ❑ BPR APPROVAL (Restaurants) 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 -
APPROVAL (Commercial t (Septic / Sewer) ! ted along with this permit application.
multi - family) Step Z Submit the completed annLication 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.
• CONCURRENCY ❑ IMPACT FEE ❑ CONTRACTOR REGISTRATION
(New Construction) (New Construction) (On File)
❑ OTHER ❑ OTHER. Job Address: q & 4 Al 4r
(Specify & Attach) (Specify & Attach) Address Apt. City State Zip
Folio Number Description of Work Era® a A-Pe A- Ad
Lot Block
$3.00 per page (Scanning Fee) $ Subdivision PB PG Zonin Linear Feet
Current Use.of Property err G E - Square Feet Units Floors
Miami Shores Village $ Proposed Use of Property Value of Work to. '0 Bldg Value
Bond $ Tenant Information Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
Metropolitan Dade County (C.C.F.) $ (R4¢ 60) x/1000 PERMIT TYPE ( ✓) PERMIT CHANGE ( ✓) TYPE OF MANAGEMENT (.,-)
Inspector State Educational Fund $ (0.005Jsq.ft) Building Ch g. Contractor New Construction Enclosure
Electrical Renewal Alteration Exterior Repair
Mechanical Revision Alteration Interior Demolish
State DCA (Radon) $ (¢.01 /sq.ft) Plumbing Extension Relocation of Structure Shell Only
LPGX Supplement Foundation Only Add'I Attachment
Code Enforcement Fine $ Roofing Reinspection Other Add'I Detachment
Fence Other
Zoning Review $ Other
No $ ARCHITECT ENGINEER
TOTAL $ Name Name
License No. License No.
ISSUING OI--'I--ICIAL t
Address Address
REVIEWED AND PREPARED BY DATE: 'T ®° -:a;
Telephone Telephone
SECTION BY DATE
CON DITION Fax Fax
Zonin
Electrical PROPERTY OWNER CONTRACTO
Mechanical -T7a
Plumbing Nam ,r# � A- f 4 Name 0 ® ® ! 4 4 4
Fire Address License No.
Public Works
Structural Address
Building Official Home Telephone �, Q
Revised July 2001 Business Telephone Telephone Fag
Fax Qualifier Name
10050 N.E. 2ND AVE., MIAMI SHORES, FL e (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com 0 *x) 6 it)
C,� BCD tcvu)� - I� 10)7
Page 2 Page 3
PERMIT APPLICATION PERMIT APPLICATION
IMPOIZTANT NOTICES
1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below.
the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:34 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 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 Nfinimum Fee Dryer Outlet, Appliance Service Repair
required for work in or near the street/sidewalk.
5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer A/C Central 1 -3 Ton Fan Outlet, Wall Service, Temporary
which requires a separate permit A/C Central 4-7 Ton Fire Pump Outlet, Switch Signs
6. PORTABLE TOILETS for a construction site require a separate permit A/C Central 8 -15 Ton Fixture - Fluorescent Oven Space Heater (kw)
7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department A/C Central 16-20 Ton Fixture Light Parking Lot Lights Spas/Hot Tubs
8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps
9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources A/C Window FPL -Load Central Posts Swim Pool, Commercial
Management (DERM) and/or Miami Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers.
Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential
Chiller Generators, etc. Receptacles Switchboards
Clear Violations Heat Recovery Refrigerator, Comm. (p1PH) Temp Sere, Construction
Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, certify that all Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days
work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits Deep Freezer Low -volt, Fire Renew - Tlemp Service L
are required for ELECTRICAL, PLUMBING, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, Demolition Low -volt, Intercom/Teleph. Repair Circuits
ROOFING and SIGNS and there may be additional permits required from other governmental agencies. Dishwasher Low -volt, Television. Service, Number of Amps
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 MECHANICAL
, TYPE QTY., TYPE QTY. TYPE QTY. TYPE Q'I
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 Mimmum Fee Condensate Drain Generator Refrigeration, Tons
under this and any other permit exceeds fifty percent (50 of the replacement cost of the structure, then the entire structure must A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost
conform to the current code requirements of the Building Code. A/C WaWWW. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost
Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections
WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for Barbecue Fire Sprinkler System Pr essur Presse Vessel
l Piping
improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with Bath Fan - Vented, # Fireplaces, Number of Pr essur
your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at:
22 N.W. lst 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. TYPE' QTY. TYPE, Q'ry. TYPE , QTY. TYPE Q'ry.
A/C Condensate Drains, Roof Nliiscellaneous Fixture Soakage Pit
Bath Tab Drinking Fountain Miscellaneous Repairs Solar Water Heater
STATE OF ORIDA, COUNTY OF MIAMI -DARE 4S, OF FLORIDA, CO F MIAN�- ADE Bidet Filter Replace Pool Piping Sprinkler Repair
Cap - Fixture Fountain Pump and Abandon Sprinkler System
Si tune of Owner of Contractor / er Cap - Water Gas - Ap fiance Pump, Domestic Supply, AC Well
�. Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet
Print Name Print Name Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet
Sworn to and subscribed before me this day of Sworn to and subscribed before me this � day of 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
Signature of Notary Public - State of Florida SijaaVwe of Notary Public State o b0� At DtSAI Interceptor Roof Inlet Water Closet
#DD231994 Domestic Well Laundry Tray Septic Connection Water Heater
SEAL: SEAL: Comm 2007 Drainfleld, 4" Tile/Res. Lavatory Septic Tank
* Ex iYeS� ,u113' Water Heater New
=* P Banded Chru Drains, Area Meter Set (Gas) Sewer Connection Water Re-pipe
'•�;isa;o io Boriding Co • I Drains Floor Minimum Fee Shower Water Service
Personally known OR, Produced Identification Personally known OR, Produced Identification Drakes, French 11Tiscellaneous Equipment Sink Well, Supply
Type of Identification Produced Type of Identification Produced:
RECEIVED AND REVIEWED BY: DATE:
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