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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 • •• ••.• •. •. •••••• •• •• • • • •.• • ••• • • •• • • • • • •• •.• •• • • • • •.• • •• • • •. • • ••• • •.• • ••• • • ••• • • ••• • •••... • ...• • • • • • • • • • • • • • • ' ❑ 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 • •• •• • • • • • • • • • ••• • .• .• .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. • • • • . • . . • . • • • • • • • • • • •• • • •. • 0 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 • • • • •• • • ••• • ••• • • • • • •• •.• •• • • • • •• • • •• • •.• • • • • •.• • • ••• • •.• • ••• • • •••• • .•••.• • ••• 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: •