Fence BP2003-395SECTION
BY
DATE
Zoning
7e0
Electrical
Repair
Mechanical
Demolish
Plumbing
Relocation of Structure
Fire
Foundation Only
Public Works
Add'I Attachment
Structural
Add'l Detachment
Building Official
Other F enee-
o
CONTRACTOR
NameTs1and Fence or FL
ee
Licens No. nQ„8g _ 7
Address )-7// .c. ckeec.%tobee Ie'd
I-o AIFL
Telephon F , 9 0 q 0 Fax e .,�. Cti p_ 7. i Z . 1
U EM_ `f C
Qualifier Nang i GC, rin 14.01.02._
PROPERTY OWNER
7n f l Name .l ` /�
rfN
Address `ao l ^ c ct 1 1 e 4 c e
!- tiCcc�� ` S I S1-oyes
Home Telephone c , r _ ggR�
t
Business Telephone
Fax
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'I Attachment
Other
Add'l Detachment
Other F enee-
Page 4
OFFICE USE ONLY
❑ 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
Notary
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• •
CHECKLIST
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••••••• •
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.•
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❑ PkOt F OF QWNERSHIP
(Attach)
•• ••• •• • • • ••
• • • • • • • •
•:❑• J-tRS /3D1 P liI JPPROVAL
• • • . {Septic 2 Awes).
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
PERMIT FEES
$ o
( sq.ft. = x/1000
x ¢.60)
$ (¢.005 /sq.ft.)
$ (¢.01 / sq.ft.)
ISSUING OFFICIAL
REVIEWED AND PREPARED BY: DATE:
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ ( [ t "
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
Job Address:
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
01 1>s r 9 I Tutee
Address
Apt.
Folio Number r
Lot O�� S' E
ov > q PG U 1
Subdivision (��Ipf�G'r�o.P_ PB • 1
Current Use of Property ;A CAC
Proposed Use of Property °. q i er\ A_,' ex '
Tenant Information
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
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• • ••••••• ••.•
PERMIT APPLICATION
Master Permit No.
••• • •••
Subsidiary Peutit 11So: •
• • • • • • .
• • • • • • • • •
• • • •
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Step I. Complete the attached permit application which must be signed by thoipr c vneP an d ltfiej■ Both signatures must be notarized. Please
print or type to allow for a more accurate processing of your application•.1t roiofieg walk 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
Sia Skces -
City
State Zip
Description of Work \SO X Li 14-iQh C,' Link_ Fe
a8'2((/' 1 h e w► *f) S,' ie 64 te
Zoning
Floors
Linear Feet
Square Feet Units
Value of Wor$ \i blab , OD
Bldg Value
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
PERMIT CHANGE (✓ )
ENGINEER
Name
License No.
Address
Telephone
Fax
ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPE
Dryer
QTY.
I'I'PI•
Outlet, •_pplianct : : . . • •
QTY.
'
•I'VPE
Service Repair
Vent Hood, Cost
A/C Central 1 -3 Ton
Dryer Vents, Number of
Fan
Ventilation, Cost
Outlet, Wall
Ductwork, Cost of
Service, Temporary
Periodic Inspections
A/C Central 4 -7 Ton
Fire Sprinkler System
Fire Pump
Outlet, Switch
Fireplaces, Number of
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
TYPE
Minimum Fee
QTY. TYPE
Condensate Drain
QTY. TYPE
Generator
QTY. TYPF: QTY.
Refrigeration, Tons
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
Bath Fan - Vented, #
Fireplaces, Number of
- Pressure Vessel
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 WPTHOUT HAVING itEEE;VED *OUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant
the right to begin construction. HOURS OP CONSTRI'JCTbN are Whited 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 N 1. ST 1�F vAll n'AI1:ED IN is CLEAN, NEAT AND SANITARY CONDITION free from construction debris.
3. STREETS AND NEIGHBORING PROPERTI N SPIAtL:1313 DIRT AND DEBRIS.
4. SWALES MUST BE PROTECTED PROM BEfNG 1W MAGEti B (& QUIPMENT OR VEHICLES, AND MAY NOT 13E USED FOR STORAGE. A bond is
required for work in or near the street/sid•waik.• • • * • • ; ; • •
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
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F FLORIDA, COUNTY OF MIAMI -DADE
Signa ur
Print Name
Sworn to and subscribed before me this S day of
Signature of Notary Public - State of Florida
OFFICIAL NOTARY SEAL
MARTHA COREA
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC944701
. /e0 t�lMISSION EXP. NNE 13,2004
Personally known OR, Produced Identification
SEAL:
• • • •
• .•• • • •
• • • • • •
••••••• •
Type of Identification Produced:
STATE 0
SEAL:
Personall
IIA,
Signature of Contractor / Qualifier
Signature of Notary Public - State of Honda
uced
PERMIT APPLICATION
p e MIAMI -DADE
tcA)
Print Name
Sworn to and subscribed before me this S day of fth_
O FICIAL NOTARY 5
MARTHA COREA
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC944701
MY COMMISSIO , ' • 13 i t 4
Identification
Type of Identification Produced:
Page 3
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PERMIT APPLICATION
al
IP
INSTRUCTIONS: Please indicate the type of work being perfot rned:add kuantit}c(iQS} ir: the space provided below.
RECEIVED AND REVIEWED BY: DATE:
6' max.
Roil End
8 Band
Tension
Bond
Jr d
Standard Residential Shop Drawing
Tie
Post hole diameter is 4 times the diameter of the post.
TERMINAL POST
i :e
21/2"
Wt. per ft.
t Slze -Is outside dimension
LINE POST
Size
1 5/8 or 2"
Wire
10'-0" to center
maximum
Wt. per ft.
Top Rail
Sleeve
TOP RAIL
Size
1 3/8" or 1 5
Weight- Is pounds per linear foot
Wt. per tt.
/8 "
Top Rail
Cop
•
• •
••••
•
.•.
•• •
•••
•
Choin Link
Fabric % Gouge
. 111
• • •
• • ••••
• •
• • .••• •
• • •. ..
—.'.�• 'TT '—
• • •
•• ••
•
•
•
.... •••. • •
. • •
.... ••••
h.•■•l • t0r
5'-O" MAX
2 ' -O
r1
°
4
1
4
4
n
°
4" X 4" Wood post
/ 2" X 4" Wood Ball
I "X6 "orl "X8"
Wood Pickets
_ Concrete
Q G °II
=III
III=
la I
4 ° II
I =III
° II
II - I II
III
I I I
II a °
- II =III _
I = III =I I = I =III=
` III III =III =I I =III 11
- III 1 I 1- 111 - 11I - 1 1I
WOOD FENCES
• • • •• • • • •••
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• . . • . •
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•
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•
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•
• • .. • • • • •• • •
2915 Fences
Wood Posts
4' -0" High or Less = 6' -0" G.C.
5' -0" High or Less = 5' -0" O.C.
2915.1 Wood fences, so located on a property
that by zoning regulations they cannot be used
as a wall of a building, shall be constructed to
meet the following minirnum specifications.
(a) Fences not exceeding 5 feet in
height shall be constructed to meet
the following minimum
requirements: from nominal 4 inch
by 4 inch by 8 feet -0 inch long
posts spEced 5 fee -0 inches on
centers, having a fiber stress of
1200 p.s.i. in bendinc, and shall be
embedded 2 feet -0 inches into a
concrete footing 1 fcot -0 inches in
diameter and 3 feet -0 inches deep.
Other components shall be
designed to comply with the
provisions of this Chapter and
Chapter 23.
(b) Fences not exceeding 5 feet and 4
feet in height respectively shall be
constructed as provided in
paragraph 2915.1 (a) herein,
except that the spacing of posts
may be increased to 5 feet -0
inches and 6 feet -0 inches on
centers for these heights.
CERT l F ED TO: FRANCISCO CAMPA; SIGNATURE TITLE GROUP, INC.
ARIEL POPLACK, P.A.; ATTORNEYS TITLE INSURANCE FUND;
AMERICA'S WHOLESALE LENDER AMD/OR ITS ASIGNS AS
THEIR INTEREST MAY APPEAR
•
DATE
Nov. 3, /997
ORDER TDRANN BY
9740 .JL
FB
/4 -65
• • ••• • • • •••
•• •• • • • •• •• •
LOCATION MAP - scq /is.* � /leis
LEGAL DESCRIPTION:
Lot 25, the East 5.00 feet of Lot 24 and the West 20.00 feet of Lot 26, Block 1,
of "WATERSEDGE", as recorded in Plat Book 9,Page 141 of the Public Records
of Dade County, Florida.
PROPERTY ADDRESS: 1201 N.E. 91 Tem, Miami Shores, FLorida, 33138
SURVEYOR'S NOTES:
1). THIS IS A BOUNDARY SURVEY.
2). LEGAL DESCRIPTION AS PROVIDED BY OWNER.
3). THIS SURVEY HAS BEEN PREPARED WITHOUT THE BENEFIT OF A TITLE SEARCH,
THEREFOR ONLY THOSE EASEMENTS (IF ANY), DEDICATED BY THE AFORMENTIONED
RECORDED PLAT, AND/OR,LEGAL DESCRIPTION HAS BEEN SHOWN.
4). ALL ELEVATIONS THUS WERE DERIVED FROM DADE COUNTY BENCHMARK
No. B-82, LOCATOR INDEX 3250 S, ELEVATION 8.74 FT., NATIONAL GEODETIC VERTICAL
DATUM OF 1929.
FLOOD INSURANCE RATE MAP INFORMATION
COMMUNITY NO. PANEL NO. SUFFIX DATE Of F6111 FM ONE BASE FLOOD
120652 0083 J ARCH 2.1994 AE 8.0 FT.
SURVEYOR'S CERTIFICATE
1 HEREBY CERTIFY: That a Survey of the property as described in the foregoing caption has been
made under my direction, and meets the minimum technical standards set forth by the Florida Board of
Professional Land Surveyors in Chapter 61-0-17 of Florida Administrative Rules, pursuant to Section
472.027 of Florida Statutes.
1 FURTHER CERTIFY: That this SKETCH OF SURVEY is an accurate representation of such survey,and is
true and correct to the best of my knowledge and beget, and that no visible encroachments exist, except as
shown hereon. •
CAMPA & ASSOCIATES, INC.
. LAND SURVEYORS
8013 WEST 16 AVE. HIALEAH, FL. 33014
Ph. (305) 558 -8072 FAX (305) 558 -2153
•
• •
Revised July 10, 2000
JOSE L. •A
PROFESSIONAL LAND SURVEYOR # 2936
STATE OF FLORIDA
t
•
LEGEND OF ABBREVIATION:
C.B.S. = Concrete block structure
Sty. = Story
Conc. = Concrete
Res. = Residence
= Center line
C.L.F. = Chain link fence
O.E. = Overheah electric service
A.C. = Air conditioner
F.F.E. = Finish floor elevation
W.M. = Water meter
F.I.P. = Found 1/2' pipe
NOTE: Not valid unless sealed
with an embossed Surveyor's Seal
:: .
SKE SURVEY SCALE: 1"= 20'
9'
F11,- /� • 1.1) • • • cJ t,ry/ • • • • •
• • • • •
•) • • •
d9 0
• � -•
•• O . •• • ••
• • • • r, •
• • • • • •
• • • • • • •
• • ••• • • • • • • •
Pole • ., •
090'
'
r
cax, 51.7d sAC. Jn:t
4.
/4a4'
0 /E
1 r I VI
75.40'
//
i j/
, ! - sty. CBs
Re? /20/
'I / ,f F E = 7. 70'
/
4' /lire Fence
X
5
Conk. . •
$ /a b'
75.00'
1
/ 4.8
CP
0 1.
tS�
E
Cai&4
bas.;,-
SIP.
roe
o ¢�GLF 040'
Po
° Zoning
6, 1,4 Zoning
430:'Od ''
g
/1
w• N • C
• •• ••
'
• •
• •
•
: 21
22
23
24
25 6
27
28
30
3/'
32
33
5 '
Sd
9
II
w
a
•j
• h 1
it :•
n
50J
CERT l F ED TO: FRANCISCO CAMPA; SIGNATURE TITLE GROUP, INC.
ARIEL POPLACK, P.A.; ATTORNEYS TITLE INSURANCE FUND;
AMERICA'S WHOLESALE LENDER AMD/OR ITS ASIGNS AS
THEIR INTEREST MAY APPEAR
•
DATE
Nov. 3, /997
ORDER TDRANN BY
9740 .JL
FB
/4 -65
• • ••• • • • •••
•• •• • • • •• •• •
LOCATION MAP - scq /is.* � /leis
LEGAL DESCRIPTION:
Lot 25, the East 5.00 feet of Lot 24 and the West 20.00 feet of Lot 26, Block 1,
of "WATERSEDGE", as recorded in Plat Book 9,Page 141 of the Public Records
of Dade County, Florida.
PROPERTY ADDRESS: 1201 N.E. 91 Tem, Miami Shores, FLorida, 33138
SURVEYOR'S NOTES:
1). THIS IS A BOUNDARY SURVEY.
2). LEGAL DESCRIPTION AS PROVIDED BY OWNER.
3). THIS SURVEY HAS BEEN PREPARED WITHOUT THE BENEFIT OF A TITLE SEARCH,
THEREFOR ONLY THOSE EASEMENTS (IF ANY), DEDICATED BY THE AFORMENTIONED
RECORDED PLAT, AND/OR,LEGAL DESCRIPTION HAS BEEN SHOWN.
4). ALL ELEVATIONS THUS WERE DERIVED FROM DADE COUNTY BENCHMARK
No. B-82, LOCATOR INDEX 3250 S, ELEVATION 8.74 FT., NATIONAL GEODETIC VERTICAL
DATUM OF 1929.
FLOOD INSURANCE RATE MAP INFORMATION
COMMUNITY NO. PANEL NO. SUFFIX DATE Of F6111 FM ONE BASE FLOOD
120652 0083 J ARCH 2.1994 AE 8.0 FT.
SURVEYOR'S CERTIFICATE
1 HEREBY CERTIFY: That a Survey of the property as described in the foregoing caption has been
made under my direction, and meets the minimum technical standards set forth by the Florida Board of
Professional Land Surveyors in Chapter 61-0-17 of Florida Administrative Rules, pursuant to Section
472.027 of Florida Statutes.
1 FURTHER CERTIFY: That this SKETCH OF SURVEY is an accurate representation of such survey,and is
true and correct to the best of my knowledge and beget, and that no visible encroachments exist, except as
shown hereon. •
CAMPA & ASSOCIATES, INC.
. LAND SURVEYORS
8013 WEST 16 AVE. HIALEAH, FL. 33014
Ph. (305) 558 -8072 FAX (305) 558 -2153
•
• •
Revised July 10, 2000
JOSE L. •A
PROFESSIONAL LAND SURVEYOR # 2936
STATE OF FLORIDA
t
•
LEGEND OF ABBREVIATION:
C.B.S. = Concrete block structure
Sty. = Story
Conc. = Concrete
Res. = Residence
= Center line
C.L.F. = Chain link fence
O.E. = Overheah electric service
A.C. = Air conditioner
F.F.E. = Finish floor elevation
W.M. = Water meter
F.I.P. = Found 1/2' pipe
NOTE: Not valid unless sealed
with an embossed Surveyor's Seal
:: .
SKE SURVEY SCALE: 1"= 20'
9'
F11,- /� • 1.1) • • • cJ t,ry/ • • • • •
• • • • •
•) • • •
d9 0
• � -•
•• O . •• • ••
• • • • r, •
• • • • • •
• • • • • • •
• • ••• • • • • • • •
Pole • ., •
090'
'
r
cax, 51.7d sAC. Jn:t
4.
/4a4'
0 /E
1 r I VI
75.40'
//
i j/
, ! - sty. CBs
Re? /20/
'I / ,f F E = 7. 70'
/
4' /lire Fence
X
5
Conk. . •
$ /a b'
75.00'
1
/ 4.8
CP
0 1.
tS�
E
Cai&4
bas.;,-
SIP.
roe
o ¢�GLF 040'
Po
° Zoning
6, 1,4 Zoning
430:'Od ''
g
EVELYN L
k ARTHUR 1• PAS CAL
35 38 -7843 CAL
W. 164
pa1BR0 TH AVE 3 _ , r
IpW /
Pay to the 30 � =1 o8sJ
Order of /Yf
1! _
/i /Banko A
ACH WT013 3100277
For
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 3/11/2003
Applicant: FRANCISCO
Owner: CAM PA
JOB ADDRESS: 1201 NE 91
Contractor ISLAND FENCE OF FLORIDA INC
Local Phone: 305 - 888 -9090
and approved by the pi.., _. _ _
authorization. A further condition
ordinances and regulations pertaining to the work cove.....__ .
by his agents, servants or employees.
Signed:
0 034 3 75 219 5 Ian*
to e3
Legal Description: WATERSEDGE PB 9 -141 LOT 25 & E5FT OF LOT 24 & WLY 20FT OF LOT 26
V /a3
$ C /
9o/ /Are
Bank of A 6 O f tb ,'
America I4d�antageo
(INSPECTOR)
Building Permit
Permit Number: BP2003 -395
CAMPA
FRANCISCO
TERR
Contractor's Address: 711 E OKEECHOBEE RD
Amount
no
1628 .)
63- 2 7/63, FL
773
8C0081,000 wsr
I1 the equipment or device described in the application herefor in strict compliance with all
ce with any plans, drawings, statements or specifications that may have been submitted to
is is not done in compliance with such ordinances or if the plans are changed without
tractor or builder named above assumes the responsibility for a thorough knowledge of the
awings or in the statements or specifications and that he assumes responsibility for work done
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.
(Contractor or Builder) BY:
alue:
$1,660.00
Page 1 of 1
Total Fees: $61.20
Total Receipts: $0.00
:rify, there will be no inspections. Re- inspection
ction.
BY:
STATE OF FLORIDA)
COUNTY OF DADE)
attached survey, performed by dAA. 7 ,4 .ISSS,,C M
(name of surveyor's company)
(date of survey)
iu�ni �ha'r
o Gar y
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. •• •....- .. . • AFFIDAVIT •
•
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The undersigned Affiant, , 4Le /4G4 C% ,iQ— , does hereby attest that the
(property o�
performed on 1 j 0 eon , is an accurate representation of the existing conditions and
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.
Witness(sign and print)
cl,pt,iveit
Witness(sign and print)
SWORN TO AND SUBSCRIBED before me this 3 day of (larch
Affiant is - -- -CPc"onally Icno to me, produced as identification.
OFFICIAL N • • t,
MARTHA COREA
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC944701
MY COMMISSION EXP. NE 13,2004'
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby unnde for the appro\al of the detailed statement ur one 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, I Inrid.t, 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 progress of the work.
Date .__..._ � ... _ ,19 . ._
Owner's Name and Address iCal fi.4 . - TO kale ke3fr _ No..../adt...._.. Street E.1.1.... r .
Registered Architect and /or Engineer ..............
Name and address of licensed contractor K/LVU—,--
Location and legal description of lot to be built on:
Lot Block Subdivision r
Street and Number where work is to be done ! °Z4 / L.
State work to be done and purpose of building (by floors)
New Building
To be constructed of
and for no other purpose.
Remodeling Addition Repairs
l Kind of foundation
,1L No. 'of Stories
oo6bovering
Estimated Total cost of improvements $....(.>... (. Amount of Permit S.
Zone cubage required plan Cubage
Distance to next nearest building Size of Building Lot _ sass ... ..........._...... -._
Maximum live load to be borne by each floor
I hereby submi 11 the plans and s ccificatt'ons for said building. All notices ith reference to the building and its construction may
be sent to.. .�fuf�/k>Q) .. {�1L 1a� /ty
� Ef ..�
The undcrsigr applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of 1.1bur under the Honda Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement,
and has complied ith 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 the site of the work such public notice
or notices as arc required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this
pcnnit, as are licensed by Miami Shores Village.
Remuks (Signed)
STATE OF FLOP I DA,
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,
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. y
Permit No LX.1. Date 4 l 9 , ` 1 Q►
Read, Sworn to and Subscribed before me.
Disapproved 1 —>� 1!/_ e _ Date.
(Signed)
Notary Public, State of Florida
Building Inspector My Commission Expires
PLANNING BOARD ................
Cirair:nan Member
Mcrr,ber 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 Plnnnii.;t Board.
A re- :n.pection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
C •
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