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PAINT PERMITPERMIT APPLICATION FOR MIAMI SHORES Date / 1 Job Address ; / (O 6 9/ S ax Folio Legal Description Owner/Lessee / Tenant Owner's Address /11/ ` P,'U/ Contracting Co. Qualifier SS #266- 7, f `/ phone State # Municipal # Competency # Ins. Co. Address Address Architect/Engineer Bonding Company Mortgagor Address Permit Type (circle one): BUIL G ELECTRICAL PLUMBING ECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIP'T'ION /' e7 ) Q//) 7 4 DVS /f) Sa r® /o. trE. tom p Fit 7/-t r/t i /\1 ("l o O E l /A 1 `f 7 Square Ft. WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.) Application is hereby made to obtain a permit to do work and installation 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 al ork will be d•. e ' .mpliance with all applicable laws regulating nstruction an oning. Furthermore, I authorize the above- named do the wo -�, / /4% Signature of owner and/or Condo Pre 'dent ate U Signature of Contractor or Owner - Builder Notary as to Owner and/or Condo President Date My Commission Expires: FEES: PERMIT RADON APPROVED: Zoning Building Mechanical C.C.F. Historically Designated: Yes /✓Master Permit # Q Phone r9,5 Address Estimated Cost (value) 10 r 6.1.2 Notary as to Contractor or Owner - Builder My Co a 2 �PY P0 OFFICIAL NOTARY SEAL SANDRA M MONTIEL � C OMMISSION NUMBER @C401261 ,`Q i.: ' COLC3I95ION , E XP. OFF� n. `, °2.74• V7.`iSof? NOTARY BOND Electrical Date Date Z -/i9-7? Plumbing Engineering SECTION Y B �`?�s D T Zoning t/ (4/(� .z / Electrical Mechanical Plumbing Fire Public Works Structural Building Official fry_ ! l' !J 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 $ ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) O IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) PERMIT FEES $ (sq.ft. = x/1000 x ¢.60) (¢.005 / sq.ft.) (¢.01 /sq.ft.) REVIEWED AND PREPARED BY: PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2N° AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com 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. TYPE. Generator Q'fY. 'I'YI'E Refrigeration, Tons QT1'. 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 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 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: Page 2 IMPORTANT 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. 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 FLORIDA, CO Y F MIAMI DADS STATE OF FLORIDA, COUNTY OF MIAMI -DADE MOB N ignature of Or Signature of Contractor / Qualifier fe� T 2,bt EB X. E Print Name Sw. • and subscribed before me thi day \ Signature of ©tair Pub SEAL: Personally known ;Stakef Fla,da qf OR, Produced Identification l -" Print Name Sworn to and subscribed before me this day of Signature of Notary Public - State of Florida SEAL: PERMIT APPLICATION Personally known OR, Produced Identification Type of Identification Type of Identification Produced: PROPERTY OWNER � i , 1 ` ,, ,, , Name yVi n ,, I e ) W 1 "t QYYI Lte � Address 323 iv 5 Q I Lytrej2k Home Telephone ...305 r75 I - 32 `7 •J ✓ 7 '7 Business Telephone n ) a Fax "15 7 -/ i 4o TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'l Attachment Other Add'l 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 Job Address: 3Q3 ?k= c1 61 l- Cri and &ores L 3308 PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Address Apt. City State Zip Description of Work 1 H oL _ l X k' l)C)Y Folio Number Lot Subdivision PB Current Use of Property Proposed Use of Property Tenant Information Block PG x Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Master Permit No. Subsidiary Permit No. Ori c . l 1\ e PERMIT APPLICATION Zoning Linear Feet Square Feet Units Floors V alue of Work Bldg Value a ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. Address Telephone Fax Qualifier Name DATE: q �® OWNER'S NAME: Mir .� I_1A2b1, ! , PHONE: 30r, r 3 2 5 ADDRESS: 3,23 7(E 631 orb ********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ADDRESS OF SITE: CONTRACTOR & LICENSE (if applicable) COMPANY NAME: PHONE: ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All Elements on the site must be listed and indicate the color to be painted. Walls S tdkin i Al a bays' Drip Cap/Drip Edge l ,o Soffit 9 TOOL MS Roof 10� Flower Bins Sur r /SGT Shutters v► ► p.. Awnings n �a Chimney - Terra 3 , D,sor -and door jams ) Oi . S Garage Doors Railings Fences mil!? 1 Decorative Metal All brick (simulated or regular) n / Stucco Banding vi /a_ Any other stucco features :i1, Accessory Buildings n Other ✓� 1 Fascia MIAMI SHORES VILLAGE Paint Color Approval and Agreement Zvi ri S APPROVED: WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION ‘0_6a4c). y /6.1 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 sam les. Signature of Owner 4 D - ate Signature of Contractor Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** 4/23/01 I t • FLORIDA UC NES"E The Sunshine State MARGARET CATHERINE LUEBKE 312 N MIAMI 331 . -rrrr ■ONS EMUnn<EVFNtl 04-•14..67 F 5.07 04 10 1996 SAFE DRIVER :*-OC CCC ODOR 6r''SF"d'S 1 • Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 tPrinted:4 /11/2002 • Applicant: MARGARET Owner: LUEBKE JOB ADDRESS: 323 NE 91 Contractor Local Phone: Parcel # 1132060136500 Fees: FEE2002 -2115 FEE2002 -2116 FEE2002 -2117 Description Building Permit Application Fee CCF Notary Fee Total Fees: Amount $60.00 $1.20 $5.00 $66.20 Total Fees: $66.20 Total Receipts: $0.00 Permit Status: Approved Permit Expiration: 10/8/2002 Construction Value: $1,500.00 Work: 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 hienortinn- This Permit is granted to the contractor or builder named above to construct the t pertaining thereto and with the understanding that the work will be performed in Corr 1011 'proper municipal authorities. This Permit may be revoked at any time if the work Is 1 which this permit is granted is the understanding that the contractor or builder name ,,hovered hereby whether shown on the plans or drawings or in the statements or six Signed: (INSPECTOR) In consideration of the issuance to me of this permit, I agree to perform the work plans, drawings, statements or specifications submitted to the proper authorities of servants or employes. Signed: (Contractor o Building Permit Permit Number: BP2002 -737 LUEBKE MARGARET ST Contractor's Address: Legal Description: 1 53 41 6 53 42 MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 15 & 16 :ter WILLIAM G LUEBKE MARGARET M LUEBKE 323 NE 91st St Miami Shores, FL 33138 Ph 305 - 751 -3275 DATE PAY TO THE /y1 // ORDER OF / I /� • QPQ r yi &A .., I $ 66 , � p ® First Union National Bank firstunlon.com Org. 003 R/T 067006432 F i iCL 7 er0" -A •:06 70064 3 21:116 7460 2 2 2 26 30' BLK 48 5276 63- 643/670 BRANCH 00772 20 DOLLARS 1=- Organized Banking° •. BUILDING ELECTRICAL PLUMBING" Owner o Building Contracto ' !or Builder Legal Lot Description Address of Building MIAMI SHORES VILLAGE, FLORIDA DATE — PERMIT N? 4313 Work to be performed under this Permit Architect ILO • Bl. Subdi- vision Amt. of Value of Permit -e) Project 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 appli- cation 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 draws or in stater ehJs or specifications and thfCr assumes respon- sibility for work done by his agents, servants or employees. Contractor's License No. 1944 Signed • `..� N. '" By � �. INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with gilisdinances and;egpiatipns 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 responsibility for all work done by either myself, my agent, servant or a ployee. i" •` ✓ _ CO am„- CONTRACTT OR OR .BUILDER ` t` BY AUTHORITY MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date 5'13 `Qo- Time Type Insp'n Permit No. Name !fyLQJI Address Company Phone # Approved Correction Re-Insp'n Fee 61,1512.0.30 ?O3' 75/ -32 7.c" For Inspectors - �� -Q �, Name 5 ic(