901 NE 91 Terr (8)4
Date (0 '`>S' g•
Job Address 9 l t• c T< ✓ - Tax Fo lio// y ow ®5
Legal Description/J /
"/' / f
Owner / Lessee / Tenant
Owner's Address k 31 O y \ ' O - ( - 7,-„,v(._ Phone 3 6 '. 1 3o8
4" y� /10
Contracting Co. dc� r .�'Z . Address
Qualifier SS# - - Phone
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOPING PAVING FENCE SIGN
wvh-I TE
WORK DESCRIPTION ? Pt- �v'C
Square Ft. Estimated Cost(value)1• On 0 ' CT
WARNING TO OWNER: YOU MUST RECORI
SO MAY RESULT IN YOUR PAYING TWICE
TO OBTAIN FINANCING, CONSULT WITH
NOTICE OF COMMENCEMENT).
Application is hereby made to obtain a permit t, (1,0 _nstallation as indicated above, and
on the attached addendum (if applicable). I 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, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
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. Furthermore, I
authorize the above -named contractor to do the work stated.
Date:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Signature of owner and /or Condo President Signature of Contractor or Owner- Builder
• a
N f a' as to Owner and
My Commission Expires:
APPROVED:
JOSEPI4INE OWEN
mm4 1:1
o :ipm+m 1 W. Aprd 30. l
'. No. CC197545
Mechanical
// ;
Master Permit # 7
OF COMMENCEMENT AND YOUR FAILURE TO DO
PO YOUR PROPERTY (IF YOU INTEND
ATTORNEY BEFORE RECORDING YOUR
Date: kO • ∎3
Notary as to Contractor or Owner- Builder
My Commission Expires:
* * * * * * * * * * * **
FEES: PERMITJ 7 6 O RADON C.C.F. /;,� O NOTARY Jr. z0 TOTAL DUE -26i
Fire
Zoning / Buildin
Plumbing
Other
Electrical
Engineering
( 0 .
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 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.
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:
Street and Number where work is to be done
STATE OF FLORIDA, I
COUNTY OF DADE. ss.
APPLICATION FOR BUILDING PERMIT
( Signed)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Date
Lot Block Subdivision
No. L Q 1
Str
eet
and for no other purpose.
Repairs 1--- No. of Stories
Roof Covering
New Building Remodeling Addition
To be constructed of Kind of foundation
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.
be sent to
The undersigned applicant for this building permit does hereby certify that he under tan. s and accepts his obligations as an employer
of labor under the Florida Workmen's Compensation Act, being Section 5966, Com • e Ge ral Laws of Florida, Perma : nt Supplement,
and has complied with the provisions thereof, and will require similar compliance om :11 ntractors orub -con actors : ployed by him
in the work to be performed under this permit; and will post or cause to be pos tiomo th sitd'of / �4e wo such public notice
or notices as are required by the Act. The undersigned agrees to employ only s r: • �co� act.g�w performed u .er this
permit, as are licensed by Miami Shores Village.
Remarks (Signe
All notices with reference to the building and its construction may
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, bang \ by me first duly sworn, u on oath deposes and says that he is the
of the abov describe., onstruction, that h has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by m state . are true.
Permit No ____ � D f 1 c ead, Sworn to and Subscribed before me.
Date
Notary Public, State of Florida
uil. ing In . ector 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.
PROPERTY OWNER
Name
j) 0A) 0 R
(�
° r Ke-, j�"r Ix 1
Address ^ I
P4 t h iLl (
C r ( 610 C
S 1--ED 2 C s F I. 3 13
Home Telephone
3 u S 7 5 7 E. 3 b
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'I Detachment
Other
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
b Address: 9 ' A 9( f Ci R ite E
Address /, Apt. City State Zip
Folio Nu r\J ber 1 1 — 3.2 a 6 6 D 3 ^ � I7@3crD pion of Work
Lot 1 �� (All)
r 1 .
Subdivision f J 0 t t ' B 1 � � P: PG Zoning Linear Feet
Current Use of Property �'L U.,a o __ Square Feet
Proposed Use of Property 1s( * - )C e Clue of Work / 7 Q 0 Bldg Value
Tenant Information Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Othee
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
PERMIT CHANGE (✓ )
ARCHITECT
Name
License No.
Address
Telephone
Fax
Master Permit No.
PERMIT APPLICATION
Subsidiary Permit No. .(
rt ktt-i t S t{ ),q6 F 3 3 1
Units Floors
ENGINEER
Name
License No.
Address
Telephone
Fax
CONTRACTOR
Name
License No.
Address
Telephone Fax
Qualifier Name
Page 2
1NIPOR'I'ANT 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.
AFFIDAVI'1' - Please read carefullv%
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, PI 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.
ST OF FLORIlt COUN �Y OF MIAMI -DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE
G( X c L t 'I (
Signature of Owner
110 10 G
Print Name O _ 1 Print Name
worn to an� subscribed before me this
tary Public
ti'i6AS- OTAHY SEAL
SEAL: 0 1PRY P ®! .t.;), A0CELA PJ1 BECKER SEAL:
- /n Co4.1:4u�On qU Z O R
9 j, -" ' 4 b t. Co:1SS."O; EISR%S
s OFf A .O ROV i 32O02
Personally known ' ---- OR --- , fi
OR, Produced Identification \_ — Personally known OR, Produced Identification
Type of Identification Produced: f4.D...) h O''17I - ) (6 b4' () ype of Identification Produced:
Signature of Contractor / Qualifier
Signature of Notary Public - State of Florida
PERMIT APPLICATION
Sworn to and subscribed before me this day of
ELECTRICAL
TYPE
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+ 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.
TYI'E
Generator
QTY.
TYPE
Refrigeration, Tons
QTY.
A/C Central, Tons
Cooling Tower
Heating Strips, each
Vent Hood, Cost
A/C WallNVin. 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
I
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
D E •
Zoning
--ra.efoo
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
Page 4
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi - family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
❑ PROOF OF OWNERSHIP
(Attach)
O FIRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
PERM FEES
$3.00 per page (Scanning Fee) $
Miami Shores Village
Bond
Metropolitan Dade County (C.C.F.) $ t C
Inspector State Educational Fund $
State DCA (Radon) $
Code Enforcement Fine
Zoning Review
$ a �
$
(sq.ft. = x/1000
x 0.60)
(¢.005 / sq.ft.)
(¢.01 /sq.ft.)
REVIEWED AND PREPARED BY:
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
1;> &.tL1 gr
ISSUING OFFICIAL
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
MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
DATE: �'- • 02,p0 1
OWNER'S NAME. (R1 G-R PHONE: 3
ADDRESS: `7` O I N C ( ^ R R fic.E t Za tAA%t E L, t) i 3 2
********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE: 6
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME: PHONE:
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted.
Walls c% Pk-
Fascia he [ 0
Drip Cap/Drip Edge N/ 0
Soffit '------
Roof NlI 14
Flower Bins �y.I 6
Shutters egfi
Awnings a
Chimney R
Doors and door jam '
, '�� y 53
Garage Doors Ai 8
Railings ry H
Fences M fr
Decorative Metal M #.
All brick (simulated or regular) L-
Stucco Banding /v
Any other stucco features
Accessory Buildings
Other
APPROVED:
7/-`7 /
Building Official Date
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. I authorize the above -named contractor, if applicable, to
do the work stated. Furthermore , the paint colors will be as per the attached
mples.
t • C4) I a-e1D 1
Signature er Date Signature of Contractor Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
4/23/01