934 NE 91 Terr (3)SECTION
BY
DATE
Zoning
License No. CA c 0 3 ( 8 . 0 t/
.m741.
P4
Electrical
Home Telephone
Teleph 1ne 9 89 0 63ij Fax lS 7 9‘
Mechanical
,'-69 L
Z ./3,Q Z
Plumbing
Fax
Fire
Foundation Only
Public Works
Add'l Attachment
Structural
Add'l Detachment
Building Official
Other
CONTRACTOR
New Construction
�^ -T
Name , fi- f J
roe_ lac
kfs3 ury
License No. CA c 0 3 ( 8 . 0 t/
.m741.
P4
Address ( 1 �V Jo rJ c T ,
i -4vJa- F. 33
Home Telephone
Teleph 1ne 9 89 0 63ij Fax lS 7 9‘
/- 6/ � u
Qualifier Name 1 .—. 0 S(7 1) 4 A 'Si r e4
L.
PROPERTY OWNER
New Construction
To Name Tn4 y4,4-- S
kfs3 ury
Address � 3L Ai c- q
r-", S NBC.
.m741.
P4
Home Telephone
Alteration Interior
Business Telephone
Demolish
Fax
Shell Only
TYPE OF MANAGEMENT (✓ )
New Construction
Enetnsnre
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'l Attachment
Other
Add'l 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
Notary
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1
(Attach)
•• ••• .•• .•. •.• •• • • ••
• • • • • • • • • • • •
. EI HAI /TICRM • pP O; .: •: • • • • ❑ BPR APPROVAL (Restaurants)
. (SIpOG t start • • • • . • •
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
$ (¢.005 / sq.ft.)
(¢.01 /sq.ft.)
•
$ o (sq.ft. = x/1000
x ¢.60)
PERMIT APPLICATION
•
• • • ❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ CONTRACTOR REGISTRATION
(On File)
PERMIT FEES
TOTAL $ b V
ISSUING OFFICIAL
REVIEWED AND PREPARED BY: 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
Step 1. Complete the attached permit application whi t
print or type to allow for a more accurate prtSessiQp
ted along with this permit application. • •
• •
•• •
Step 2. Submit the completed application with all necessary
processing of your application, you may be asked to
Job Address:
Address
Folio Number 1 1 215 6 V d 3 - G r'( o
Lot e Block 2.
Subdivispto�t PB 11 PG
Current Use of Property
Proposed Use of Property
Tenant Information
PERMIT TYPE (✓ )
Building
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
Electrical
3t Alt, _
Apt.
Chg. Contractor
•
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• •
• •
• •
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.•
.•
.8
•.•
PERMIT CHANGE (✓ )
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
•
• •
•••
• •
• •
• 0 $ • 000
•• •• •.•• •• •
••. • •.• • • •
.• • • •
•• • •.• • •
••• • 8.8 • •••
Master Permit No.
PERMIT APPLICATION
ry?p , 63 , /s
• • • •: •':' St.>Iiisitiia>y Pe iilit'No.
• • • • . • . . • . • • • •
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INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
e si j d I he ' • . - ow - and ! alifier. Both i natures must be notarized. Please
:f v: alrlitatip ICr woNwill be done, a roofing application must be submit-
• • • *coo • • • •. • •
• • • • • • • • • • •
• •• • • ••• ••• ••• ••
documents to the Building, Planning and Zoning Department for processing. During the
submit additional information.
APPLICATION
nu, .rS /ts. F
City 12e7-PC- State Zip y _`
Description of Work ACE 6)
ACE 5 /�,— S T
C.onl L) Ln1S V t rt- NF‘,..)
Linear Feet
Zoning
Square Feet Units Floors
Value of Work 2 L4 CIA .+'
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
Bldg Value
ENGINEER
Name
License No.
Address
Telephone
Fax
ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPE
Dryer
oT t'_
•
T %P•
Wit, :kW' • nce •
QTY.
Tl'PI?
Service Repair
()'I'V.
A/C Central 1 -3 Ton
S
Fan •' ' ' ''
'
' Ouuet, wail
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, IntercomlTeleph.
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.
TYPE
Refrigeration, Tons
QTY.
A/C Central, Tons
S
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
ST
Si
,f
weer
OR • A, 6 NT OF ` iAMI -DADE
-761-IN L. SToKESBER
Personally known
Signature of Notary Pub is - State of
SEAL:
Print Name ''��
Sworn to and subscribed before me this Ivy day of )612-0
c 3
Type of Identification Produced:
• •• •••• •• •• • •• ••
• • • • • • • •S. • • • • • • •
• • •.001 •• •.• •• • •
• • 0 0 0 • • • • • • • • •
••• • ••• • •• • • ••• • •
•
Signature of ntractor / Qualifier
Print Name
SEAL:
o and subscribed before me this
PERMIT APPLICATION
IMPORTANT NOTICES
DO NOT BEGIN ANY WORK WITHOUAHAVKJOR&L AD•`fOUR VALIDATED P8RMIT AND PERMIT CARD. Applying for a permit does not grant
the right to begin construction. HOURS OF GaN S'GItUCTAN thscugh 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 PROPERTIE9VHAE; 1314IEPTI2E 4It pI1;1' r3NDIVBRIS.
4. SWALES MUST BE PROTECTED FROM BVNG DP1.4131113 Dvrcku.M{NT Or PEIIICLES, AND MAY NOT BE USED FOR STORAGE. A bond is
required for work in or near the street/sidewalk• • • • • • • • • • • • •
5. CONSTRUCTION TRAILERS ARE PROHIBIMD UIVSITsIttEft4It,Y 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 FLO ID . COUNTY OF MIAMI -DADE
•�,�1_ LOIS E. UNDIEY
COMMISSION l; CC978568
EXP*ES DEC 15 2004
BONDED THROUGH
AINANTACit NOTARY
V OR, Produced Identification
iL . 41
S : ature of N 'r Pu
orida
day of
Personally known OR, Produced Identification
Type of Identification Produced:
Page 3
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• .•••.• • •••
PERMIT APPLICATION
• • ••• • • 0 0 0 • • * • •
type of work it 000 e • • p • a rld • i tes in the space YP .� � P �D:�� xl� NYC ) i provided below. �
INSTRUCTIONS: Please indicate the t P P
mr
00 •0
RECEIVED AND REVIEWED BY: DATE:
h
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 2/13/2003
Applicant: JOHN
Owner: STOKESBERRY
JOB ADDRESS: 934 NE 91
Contractor SITRA FOR SCV INC
Local Phone: 954 - 980 - 0638
Parcel # 1132060030140
SERVICE, INC.
P H R54 ) 91- 66100 OR (954) 961 -COOL
g100 JOHNSON STREET
HOLLYWOOD, FL 3302
P • OF
,,fir/
'� /�S� t r 02992 FL
i ACH Ra 06300004
�kc3� � �,
Mechanical Permit
Permit Number: ME2003 -15
STOKESBERRY
JOHN
TERR
Contractor's Address: 6551 LILCOLN ST
1 -3
Permit Status: APPROVED Permit Expiration: 8/12/2003 Construction Value: $2,400.00
Work: REPLACE EXISTING 5 TON CONDENSING WITH NEW
63-4
DATE
0/ g
DOLLARS 8
Page 1 of 1
rio inspections. Re- inspection
Legal Description: PL OF BISCAYNE RIDGE PB 39-41 LOT 7 & LOT 8 & W7.47FT OF LOT 6
P v A. 4 o 0
.Fo
Total Fees: $O0g
Total Receipts: $0.00
described in the application herefor in strict compliance with all
:, statements or specifications that may have been submitted to
with such ordinances or if the plans are changed without
we assumes the responsibility for a thorough knowledge of the
r specifications and that he assumes responsibility for work done
•
i
' lZl�
f6°
M' inces and regulations pertaining thereto and in strict conformity
3 permit I assume responisibility for all work done by either
er BY:
•