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1061 NE 91 Terr (6)Owner's Name and Address -'R-ti d ....:........ ... No. � ' 9 ..... Street.__ i C r Registered Architect and /or Engineer , ,,.. ..•••.•••t..,.,,..,...• Name and address of licensed contractor — rift. . .. 1...,�t �1., _...,.: APPLICATION FOR BUILDING PERMIT Application is hereby wade for the approval of the detailed statement or the plans and specifications herewith submitted for the build • ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida. and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the 1uilding Divisinn of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progreu of the work. Location and legal description of lot to be built on: :ri MIAMI SHORES VILLAGE Block Lot Street and Number where work is to be done 1 M! r.... ,. rl.. _ re: r •• State work to be dear and purpose of building (by floors). ...1&. p k: 1...12 -1 9 dad 4 .11c � C • �^ �;� ire C + . ff ��y�. .L.�•�3�A.i.� J � f >��l1 l � �1�1��1" �1 1.. Q �i..��....��.:�: ',i. � _ p r • ... ��(�'t�1�... o.� �� .......__........a�• 4,1124 rip 1 and for no other purpose. Ncw Building Remodeling ,L Addition To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements S.•.. n:D. :- tub Amount of Permit S. 7..� Zone cubage required .Plan Cubage Size of Building Lot Distance .to next nearest building Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may • be sent to.. -\; (111 �' }Z y� �Al\ 1� �• ( •LS , c QA.� ' - nut_ The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of Labor under the Florida Workmen's Compensation Act, being Section 5066, Compiled General Laws of Florida, Prominent Supplement, and has complied faith the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for 'nspection on the site of the work such public notice or notices as arc required by the Act. The undersigned agrees to employ only such to onixactors, on work to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) STATE OF FLORIDA, COUNTY OF DADE. j Ss' Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared and who, being by me first duly sworn, upon oath deposes and says that he is the. of the above described construction, that he has carefully read the foregoi 'cation, and that he did si*rt the same, and that all facts therein by him stated are true.. n, i \n ,, Permit No.. ` Disapproved ° Date (Signed) Building Inspector Date BUILDING INSPECTION DEPARTMENT Chairman — Mcrr,bcr Member .. .. Council Approved Subdivision Ja1 Et6 Date My Commiuion PLANNING BOARD DATE Date..._... r R Repairs No. of Stories orn to and Subscrilkd bcfor otar Public, StaIj D f F (i a r, Expires ■ to me well known, Member._ ...... ............. • .._._ Member — Member — Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has hero obtained from the Planning Board. A rv.in.pectiun fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inapectirm oe faulty materials and /or workmanship. MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during prggress of the work. Owner's Name and Address Name and address of licensed contractor Disapproved t . (Signed) �� l Registered Architect and /or Engineer eo - re °w Ay Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done ®6Q Tg tee State work to begone and purpose of building (by floors) c Date..._..._......._..... _ ._ _..__ __ _...._.�.._.... ,19.. _. No t ® if Str eet... ' 1 Tr Vii• 1111, ttt Building Inspector ac' and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ Z Amount of Permit $.._..._...� Zone cubage required plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to The undersigned applicant for this building pennit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for r spection on the site of .the work such public notice or notices as arc required by the Act. The undersigned agrees to employ only such '.!.ntractors, on worl oerfgrmed under this pennit, as are licensed by Miami Shores Village. Remarks (Signed)... STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared to me well knows, and who, being by me first duly sworn, upon oath deposes and says that he is the. of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him scat d are Permit No. _____.'_. I� ( Date ? - ? - Read, Sworn to and Subscribed before me. Notary Public, State of Florida My om ' sion Expires PLAN INC BOARD DATE Chairman Member Member Member Member ...... Member Council Approved Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials anti /or workmanship. Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida. and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the ilu:lding Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. Owner's Name and Address Registered Architect and /or Engineer ,t,t „tt,,,,,,tt,..t,ttt,,,_,t Name and address of licensed contractor Location and legal description of lot to be built on: Lot / • Block Subdivision Street and Number where work is to be done S ate work k be d one and e d of building (by floors) v p c I pa vl.) New Building Remodeling Addition To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ Amount of Permit $. Zone cubage required plan Cubage Distance to next nearest building Size of Building Lot Maxunum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to .... The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on-th e of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only's4'c st contra< •r to be performed under this pennit, as are licensed by Miami Shores Village. Remarks STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared to me well known, Disapproved _ Date (Signed) C-' /- / , (ding Inspector APPLICATION FOR BUILDING PERMIT Chairman Member Member ...... Council Approved Date NOTE: A charge of $1.00 will be made for the Planning Board. A re- inspection fee of 31.00 will be charged materials and /or workmanship. MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT c y and for no other purpose. Repairs No. of Stories J L LQlLA�E= 2� 4/ // Notary Public, State of Florida My Commission Expires PLANNING BOARD DATE , and who, being by me first duly sworn, upon oath deposes and says that he is the. of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Permit No __ �± .`��.._ Date Read, Sworn to and Subscribed before me. Member Member Member — .._..... Disapproved Date making corrections or changes to this application after approval has been obtained from when such re- inspection is made necessary by improper notice for inspecting � faulty ELECTRICAL TII'E Minimum Fee QTY. TYPE Dryer QTV. TVPI{ Outlet, Appliance Q I V. TN IT Service Repair Q'I V. 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 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 Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New MECHANICAL TYPI. Minimum Fee QTY. .TYPE Condensate Drain QTY. .I.yI,I', Generator QTY. 'I'VI,I', Refrigeration, Tons QI'V. A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost A/C WaWWin. 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 Supply, AC Well Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Temporary Toilet PLUIIBING 1 'rvpi; A/C Condensate QTY. TVI'l:. Drains, Roof Q'I'1'. TYPE Miscellaneous Fixture QTY. 'I'VI'i' Soakage Pit Q'I 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 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 Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (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.F.) ( sq.ft. = x/1000 x ¢.60) Inspector State Educational Fund $ State DCA (Radon) $ Code Enforcement Fine Zoning Review Notary REVIEWED AND PREPARED BY: ❑ PROOF OF OWNERSHIP (Attach) LJ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) $ $ SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE (¢.005 /sq.ft.) (¢.01 /sq.ft.) TOTAL $ ( 0 - PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) DATE: fr'�l `'tea ea CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com Page 2 PERMIT APPLICATION IMPORTANT NO'T'ICES 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 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 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. AFFIDAVIT - Please read Carefully. 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, 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 OF FLORIDA, COUNTY OF MIAMI -DADE STATE OF FLO "IDA, COUNTY OF MIAMI -DADE ature of Owye Print Name Sworn to and subscribed before me this Signature of Notary Public - State of Florida SEAL: day of Si ature Co tra . / Qltfa lifier nt S Name �J S o to and subscribed before me this DC) day of ANGELA MASSIMO TANI My Comm Exp: 5/26/05 No. DD 010291 !y Komi. `'S bo t D. Signature of Notary Public - SEAL: Personally known OR, Produced Identification Personally known OR, Produced Identification Type of ldentification Produced: Type of Identification Produced: CONTRACTOR /� Name hi nA� i 4 g /�'dii License No. E is l 3OQ 0 3 ci `Z Address5c / / S lA) t 9 c-- 4..e. r tt F-4- L-iVO1 era. LC PL 3333 T e l e p l t g n e . , (6 q _ ! 7 7 Fax �� c , S te` Qualifier Name 1 CA.. "v.fr1'I'1ellv P ' } 'RTrOWNER . ,' - -- - N p e i'V∎l C 5O v\ A'i . A. es`�0 i o I . 1 :- %( bik(Av -L. , S6 � f C )° d- Home Telephone Repair Business Telephone Alteration Interior Fax Demolish TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'1 Attachment Other Add'I Detachment Other Step 1. Job Address: Lot f O O4 ii Address J Cam' I IJ V E V APsi 2003 INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures 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 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 11' elf- ‘Z Apt. Folio Number tikiription of Work -'f Gt; 1.— 1r (t— Block SubdivisionW4f rS to 5 PB PG Current Use of Property tZ ' Proposed Use of Property lL -e Tenant Information PERMIT TYPE (✓ ) Building ?` Electrical Mechanical Plumbing LPGX Roofing Fence Other PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax horeS Master Permit No. �l ' 0-3* �v Subsidiary Permit No. City / • State PERMIT APPLICATION a Bldg Value Zip Zoning Linear Feet Square Feet Units Floors LVahte of Work / r? OW, U Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax