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825 NE 91 Terr (10)CONTRACTOR Name /� ) > �-/ w ( 9 �� /!C/ J6 License No. C f (A le x (461 Cy/ ! 7 c' �7 " /� Address /ef -7�/ ,t) / 7,y / �i 1 / L 35 '' f 7 Telephone 5 , ., � 2, Fax O,/I f zg _ J � 6 :7 � J Qualifier Name opy/ � ?5 i PROPERTY OWNER New Construction �,� Name 7' i/yep 7 1/ � / C� e L,,,..„- Enclosure Address g A4— 9, 7-� ;� >y ' Sf� / .331,6 / Home Telephone ( ® j) 3 7 / _ e [ gj 7 / _ ( J Repair Business Telephone 9 /11/7 Alteration Interior Fax Demolish 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 INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. Step 2. A PPLICATION Job Address: 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. 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. 9 ( % lam HitYf ' 7)/6/ Address Lot Block (_5.z "1 �- � �(,� i Folio Number p - S/ / � 1,-Lt scri tion of W ork Subdivision PB PG Zoning_ Linear Feet n p - Current Use of Property ( C i�� /, D Lie Square Feet Units Floors l Proposed Use of Property �r , Value of Work S [ . 00 Bldg Value Tenant Information Tax Assessed/Appraised Value Flood Zone 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 Master Permit No. Subsidiary Permit No. PERMIT APPLICATION Ap . City �/ State Zip � v � / t 7 � Base Floor Elev. ENGINEER Name License No. Address Telephone Fax IMPORTANT NOTICES AFFIDAVIT - Please read carefully. Signature of Notary Public - State of Florida Page 2 1. 2. 3. 4. 5. 6. 7. 8. 9. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALI the right to begin construction. HOURS OF CONSTRUCTION are limited to: to 5:00 p.m. No inspections will be conducted on weekends or holidays. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FRO SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPM required for work in or near the street/sidewalk. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RE which requires a separate permit. PORTABLE TOILETS for a construction site require a separate permit. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM D EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from th Department of Health and Rehabilitative Services (HRS) approval is required f Management (DERM) and/or Miami -Dade Water and Sewer Department (MDW Application is hereby made to obtain a permit to do work and install work will be performed to meet the standards of all laws regulating c are required for ELECTRICAL, PLUMBING, POOL, EXTERIO ROOFING and SIGNS and there may be additional permits required I, the OWNER of the property, have disclosed all information rel months to the Building Official. Further, I am fully aware that if th any other permit equals or exceeds fifty percent (50 %) of the fair present federal flood criteria for finished floor elevation. I am also under this and any other permit exceeds fifty percent (50 %) of the conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE improvements to your property. If you are spending more than $2, your attorney or lender before recording your Notice of Comme 22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the N accordance with Section 713 -35 of Florida Statutes. Review Choosing a Contractor. STA OF ORIDA L�IAMI -DADE Signature of Owne Print Name SEAL: c Sworn to and subscribed before me this SHAWN O'TOOLE MY COMMISSION # DD 026739 EXPIRES: July 10, 2005 Personally knorn oV� dice �r�sa�Yices. y of (/ Type of Identification Produced: PERMIT APPLICATION ATED PERMIT AND PERMIT CARD. Applying for a permit does not grant onday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. AT AND SANITARY CONDITION free from construction debris. DIRT AND DEBRIS. NT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is IDENTIAL CONSTRUCTION SITES. Other construction may have a trailer INS without approval from the Building, Planning and Zoning Department. edge of pavement. r applications involving septic tanks. Department of Environmental Resources SD) approval is required for applications involving sewers. tion as indicated. I, the OWNER of the property, certify that all nstruction in this jurisdiction. I understand that separate permits DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, from other govemmental agencies. ted to any work at the property performed in the prior twelve cumulative cost of work to my home or business under this and arket value of the structure, the entire structure must meet the ully aware that if the total cost of work to my home or business replacement cost of the structure, then the entire structure must F COMMENCEMENT may result in you paying twice for 00 or intend to obtain financing, you may wish to consult with cement. The Notice of Commencement must be recorded at: tice of Commencement must be POSTED AT THE JOB SITE in he brochure at Village Hall on Construction Lien Law and STATE OF FLO DA, CO Y OF MIAMI -DADE Si ature of Contractor / Qualifier M /CGi j9'L m 14/ 7 ��L Ifn Name Sworn to and subscribed before me this da of 1.7 Signature of Notary Public - State of Florida SEAL: SHAWN OT00LE * c_ . * MY COMMISSION # DD 026739 July 1 n 2015 Personally knciLi_l____tea1624c.rigu,ntar....qateoliFIFve son Bu or No son/ices n Type of Identification Produced: SECTION BY DATE G / /1 y � oL Zoning CO' Electrical Mechanical Plumbing Fire Public Works Structural . Building Official `/� � G (u L.Z ` 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 Notary ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) $ (c) • o c) $ 3OD $ f O ( sq.ft. = x/1000 x 0.60) $ (¢.005 / sq.ft.) $ (e.01 /sq.ft.) PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) PERT BIT FEES TOTAL $ L 3LQ 1 ISSUING OFFICIAL REVIEWED AND PREPARED BY: DATE: CONDITION OF Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL o (305) 795 -2207 • FAX (305) 756 -8972 http : / /www.miamishoresvillage.com ELECTRICAL, .L1.PI: Minimum Fee U.I.y. 'rvii. Dryer U . 11 Outlet, Appliance QTY. Typi,: Service Repair U.I.Q. A/C Central 1 -3 Ton Drinking Fountain Fan • cellaneous Repairs Outlet, Wall Service, Temporary A/C Central 4 -7 Ton Fire Pump Outlet, Switch Cap - Fixture Signs Fountain A/C Central 8 -15 Ton ; mp and Abandon Fixture - Fluorescent Sprinkler System Oven Cap - Water Space Heater (kw) A/C Central 16-20 Ton Fixture Light Parking Lot Lights Gas - Natural Spas/Hot Tubs p, Fire Stand A/C Central 20+ Ton Temporary Toilet Flood Lights Catch Basin Plugmold/Strip Gas - Propane Subfeeds, No. of Amps A/C Window FPL - Load Central Posts p, Replace - Pool Swim Pool, Commercial Urinal Air Conditioners Dental Chair Garbage Disposal Grease Trap Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Utility - Water Switchboards Dishwasher Clear Violations Indirect Wastes Heat Recovery ' elay Repair Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Domestic Well Temp for Test - 30 days Laundry Tray Deep Freezer '. eptic Connection Low -volt, Fire Water Heater Renew - Temp Service Lavatory Demolition Low -volt, Intercom/Teleph. Repair Circuits Meter Set (Gas) ewer Connection Dishwasher Water Re -pipe Low -volt, Television Drains, Floor Service, Number of Amps hower PLUMBING .LYPI,: A/C Condensate QTY. .LYI,I, Drains, Roof QTY. 'I'YI,I. • cellaneous Fixture UTV TVI Soakage Pit QTY Bath Tub Drinking Fountain • cellaneous Repairs Solar Water Heater Bidet Filter Replace i ool Piping Sprinkler Repair Cap - Fixture Fountain ; mp and Abandon Sprinkler System Cap - Water Gas - Appliance ; mp, Domestic Supply, AC Well Cap - Sewer Gas - Natural p, Fire Stand Temporary Toilet Catch Basin Gas - Propane p, Re- circulate Temporary Water Closet Clothes Washer Gas Piping p, Replace - Pool Urinal Dental Chair Grease Trap mp, Sprinkler Utility - Sewer Discharge Well Ice Maker mp, Sump Utility - Water Dishwasher Indirect Wastes ' elay Repair Vacuum Pump Disposal Interceptor ' oof Inlet Water Closet Domestic Well Laundry Tray '. eptic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory eptic Tank Water Heater New Drains, Area Meter Set (Gas) ewer Connection Water Re -pipe Drains, Floor Minimum Fee hower Water Service Drains, French Miscellaneous Equipment ink Well, Supply Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being pe ormed and quantity(ies) in the space provided below. MECHANICAL TYPE U'FV. TVPIv: U'I'V. 'I•VPI': U'I'V. 'I'vI'li QTY. Minimum Fee A/C Central, Tons A/C Wall/Win. Tons Air Handler, Tons Barbecue Bath Fan - Vented, # Condensate Drain Cooling Tower Dryer Vents, Number of Ductwork, Cost of Fire Sprinkler System Fireplaces, Number of Generator Heating Strips, each Paint Booth Piping, Flammable Liquid Process/Pressure Piping Pressure Vessel Refrigeration, Tons Vent Hood, Cost Ventilation, Cost Periodic Inspections RECEIVED AND REVIEWED BY: DATE: Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 6/25/2002 Applicant: TIMOTHY Owner: MIELKE JOB ADDRESS: 825 NE 91 m ' Contractor ARROW ASPHALT & ENGINERING INC Contractor's Address: 14799 NW 117 AVE CN Local Phone: 305 - 556 -5702 c� CY) Parcel # 1132060050250 Legal Description: GOLDEN GATE PARK ADDN PB 6 -130 LOTS 18 & 19 BLK 2 LOT SIZE Fees: Description Amount FEE2002 -3571 CCF $1.20 jp Total Fees: $361.20 FEE2002 -3572 Building Permit Application Fee $60.00 Total Receipts: $0.00 FEE2002 -357 3 Buildier's Bond $300.00 Total Fees: $361.20 Permit Status: 0 Work: RESURFACE EXISTING DRIVEWAY If there is no permit package accessible on 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 calling for another inspection. This Permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. Signed: Approved Permit Expiration: 12/22/2002 Construction Value: 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 rvants or employes. Sign Building Permit Permit Number: BP2002 -1148 MIELKE TIMOTHY TERR $1,459.00 Page 1 of 1 (INSPECTOR) BY: (Contractor or Builder) BY: PAY TO THE ORDER OF ARROW ASPHALT & ENGINEERING, INC. D /B /A DIGGER O'TOOLE 14799 NW 117 AVE. HIALEAH, FL 33018 (954) 963 -2381 (305) 556 -5702 10 -4 2 FIRST UNION NATIONAL BANK 63 -2 -630 DATE 7877 i f AMOUNT TYP SIGNATURE ,REQUIRED LL "0000 78 ? 711' 1:06 30000 2 LI: 9913 17 7 2 20" 1 following described property: Legal description /folio #: Lot Tax Folio #: requests permission to install: fl?iamj SIior Wiage COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY Block Subdivision }- As,phalt, concrete, brick pavers [ ] Landscaping [ ] Other within the public road right of way of ' /..‘ E SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on this SIGNED. SEALED AND DELIVERED in the presence o 10050 N.E. SECOND AVE. MIAMI SHORES. FLORIDA 33138 -2382 Telephone: (305) 795 -2207 Fax: (3051_756-8972 , hereinafter referred to as the Owner of the (address) IN CONSIDERATION of the approval of this permit by the Village, the Owner agrees as follows: DR[ut - c fPPeoo4ct 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 rep esentative). owner on STATE OF FLORIDA) COUNTY OF DADE) attached survey, performed by Further, Affiant sayeth naught. Witness(sign and print) The undersigned Affiant, " fi" #, / /72 t6 5 f (p operty owner) AFFIDAVIT SWORN TO AND SUBSCRIBED before me this (name of surveyor's company) Affiant is personally known to me, roduced 2 .Z) oes hereby attest that the performed on , 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.. Witness(sign and print) 0 c Jr � rR & L 01 ✓ij ✓✓ 7 �' L day of as identification. SHAWN 0700LE MY COMMISSION # DD 026739 EXPIRES: July 10, 2005 Bonded Thru Budget Notary Services t 7 ! � %� .Li& • 244 a C PROPOSAL SUBMITTED TO ; �' t STREET '2? 7) A)( 97 'tee. CITY, STATE ylici COD ARCHITECT ARROW ASPHALT & DATE OF PLANS , e/ 14799 NW 117 Avenue HIALEAH, FL 33018 Dade (305) 556 -5702 Broward (954) 963 -9034 Fax (305) 556 -0288 Lic. #E97200 CC #98- 1608 -X aA I All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance \ Our workers are fully covered by Workman's Compensation Insurance. Acceptance of Proposal - The above prices, specifications \ Date of Acceptance: 1' peiSb1 ENGINEERING, INC. PFE JOB NAME JOB LOCATION Authorized Signature and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified. Payment ill be made as outlined above. 3 7 '1 Signature (7 To Reorder. 800- 225 -6380 or nebs.com Page No. ,i_c) 3..3i -Z /'• �' his proposal may be withdrawn by us if not accepted within DATE 1 � of Pages /o% JOB PHONE e hereby submit specifications and estimates for: (6 C � �' ;4)(7 tJ� r r�' 1 G'1ft?u if 3/Oc- Pg-A /C= �� % ,��� �� y a c ee?T ?m /E 7 7 . j it 7 (4 / '1 7 ( �;�� L—�u � -19ev'7" prnpnSP hereby to fur • aterial an lab— complete in ord ce with,a.b, v sa.cifications, for the sum of: /it/5 ' 7 71- / � J.7 Az .e ,. ' - f C(= � 2 7 rs ) Payment to be made as follows: O - 9 C��� ,g1 iiIP / &r2i days. j STREET PRODUCT 118 • PROPOSAL SUBMITTED TO �� M1 WY, STATE �nd ZI CODE ( . We hereby submit specifications and estimates for: .3;t6 PAVE ei.) Ptf/ y J APe90, / 7 2 2 • ARROW i ASPHALT & EMO iN[ ERIMG, OH C. 14799 NW 117 Avenue HIALEAH, FL 33018 Dade (305) 556 -5702 &maud (954) 963- 90334 Fan (305) 556-028 :Lk. #E97200 CC #98- 1608 -11 / 'f//'i 5 .-.- DATE OF PLANS • 9 / *- 2)47 ); 4) ( 7 2 /L.4 l - A /922- " 6V0,1-) aterial and lab complete in All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. \ Our workers are fully covered by Workman's Compensation Insurance. / Acceptance ®f Proposal — The above prices, specifications JOB NAME • and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified. Payment /ill be made as outlined above. Date of Acceptance Signature ,4074 Pr r--7 T ® .�l air r at Rz IY''h" .' ord S Page No. P (70 E 5) 77/-Z/7? JOB LOCATION Authorized Signature . r .NgleJThis pioposal may be withdrawn by us jf not-accepted within DATE • ' ©1,( 4/ 11 —7j it( 4 1? / r of JOB PHONE • Pages ce with b - sp ,cjfications, for the sum of: Date Type Insp'n Permit No. Name MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request T /A4 Address O c JE I -- k 4(2 4( 2— Company A lA Phone # � 5/ • D For Inspector: I Name & Date Approved i i Correction ❑ Re- Insp'n Fee ❑ Date f 2 2 e Time Type Insp'n Permit No. Name Address Company Phone # For Inspector: Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Pxo72 -/ f�� Thi e /r€ 92/5` ho'' ��� 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 Div ision 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. (Signed) Owner's Name and Address .: Registered Architect and /or Engineer ._ 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 Building Inspector MIAMI SHORES VILLAGE N Date 6 -. Street 2 �L - 7X- 6 xL -y� ; t State work to be done and purpose of building (by floors New Building Remodeling Addition._.. .. -__ -__ _- .__ - -- Repairs No. of Stories 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 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_. and for no other purpose. 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 the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this permit, 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 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 hi stated are true. Permit No. _ // 6.3 Read, Sworn to and Subscribed before me. Disapproved Date Notary Public, State of Florida My Commission Expires PLANNING 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- inspection 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.