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1094 NE 91 Terr (4).*::•;"` • 4. i• I ;7„4 • 14 i.e. L. 4 zA• . . — • r — 41. . u. ••,•,•• „ - , r • ; • • • f .;‘, 4 • ii).• •„ • • k v j • _ / I/ Lc:7i • 41 4 /•,",-. • •. . J•• • . . A . • , • 1• • • 4 . - Ye***:*”. • - • • 44 C • 47 • 1 ,• ' " • - , ;,?; • ) 1 1/4 v •.• • ik/ 4" II C 7 14.0 4 1 - I? 4.74 • „ . ..e Al F e Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 1/20/2004 Applicant: ALEXIS Owner: JUSTO JOB ADDRESS: 1094 NE 91 Parcel # 1132050010380 Signed: (INSPECTOR) Signed: (Contractor or Builder) Building Permit Permit Number: BP2004 -49 JUSTO ALEXIS TERR Legal Description: WATERSEDGE Permit Status: APPROVED Permit Expiration: 7/12/2004 Construction Value: $330.00 Work: FABRIC AWNNG OVER FRONT DOOR BY: PB 9 -141 LOT 12 Page 1 of 1 Contractor CULPEPPER, CHARLES E JR Contractor's Address: 801 BRICKELL BAY DR ST2 Local Phone: 305 - 759 -8255 BLK 2 LOT SIZE 50.000 X 125 Fees: FEE2004 -548 FEE2004 -549 FEE2004 -550 FEE2004 -551 FEE2004 -552 Description Building Fee CCF Training and Education Fee Technology Fee Scanning Fee Total Fees: Amount $100.00 $0.60 $0.20 $2.50 $6.00 $109.30 Total Fees: $109.30 sa_ o Total Receipts: $0.0 c3 - l - 3 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 I assume responisibility for all work done by either myself, my agent, servants or employes. BUILDING PERMIT APPLICATION FBC 2001 Mechanical Owner's Name (Fee Simple Titleholder) WE JUSTO PhoZte - Owner's Address / / J 44Ir t✓ aq Permit Type (circle): Building Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Electrical Plumbing City /WAN Vile 'ES State Tenant/Lessee Name —' Zip .33/38 Phone # Job Address (where the work is being done) /cy •'7 7 . /9cf City Miami Shores Village County Miami-Dade Zip 3:5 Is Building Historically Designated YES NO X r c _ k Contractor's Company Name&Vic (!2L ieeE- 4- 1 7 (5 � i - (ES Contractor's Address City Qualifier $ Value of Work For this Permit Type of Work: ❑Addition 2004 Permit No. .:4,1,.f .1) Y Master Permit No. one # 6 - 7G/7 rr / l0 Aga 4 7 • /g/j // State j zip 3 Architect/Engineer's Name (if applicable) ii i e ei (/2/ 7 7 3 ' ' / Phone # (78 4 76/7 ie co Square Footage Of Work: _- ['Alteration f INew ❑ Repait/Replace ❑ Demolition Describe Work: fA&P /C 4 ' u /,v oC PiQ•1E/7 Z.: * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee S a O Permit Fee $ /0 CCF $ 6 t) Notary $ Training/Education Fee $ c D Technology Fee $ / 50) Scanning $ 6 Radon $ Bond $ Code Enforcement $ Structural Plan Review. $ <D. D Total Fee Now Due $ (Continued on opposite side) 31- 3D Roofing Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) "' Mortgage Lender's Address City State 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 subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued inspection will not be approved and a reinsvection fee will be charged. NANCY GONZALEZ Comm En). 7/15OO4 CC 907099 : ignature Known (101iw I.D. Signature NOTARY PUBLJC: Sign- Print: /.4, c Chc 10/14/03 Owner . r Age * The foregoing instrument was ac • owledged fore me this 7 day of �Vo#(y, 20 G f , by who is personally known to me or who has produced As identification and who did take an oath. e My Co mmission x pires: / //f State Certificate or Registration No. r (Certificate of Competency Holder) ******* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *> *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** JAN 16 2004 , 7J �S /��, s � . Plans Examiner APPLICATION APPROVED BY: ,f ee_ = r' // S 10,7 Contractor The foregoing instrument was acknowled:ed bef; e me this 7 day of �, /WAX'Y , 20 who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: o1 c• r 2/5 'NANCY GONZALEZ My Comm Ems. 2/15r04 No. CC 907099 t hnonit, Known (106.1.1Z Certificate of Competency No. C C. c 54 Engineer Zoning PROPOSED ENTRY AWN //Y6' AR AIR. ALEX ✓asro AVOPOSF,D r& ,c 4WW /NG /4 Witt //i/C G oc rn W A114P C /09y� N.4:49/ 7 ) (vor 70Sc 1 4 , • /Mho MvAu TR,u('- auE 5 y 'f35 9UfLO/NG arlAY y'9 • I/ 9/ TEfRAcE AM/ t51-/OXIS 44., 33/38 �y FA/5 /C 4 / // ■ 3`0" zxchtiC 00 COL (/l9AJ / / 'E.D c(leWEJ IJL-E 5'e) PIPE RA/HE 6 a ( a cars /DE _Pi9414 4, k ,. 7/f (3) 2 -BR/9Cg4 s w /r�'/ /t '���' 8 y f ?w /DE s - vim ANCHORS SPACED L 655 7W44 J 30" APQ/T 770/ec Cry FQ'1cK (y "x irk/00 c,o) O EVO Aitt//cRsl EAR/ ,3.P11CKe / / O75/? 0) 9/4e1/< 7 5' iu� E ( ? Cz) BM&( L/Ae/A/a :0,Pp j (3) AC de 7 IQVEV ZONING Si RUCTURAL ! ELECTRICAL PLUMBING MECHAN AL WOG. DATE BY COR'Llikk..E miff iEDERAL. STATE Ni ; COUNIY RULES AND REGULArIONS, T � Certificate of jftame 3&ettance Telephone (001) 336- 227 -6211 Fax (001) 336 - 229 -4039 This is to certify that the materials described at the bottom hereof have been flame - retardant treat- ed (or are inherently nonflammable). FOR 11 S INC CITY BOYNTON BEACH 13 Certification is hereby made that: (Check "a" or "b ") (a) The articles described at the bottom of this Certificate have been treated with a flame- retardant chemical approved and reg- istered by the State Fire Marshal and that the application of said chemical was done in conformance with the laws of the State of California and the Rules and Regulations of the State Fire Marshal. Name of chemical used Chem. Reg. No. Name of application REGISTERED APPLICATION CONCERN No. 1 FA -36801 (b) The articles described at the bottom hereof are made from a flame - resistant fabric or material registered and approved by the State Fire Marshal for such use. Trade name of flame- resistant fabric or material used SUNBRELLA FIRESIST Reg. No. FA - 36801 Glen Raven Custom Fabrics, LLC Name of Applicator or Production Superintendent ) itie GENERAL MANAGER STYLE YARDS PER STYLE STYLE YARDS PER STYLE FF 8604 -0060 202.5 ISSUED BY Glen Raven Custom Fabrics, LLC 1831 North Park Avenue Glen Raven. NC 27217 - 1100 CONTROL No. 0248022000 CUSTOMER ORDER No. CUSTOMER INVOICE No. 0000331856 TOTAL INVOICE YARDS 202.5 DATE PROCESSED 07/03/2003 ADDRESS 2003 & 2005 CORPORATE DRIVE STATE FLORIDA The Flame Retardant Process Used will not Be Removed By Washing (will or will not) GLEN RAVEN CUSTOM FABRICS, LLC By lira* a' Date treated or manufactured 07/03/2003 Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request 31S- Dat Type Insp'n Permit No. D. p O 4 Name Address I ) � 0 `,"{ r , / Ci • _ n Company Phone # Inspection Date/ / Z) 1 D Qe,t. 1 , 3 12,0 Approved Correction Re- Insp'n F MIAMI SHORES VILLAGE BUILDU G DEPARTMENT 305- 795 -2204 Building Inspection Request Date/ Type Insp'n �� 0 L 7 Permit No. 91 Name \.! - -t ,c NI Address (0 1 1 /A (' rJ . Company ). A =� Phone # �� (_) S /_> I Inspection Date/ / ? 1 I D -I - � N •1 .3 . 4 - -N • 6 . 7 . 8 . 9 . /0 . // . / A /3 . /4 . /5 /6 /8 . /9 . l 22 _ '°. __ is/349 ?5 ,� _.,W.C9' fmr . _.-e .. /. . • _ i.a.t. J4 ;:DGE, according to the plat 9, at Page 141, of the Pu',)lic Florida. O FI/ZP IV/NO/ID CONC ' FI2P W/N0/10 500.00' P.B.fI 5.00' 25.00' -t 4.00' 4.20' Certified To: ALEX JUSTO AND ROSE SAYRE, GREEN, KAHN & PIOTRKOWSKI, P.A., ATTORNEYS' TITLE INSURANCE FUND, INC., MAGGIE MORTON, ITS SUCCESSORS AND /OR ASSIGNS. ORTH SCALE: V20 LOT -13 0 o: LOT -11 125.00' (M&R) 52.80' ONE STORY RESIDENCE #1094 125.00' (M &R) BLOCK-2 SHED ALUM CONC 20.65' ti BLOCK-2 FI/2.P W/NO/ID 1 -0 FI2P IV/NO/ID Panel Number: 0093 Suffix: J Data of Firm Index: 3/2/94 Flood Zone: X Date of Completion: 01/17/2003 Property Address: 1094 N.E. 91 TERRACE MIAMI SHORES, FL 33138 Survey: M13348 GENERAL NOTES: I HEREBY CERTIFY REPRESENTATION 0 SIGNED 2 3 4 5 6 7 8 9 MY IDLE THIS BOUND SURVEY PREP /0 /2 /3 LESP ` ' P.S . NO. 51' STATE OF ORIDA 11 , /r7 /4 15 VEY IS A TRUE /6 I /7 1) LEGAL DESCRIPTION PROVIDED BY OTHERS. 2) THE LANDS SHOWN HEREON WERE NOT ABSTRACTED FOR EASEMENT OR OTHER RECORDED ENCUMBERANCES NOT SHOWN ON THE PLAT. 3) UNDERGROUND PORTIONS OF FOOTINGS, FOUNDATIONS OR OTHER IMPROVEMENTS WERE NOT LOCATED. 4) ONLY VISIBLE ENCROACHMENTS LOCATED. 5) WALL TIES ARE TO THE FACE OF THE WALL. 6) BEARINGS REFERENCED TO LINE NOTED AS B.R. 7) NO IDENTIFICATION FOUND ON PROPERTY CORRNERS UNLESS NOTED. 8) NOT VALID UNLESS SEALED WITH THE SIGNING SURVEYORS EMBOSSED SEAL. 9) DIMENSIONS SHOW ARE PLAT AND MEASURED UNLESS OTHERWISE SHOWN. 10) ELEVATIONS IF SHOWN ARE BASED UPON "G.V.D. 1929 UNLESS OTHERWISE NOTED. 11) THIS IS A BOUNDAR SURVEY UNLESS i ' 1 RWISE NOTED. ER MY DIRECTIO /8 CORRECT &CC 19 37 2/ FOR THE FIRM 22 THIS SURVEY IS INTENDED FOR MORTGAGE OR REFINANCE PURPOSE ONLY, EXCLUSIVELY FOR THIS USE BY THOSE TO WHOM IT IS CERTIFIED. THIS SURVEY 1S NOT TO BE USED FOR CONSTRUCTION, PERMITING, DESIGN OR ANY OTHER USE WITHOUT WRITTEN CONSENT OF MIGUEL ESPINOSA. r REC VIED ov 0 3 2003 BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Buildin ` Electrical Plumbing Mechanical Owner's Name (Fee Simple Titleholder) A f;i,' t,...- 031 Phone # Owner's Address / 030 V t !" /o V State r( City M !lk� -- �_ Tenant/Lessee Name Job Address (where the work is being done) /0 C f V N f q f "Put- City Miami Shores Village Is Building Historically Designated YES Contractor's Company Name fl (/.`/U Phone # ?o'� 2 7 7 - �f V 3 2— Contractor's Address City II � State Zip Qualifier Architect/Engineer's Name (if applicable) Phone # $ Value of Work For this Permit Type of Work: ['Addition ❑ teration Describe Work: U rug cwr f see cyan is Qt•rtq Submittal Fee $ 100 Notary $ .� Scanning $ 3 - Code Enforcement $ Total Fee Now Due $ (Continued on opposite side) * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Training/Education Fee $ Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 IV County Miami -Dade NO opi New ❑ Repair/Replace -*-- Permit Fee $ l (90 Radon $ Structural Plan Review. $ Permit No. c-; P.2.003 -1 q3 5 Master Permit No. 303 -'7gg —ygi? CEII 30 73 38 Z2 YOMe Zip 3 3(3 k Phone # Square Footage Of Work: 00 CCF $ Zip Technology Fe Bond S Roofing (o✓ b-- ❑� m olition $ oAi ly Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State 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 CONDMONERS, 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 subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection wil of be approved and a reinspection fee will be charged. 1; Signatur- NOT Sign: Print: Owner or Agent Contractor The foregoing trument was acknowledged before me this MLA The foregoing instrument was acknowledged before me this day of , 20C3 , by V �K day of 20 by who is onall known to me or whot'ba� produced Pers y p who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: . Chc 10/14/03 As identification and who did take an oath. ' t 00 00 0 Expire : Jul 13, 2007 � ded Thru My Commission Ekp ti z ' Ati. • c Bonding Co., Inc. (Certificate of Competency Holder) State Certificate or Registration No. Certificate of Competency No. ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: Signature My Commission Expires: l74.4 1/4/03 5/ at: r Plans Examiner Engineer Zoning OWNER BUILDER DISCLOSURE STATEMENT ( )00 Located at: Legally described as , Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S. 489.103(7),,nd I have read and understand the following disclosure Statement, which entitles me to a!lrork as my own contractor, I further understand that I as the owner must appear in person to complete all applications. State law requires construction to be done by licensed contractors. You have applied for a permit under an exemption to that law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two- family residence or a farm out - building. You may also build or improve a commercial building at a cost of $25,000.00 or less. The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is completed, the law will presume that you built it for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as your contractor. It is your responsibility to make sure that people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A. and with- holding tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, building codes and zoning regulations. Proof of ownership provided ( ) initial of reviewing clerk. Tlie foregoing instrument Was acknowledged before me this3 day of l , 20 (J3 . Produced - • as identification and who did take an oath. VILLAGE OF MIAMI SHORES BUILDING DEPARTMENT being the legal property owner, for the property DISCLOSURE STATEMENT who is personally known to me or who has Mab • •= Commission #DD "do Expires: Jul 13 ; Bonded 2 ° Atlantic 07 oc �. Thru ntic Bonding Co. Inc. Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 2/24/2003 • Applicant: ALEXIS Owner: JUSTO JOB ADDRESS: 1094 Contractor Local Phone: Parcel # 1132050010380 Signed: Fees: FEE2003 -1117 FEE2003 -1118 FEE2003 -1119 FEE2003 -1120 Signed: NE 91 Description Building Fee CCF Buildier's Bond Notary Fee Total Fees: 1:1_ Permit �}} Permit Sta �,PPP Permit Expiration: 8/20/2003 Construction Value: $10,000.00 ork: L bathrooms and kitchen retile & change fixtures rewo cabinets If there is no permit package accessibl('oh 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 callin for another inspection. This Permit is granted to the contractor or builder named above to constr ordinances pertaining thereto and with the understanding that the work will and approved by the proper municipal authorities. This Permit may be revo authorization. A further condition upon which this permit is granted is the u ordinances and regulhtions pertaining to the work covered hereby whether by his agents, servants or employees. Legal Description: WATERSEDGE PB 9 - 141 LOT 12 (INSPECTOR In consideration of the issuance to me of this /fermit, I agree to perform with the plans, drawings, statements or specifications submitted to the pro myself, my agent, Q ants or employes. (Con Building Permit Permit Number: BP2003 -291 JUSTO ALEXIS TERR Contractor's Address: 'f 'Cl'•. t _3.t�: {i: �1:�. 'M1t _.... 1.4 Co C66 IrWLZ -cg L1.9 Amount $160.00 $6.00 $300.00 $5.00 $471.00 - E - 0/S - 17 - 0400 Page 1 of 1 BLK 2 LOT SIZE 50.000 X 125 . Total Fees: $471.00 Total Receipts: $0.00 L150 .11 10591,51,9E00 :IL 2,2 OOZ E90 :1 11 - 61 -- fly W 104 LLZOOICOO 1/11143V •3uawy ;o)ueg slogoa o �7 /� 7�s d 7 0-.-1 - y r e41: tat i££ 'L'I VIPI '.IS ILLtOI '3'N OM O.lsnf SDCTIV ELECTRICAL 'rm.: Minimum Fee ()Ty. TV.pi. Dryer ()Ty. 'Fv11I,: Outlet, Appliance QTY. . 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 NIECHANICAL n Minimum Fee Q . I . V ,. ' FITE Condensate Drain Q . LV .. TvI,i,: Generator QTY. . Refrigeration, Tons Q 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 Supply, AC Well Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Temporary Toilet PLUMBING . I ' V . pi: A/C Condensate Q . I . V . , TV Drains, Roof Q . LV .. . Miscellaneous Fixture Q TvI Soakage Pit QTY. 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 2 IMPORTANT NOTICES 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 Choosin: a Contractor. Pt f F FLORIDA, COUNTY OF MIAMI -DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE 0 .n Signature of Contractor / Qualifier e of Owner 9� - ; to.and subscribed before me this Print \Swo SEAL: Personally known ry Public - ta of .rida i p f "r + Angela M Becker mmission DD150048 0„,. Expires November 15, 2006 Print Name Sworn to and subscribed before me this day of Signature of Notary Public - State of Florida SEAL: PERMIT APPLICATION OR, Produced Identification Personally known OR, Produced Identification Type of Identification Produced: Type of Identification Produced: Page 3 PERMIT APPLICATION II INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. 1 RECEIVED AND REVIEWED BY: DATE: SECTION New Construction . . BY DATE Zoning ' 4( ( kier i/ A / N (i Ap .21 Electrical Business Telephone 7)( -- 4 Fax Mechanical Relocation of Structure Shell Only Plumbing Foundation Only Add'l Attachment Fire Other Add'l Detachment Public Works Other Structural Building Official .A= iM a 6 PROPERTY OWNER New Construction Name 1 s ` T V V Alteration Exterior Address lea° N'c (ef SI #4 64,- = 5 ©t- fG 32'3X Repair Home Telephone 3 ®s— 7 S cj 3 F 2 2- Business Telephone 7)( -- 4 Fax Relocation of Structure TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'l Attachment Other Add'l Detachment Other Page 4 OFFICE USE ONLY CIIECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi - family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) ❑ PROOF OF OWNERSHIP (Attach) PERNIIT FEES $3.00 per page (Scanning Fee) Miami Shores Village Bond Metropolitan Dade County (C.C.F.) Inspector State Educational Fund State DCA (Radon) Code Enforcement Fine Zoning Review Notary ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) s 0, $3 o c� $ �o+ 0 $ (¢.005 /sq.ft.) ISSUING OFFICIAL REVIEWED AND PREPARED BY: DATE: 7") ( sq.ft. = x/1000 x0.60) t' 3 (¢.01 /sq.ft.) PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ 72, 0 V 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 INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. 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 ob Address: N‘c ctt Address PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other v Apt. Folio Number 11,. ? 2- o$ - 001_ 633o ift ,S City escri ti of Work Block /e 7 4 C Lot Subdivision (0{4-6— E PB ! PG t y ( Current Use of Property 1 c-3 , 4 cJ fit: L Proposed Use of Property Tenant Information PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Master Permit No. Subsidiary Permit No. tate PERMIT APPLICATION 4i l Zip 447.44 '5 A ALA acv Zoning_ c N 54. 4ch U Linear Feet Square Feet 17 it `7 Units 1 Floors A Value of Work ptal d0 0 Bldg Value v \ Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. Address Telephone Fax Qualifier Name