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1140 NE 91 Terr (12)ELECTRICAL , I'YI'E Minimum Fee QTY. TYPE Dryer QTY. TYPE Outlet, Appliance QTY. TYPE Service Repair QTY. 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-i- 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 TYPE Minimum Fee QTY. 'I'YI'E Condensate Drain QTY. T1'I'E Generator QTY. TYPE Refrigeration, Tons QTY. 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 TYPE A/C Condensate QTY. TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. TYPE 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 Choosing a Contractor. STATE OF FLORIDA, COUNTY OF MIAMI -DADE Signature of Owner Print Name Sworn to and subscribed before me this day of ■ . i 1110 Signature o A ��\ 7V�. ,' �% rich IP A • • SEAL: _. : 4�� ty ?mo c _ � % MCC 785127 ersonall fi it . oduced Identification Type of IdentifrOft OF • D Signature of Contractor / Qua , ,er > dl Aeliti- Print Name Sworn to and subscribed before me this Signature of Notary 14 (pfN►f of Florida ���vEV HEIMe�.. z . � ir` � Si •. • � . Personal OR iced Identification ritf��t3b �� Type of Ide y : O.:nil ii It MO SEAL: PERMIT APPLICATION CO OF MIAMI -DADE day of 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: SECTION BY ,, DATE 43 , Zoning Qf �e�I�G Electrical Business Telephone Mechanical Alteration Interior Plumbing Demolish Fire Shell Only Public Works Foundation Only Structural i /04 Building Official Add'I Detachment CONTRACTOR Name/ 9/ // " Licen Nora 0 o 7:5 -d y a Address /lig /V 7 • 61,4 j /�; ,47 _13/ f/ . Telephone , s Fax Fax V Qualifier Name /t k , Ale,- PROPERTY OWNER Y New Construction - � d / 1) 1. /1`1\ °A Ad ress s Lome c— R t Tele 3 mss s 1 _. 1.3 Business Telephone Fax Alteration Interior TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'I Detachment Other Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) $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 ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) PERMIT FEES $ (¢.005 /sq.ft.) ISSUING OFFICIAL REVIEWED AND PREPARED BY: (sq.ft. = x/1000 x ¢.60) (¢.01 /sq.ft.) PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ L � � 'D DATE: 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 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 X Job Address: J 'lc NE91 -q."Tikr. Address Folio Number I I 3;0.S �+ O Description of Work c�. Block $ k eMt°fJ0 O PB et 1 c, PG Zoning Linear Feet Subt • is'. , •edlz . ,.., $ Current Use of Property Square Feet t Units Proposed Use of Property ><Value of Work g Bldg Value Floors Tenant Information Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Apt. PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax • PERMIT APPLICATION Master Permit No, Subsidiary Permit No. h p City State ENGINEER Name License No. Address Telephone Fax • COMMUNITY NUMBER 120652 OD. NOTES' 21 PANEL NUMBER 93 31 SIXFIN J LOT 19 BLK 2 4: OAT( or rpm INDEX 7/17/95 ENO I/2' 11' NO ID If) ALUM. 511E0 UN CON!. SLAB 0.05' - 5 FIRM 200E AE 5' 7.5 al 0.2' 1) BASIS OF BEARING. ASSUMED MERI 2) ELEVATIONS SHOWN IEIEON ARE RELATIVE TO NATIONAL OEODETIC VERTICAL DATUMIN.O.V.D.) 31 LOCATION NA IDENTIFICATION OF UTILITIES ON AND/OR ADJACENT TO TIE PROPERTY WERE NOT SECURE AS SUCH INFORMATION VAS NOT REQUESTED. 41 NOT \'L10 WITHOUT TIE SIGNATURE AND 'DE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED SURVEYOR NO MAPPER. 61 ENCROACHMENTS AND VIOLATIONS ON SURVEY( IF ANY/1 BOUNDARY SURVdY 14.5' 18.13 0 BASE FLOOD EIEVAT10N 8.00 (3..i 101 10 !ILK 2 7'5.0' 45,1,' 1 STORY RES 140 CRS 1OWFSI ft non FIFVAII0N • 0.05' 000f 01 ( 1 111111 fI FVAI 1110 - 1:.'11 J LAMENT 13. .08 SCALE' 1' - 20' LEGAL DESCRIPTION LOT 18 & EAST 1/2 OF LOT 17 IN BLOCK 2 OF WATERSEDGE. ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 9 AT PAGE 141 OF THE PUBLIC RECORDS OF MIAMI-DADE COUNTY. FLORIDA. 1.15' 75.0' - CONCRETE — t, NE 91 TERRACE(24' PAVEMENT) - - - 50' TOTAL R/W SKETCH OF SURVEY LEGENpe FNO - FOUND CM - CONCRETE MONUMENT IR - IRON ROD IP - IRON PIPE R/W - RIGHT OF WAY POO - POINT OF BEDINNINO POC - POINT OF CcMIEN ENT PC - POINT OF CURVE POC - POINT ON A CURVE ---- CHAIN CHAIN LINK FENCE - / -- Y000 FENCE PEI - PLAT BOO( P - PAGE M - MEASURED D - ONEG R - RADIUS A - ARC A - CENTRAL MOLE C - CHORD X.KK - ELEVATION —1 1 NON-VEHICULAR ACCESS LINE •U - • OVERHEAD LINE0 -- IWlELE COS 1111 CB CATCH BASIN L./ - TREE • •• • • • • 0 • 4141 • • • • • • • • • 00 • • • • • • • • • 000 • • • • 0 • • • • • • 0 0 • • • • • • • • • • • 4141•••• • • • • • • • • • • • • • • • • • •00 0 0 0 4100 • • • •• 410 • • • •• 0•0 •• • Ny 1 /1' • • • • NU 111 • • • - • • • • •• 041 EASI 1/2 101 17 211.25' r - 0 K K K x r .13 . .:15' A PE 1/2' II' NU ID WEST 1/2 1.01 17 IILK. 2 JU I . PHA. P.L.S. PROF' .,SIONAI_ I AND SURVEYOR LICL SE NO. PSM 5789 STATE.OF FLORIDA 1125 CERTIFICATION OF DOIJNDRY SURVEY; I HEREBY CERTIFY THAT THIS SURVEY WAS MADE UNDER MY RESPONSIBLE CHARGE AND TO THE DESI OF MY KNOWLEDGE AND BELIEF; 1111 SURVEY MEETS THE MINIMUM TECHNICAL STANDARDS AS , FORTH BY THE BOARD' OF PROFESSIONAL / LAND SURVEYDI- N CHARIER GIG1' /-6 FLORIDA ADMINISTRATIVE CODE FUR IA 0 SECTION 472.027. FLORII)A,OTlSTIJTCS. JULIO S. P1TA, P.L.S. LAND SURVEYORS 7E3015 CORAL WAY. SUITE 100 MIAMI. FLORIDA 33155 PHONE. 1 305) 262-2404 SECTION: 5-53-42 II COUNTY: DADE cER•rlFIED TO WILLIAM L. WALSI-I 1140 NE 91 TERRACE. MIAMI SHORES. FLA 33138 DATE: 9/22/98 I : 98-09-34 I p D 1G GL 1 1 4 1 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO NO. STATE OF FLORIDA: COUNTY OF DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Legal description of property and street address: `I!) Ali' 9`57 J Si g X1 33/3 4 5 2. Description of improvement: 1C/oe Pay`$) . „ raI 3. ner(s) name and address: • //10.4. a-/ ! h S h / 1� fed /Ili 9/ z &&) /"!' 04-1; flow rid.A. 33/3 Interest in property: Name and address of fee simple titleholder: �ntractor's name and address: /g 53)$/ v ./ I LL /A l i Lee' yvkLyii 1011111111 Signature of Owner Print Owner's Name a Sworn to and subscribed befi • _y of ' 0 � o sry 2,‘, V ,Z * • Notary Public Print Notary's Name My Commission Expires 5. Surety:(Payment bond required by owner from contractor, if any) Name and address: Amount of bond $ 6. Lender's name and address: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name and address: 8. In addition to- himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and address: 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date is specified) • Prepared by A1. Address: it Lot COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY WHEREAS, i � I , hereinafter referred to as the Owner of the owne following described property: Legal description /folios: Tax Folio #: requests permission to install: M iami SIor (/iCCccc�.e Block Subdivision 10050 N.E. SECOND AVE. MIAMI SHORES. FLORIDA 33138 -2382 Telephone: (305) 795 -2207 Fax: (305)_756 -8972 Asphalt, on rete brick pavers [ ] Landscaping [ ] Other within the public road right of way of / / Y 0 -- (address) IN CONSIDERATION of the approval of this permit by the Village, the Owner agrees as follows: To maintain and repair, when necessary, the above- mentioned item(s) installed within the dedicated right of way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said items within public right of way including restoration of street by reason of the Owner's failure to do so, such expense shall be paid by the Owner or shall constitute a lien against the above described property until paid. 2. The owner does hereby agree to indemnify and hold Miami Shores Village or dade County harmless from any and all liability, which may rise by virtue of permitting the installation of these items within the public right of way. 3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days notice by the Village to do so. Failure to comply with this notice will result in the Village causing the item(s) to be removed and a lien being placed on the property and/or assessed against the Owner for all costs incurred in the removal and disposal of the item(s). 4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such time as this obligation has been canceled by an affidavit filed in the Public records of Dade County, Florida by the Village Manager of Miami Shores Village (or his fully authorized representative). SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on this ,7 day of li '-- ' :�pR[uEC,vl�y f� PPS Orzc(-t STATE OF FLORIDA) COUNTY OF DADE) The undersigned Affiant, \VI LL-/A h LEE W A LSH, does hereby attest that the (property owner) attached survey, performed by JULIO S. P li,4 '?LS., LA kin ScIK VEYO T S (name of surveyor's company) performed on q/ 2 L / 9' e , is an accurate representation of the existing conditions and (date of survey) locations of all structures on the property as of this date. The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property without first providing a survey less than six (6) months old. The Affiant, as property owner, further agrees to remove or obtain permits for any structures which now may exist on the property which are not permitted or which may violate zoning or building code regulations. The Affiant further understands that the existence of any such structures may affect final inspections as applicable to this or other permits.. Further, Affiant sayeth naught. Witnes gn and print) FL rt ber-s ),Ic_YM 67 Affiant is Teri - RI CIA 4) rp Mewc-ubur SWORN TO SCRIBED before me this., 4b ' day of � GPLVU e) . 2 601 IMQ, * • �• f 4, •• # o CC 785127 J p,,� � 9�' � Miauni _ 91,oreo Vi-t,ag • -8/6 - Witness(stgn and print) ,V19 t_ ES - 0 produced AFFIDAVIT as identification.