PAINT PERMIT,_41111.- a -
MIAMI SHORES VILLAGE �-7
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date
Type Insp'n Val rI
Permit No. P b3 — )16
Name (l._ 0(
Address ICJ 1, 2 JY--
Compan J P
Phone #
Inspection Date 5/
Approved
)
Correction ❑
Re- Insp'n Fee ❑
fad
65
BUILDING
PERMIT APPLICATION
FBC 2001
Miami Shores Village
Building Department
Permit Type (circle): Building Electrical Plumbing Mechanical Roofing
e lC2'01 — 5 7
Owner's Name (Fee' Simple Titleholder), t , \ (,w ; ed.. : = �� / ki r: Phone # C `l 6.) 4 544 2 ) -- � L-C
Owner's Address>' f t `!.. h., l c.%. 6'i r- S I
Cityl;V'„ �i� 1C S State `-� . Zip -�� �� y'
Tenant/Lessee Name Phone #
Job Address (where the work is being done) ) (`i ' k1'. (1 6 2 S
City Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES NO
Contractor's Company Name Phone .# .
Contractor's Address
City State Zip
Qualifier
Architect/Engineer's Name (if applicable) _ Phone #
Architect/Engineer's Address
City State Zip
$ Value of Work For this Permit
Number of: Bays Stories Families Bedrooms Baths
Type of Work: ['Addition ❑Alteration ['New ❑ Repair/Replace ❑ Demolition
Describe Work: •exl - ev -o ✓ / ° C-•••• 1 - tel
** *** * ** *` *� * * * * * * * * * * * * * * * * * ** Fees**** * * * * * * * * ** * *� * *' * * * * *;. * * * * * * ** r,
County Escrow Fee $ a • ` 2 v Permit Fee $ (C) �. X J Notary $ . 0
Education/Training Fee $ Tech $ Scanning $
Code Enforcement $ Bond $ Struct. $
?a0 OA, 'Vo
Minus Plans Check Fee $ Total Fee Now Due $
Master Permit No.
i i + + N.E.2nd Avenue
Mi ores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Permit No. BQZCT ^
Square Footage Of Work:
Radon $
(Continued on opposite side)
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
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.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not b roved and a reinspection fee will be charged.
ignature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this (' The foregoing instrument was acknowledged before me this
day of , 20 03, by �tbo o \ e > . , day of - , 20 _, by
who is p sona ly known to me or who has producedT(t \)-t who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: .' ON OTARY PUBLIC:
Sign: Qc)OY ign:
Ci0
My Commission Expires:
chc7/7 /03
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY: JUL 17 2003 Plans Examiner
Engineer
Zoning
Signature
Print:
My Commission Expires:
MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
DATE- — f I
OWNER'S N
ADDRESS:
* * * * * * * **
NAME
�. PHONE
g
*********************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
03
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 tAe (1 o
Fascia
Drip Cap/Drip Edge - (�
Soffit f1C�
Roof JI/
Flower Bins I\16
Shutters (O
Awnings l,V)
Chimney N 0'
Doors and door jams gib
Garage Doors
Railings J o
Decorative Metal LLO
All brick (simulated or regular)
Stucco Banding b
Any other stucco features
Accessory Buildings
Other 0,0(11\ c .
Fences
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
const ion and zoning. I authorize the above -named contractor, if applicable, to
do t rk slated. Furthermore , the paint colors will be as per the attached
sa
3
Signature of Owner Date Signature of Contractor Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED: WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
Building Offici
7,074' 3
Date
to'
�
1 B Applesauce 350C -3"
2 Trim'. Popped Corn W -B -200°
3 Accent. Book Binder 140F -6"
4/23/01
PROPERTY OWNER
New Construction
-
Name V:04/04 �
Alteration Exterior
Address
(00 A/7i p
Repair
.....
Home Telephone , a . 91
/ f. ,
I J
Business Telephone ' P
Relocation of Structure
Fax
Foundation Only
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 itiliami 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
›K Job Address:
Address
Apt.
Folio Number
Lot Block
Subdivision PB PG
Current Use of Property
Proposed Use of Property
Tenant Information
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
Description Work
Subsidiary Permit No.
PERMIT APPLICATION
Master Permit No.
City . State
Linear Feet
Units Floors
Zip
Zoning
Square Feet
X Value of Work
Tax Assesses Appraised Value
Flood Zone Base Floor Elev.
Bldg Value
ENGINEER
Name
License No.
Address
Telephone
Fax
CONTRACTOR
Name
License No.
Address
Telephone
Fax
Qualifier Name
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 andiSewer 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 amifully 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 floorelevation. 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.
Ch ontractor.
ORIDA, COUNTY OF MIAMI -DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE
gnature of ry Pub is - fate of orida i Signature of Notary Public - State of Florida
r .
r —��`" o f ;ICtAL t:o :,: J,L
SEAL: `P RY F'0 APlGi LQ h1 Bct.,:'It SEAL:
z -v, ) z' i * Cop.l�7°,eioi{ i:UILEa.a
N -•. Q r;, c 7 86 6 97
rte'„ O -M MYI Q0�rS1
Personally kn ,. f�_ _ • - OR, Produced Identification 1--°........' Personally known OR, Produced Identification
Type of Identification ProducedF of Identification Produced:
Signature of Contractor / Qualifier
Print Name
Sworn to and subscribed before me this day of
PERMIT APPLICATION
Review the brochure at Village Hall on Construction Lien Law and
MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
DATE:
OWNER'S
ADDRESS: /e; /L0�
* * * * * * * * * * * * * * * * * * * * * * * ** * ******.* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
ADDRESS OF SITE:
CONTRACTOR & LICENSE (if app icable)
COMPANY NAME: /VAC PHONE: 3& WJ 2,2
********************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted. 11
Walls �.. �' �- < bS �- �/��� 2 0'1 - ) �yl oSs
Fascia V �.., .. oy y
Drip Cap/Drip Edge 1 �—
Soffit ✓ O
Roof /
Flower Bins
Shutters
Awnings
Chimney
Doors and door jams ✓( �,� r - ; , �- 50 a
Garage Doors
Railings
Fences t/ ,5" �' 011/
Decorative Metal
All brick (simulated or regular
Stucco Banding
Any other stucco features
Accessory Buildings
Other
APPROVED:
4&!q 110;"
Building Official/- Date
OI3
CD N
70 - CD
CC
a
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate
and that all work will be done in complia . 6Wi 11 applicable laws regulating
co tion and zoning. I authorize e above -nam- d contractor, if applicable, to
rk stated. Furt e ore , th= paint c.lors w' 1 be as per the attached
ature of Owner Date Signature of Contractor Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
4/23/01
O
o ' o
CO CC
CO
0
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
AJC 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 Nev;
MECHANICAL
TYPE
Minimum Fee
QTY.
TYPE
Condensate Drain
QTY.
TYPE
Generator
QTY.
TYPE
Refrigeration, Tons
QTY.
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
AJC 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 er
Indirect Wastes
',elay Repair
Vacuum Pump
Disposal
Interceptor
Roof Inlet
Water Closet
Domestic Well
(Laundry Tray
Septic Connection
Water Heater
Draigeld, 4" Tile/Res.
(Lavatory
Septic Tank
Water Heater Nev;
IDraiMS, 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:
SECTION
BY
D T
Zoning
ait
'
Electrical
K
Mechanical
Plumbing
Fire
Public Works
Structural
/�
—
Building Official
/..%
- r
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)
❑ FIRS / DERM APPROVAL
1, (Septic / Sewer)
❑ IMPACT FEE
!(New Construction)
❑ OTHER
(Specify & Attach)
$
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
O CONTRACTOR REGISTRATION
(On File)
PERMIT FEES
$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
(sq.ft. = x/1000
x ¢.60)
$ (¢.005 /sq.ft.)
$ (¢.01 /sq.ft.)
∎� ~ �
ISSUING OFFICIAL
0 0
REVIEWED AND PREPARED BY:
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com
Z
TOTAL $ y- t b
DATE:
CONDITION OF' APPROVAL
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 4/10/2002
Building Permit
Permit Number: BP2002 -721
Applicant: VERONA AUDREY HAUGHTON
Owner: HAUGHTON VERONA AUDREY
JOB ADDRESS: 100 NE 92 ST
Contractor
Local Phone:
Parcel # 1132060133290
Contractor's Address:
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 13 & 14 BLK 24 LOT SIZE
Page 1 of 1
Fees: Description Amount
FEE2002 -2068 Building Permit Application Fee $60.00
FEE2002 -2069 CCF $0.60
FEE2002 -2070 Notary Fee $5.00
Total Fees: $65.60
Total Fees: $65.60
Total Receipts: $0.00
Permit Status: Approved Permit Expiration: 10/7/2002 Construction Value: $500.00
Work: EXTERIOR PAINTING AS PER AGREEMENT (OWNER BUILDER PERMIT)
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:
(INSPECTOR) BY:
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 agent,
servants or employes.
Signed: (Contractor or Builder) BY: