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.