PAINT PERMITD.te LL 1 , ime
Type Insp'n "�(
Permit No. Z b o 7 f
Name
Address S o 'b 1
Compan
Phone _c73 ?' 2 a I
"t
For Inspecto>S )23 Name & Date
Approved
Correction
Re- Insp'n Fee
MIAMI SHORES VILLAGE
BUILDING DEPARTME
305- 795 -2204
Building Inspection Request
T
PROPERTY OWNER .
� e • 1 a r/5 /u rg/1)
Address s:Dt / J c^ / Q/ 5 4.
M. S,-
Home Telephone _ /2 ) 2 — /1..- 1
Q !
Business Telephone 30 r 6' - -1/')/
Fax
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
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• • • ••• •
• . • • • • • •
• • ••• • • • • • •••
PERMIT APPLICATION
.• N'a'gger Permit N
• •••
•.• • ••
• .••
• ...•. • • • •
ubsidiary Permit o.
• • .••• •
• •
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Step 1.
• • • • • • • •••
Complete the attached permit applicadgp Mpg stbecigaedlay the property owner and qualifier. Both signatures must be notarized. Please
print or type to allow for a more accurate pfpcCssirgbf Vo a�plicatiow If roofing work will be done, a roofing application must be submit-
ted along with this permit applications • • • • • ' "'
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
J ob Address: -0 1 NE 2/ S'7
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
Address
City
State
Zip
� f / L '
e
�J
Folio Number scription of Work -er Pr
Lot Block
Subdivision PB PG Zoning Linear Feet
Current Use of Property Square Feet /, Units Floors
Proposed Use of Property slue of Work /!") 6 Bldg Value
Tenant Information �x Assessed/Appraised Value
Flood Zone Base Floor Elev.
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
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 iiOITA ZALID MIT }D 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•eI SAblITARY.CONDITION free from construction debris.
3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE F4tONZ DTRtAI:DIA3RI$.
4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMEN AID. VQHtLVS :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, 1St 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.
S ATE OF
Signat
X Print Name / Print Name
Si
SEAL:
to and subscribed before me thi
ture of N
AQP V /?
UNTY OF MIAMI -DADE
t ker
• Q My Commission DD150048
cf Expires November 15. 2006
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•••
• ••
SEAL:
•
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• • • ••• • •
• • • • • • •
.. • • • • • .. • •
•
•
•
•
STATE OF FLORIDA, COUNTY OF MIAMI -DADE
Signature of Contractor / Qualifier
Sworn to and subscribed before me this day of
Signature of Notary Public - State of Florida
PERMIT APPLICATION
Personally known ��6R, Produced Identification Personally known OR, Produced Identification
Type of Identification Produced: Type of Identification Produced:
ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPE.
Dryer _
;QTY.
• •
':Y
• QitlgVAppliance
QTY.
'mil.:
Service Repair
Q
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
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
PLUNIBING
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
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... . • • • . •
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-- - .
• .
PERMIT APPLICATION
INSTRUCTIONS: Please indicate the type Df warlL b¢ir►g pe fc}rrx nci and quantity(ies) in the space provided below.
RECEIVED AND REVIEWED BY: DATE:
SECTION
BY
)�E �
3 �a n_
Zoning
a-, d %�
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
•
Page 4
OFFICE USE ONLY
❑ 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
• .• • •
• •
• •
••• •
•• •
• ••
CHECKLIST
• •
CI PROOF OF OWNERSHIP
(Attach) . •
•
❑ HRS / DERM APZRVIAZ
(Septic / Sew &' '
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
PERMIT FEES
$S. o
• • • •
• ••o • • •
• • o • • •
• • • ••• • •
• • •
• • •
( x ¢ . x/1000
(¢.005 /sq.ft.)
(¢.01 /sq.ft.)
• .•
•
PERMIT APPLICATION
•❑ CONDO ASSOCIATION APPROVAL
(Attach)
• • ••
O •• • BPR APPROVAL (Restaurants)
• • ••
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $
ISSUING OFFICIAL
REVIEWED AND PREPARED BY: DATE:
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL o (305) 795 -2207 o FAX (305) 756 -8972 o http : / /www.miamishoresvillage.com
MIAMI SHORES - VILLAGE
Paint Color Approval and Agreement
DATE: g / / � /I�
OWNER'S NAME:
APPROVED:
1 /k) "
Building official Da e
PHONE: 75 / /
ADDRESS: j0 6 �� 9/ . S 1
************************4:**************************************** ADDRESS OF SITE:
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME: PHONE:
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements qn the site must be listed and indicate the color to be painted.:
�
Walls e e 1'G / t'7 c
Fascia frr n
o
Drip Cap/Drip E ge o
Soffit (,� z
Roof i A.< cn
Flower Bins
Shutters
Awnings
Chimney
Doors and door jams
Garage Doors
Railings
Fences
Decorative Metal
All brick (simulated or regular)
Stucco Banding
Any other stucco features
Accessory'Buildings
Other
I
Iwl
a)
0
0
0
2143 -50
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
samples.
Signature of Owner Date Signature of Contractor Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
Building Official 4/23/01
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 3/12/2003
Applicant :+ER —
Owner:
JOB ADDRESS: 506
Contractor
Local Phone:
Parcel # 1132060400050
ermit Status: APPROVED Permit Expiration: 9/8/2003
Work: EXTERIOR PAINTING AS PER AGREEMENT
Signed:
y Signed:
ID ID
4 yr-
NE 91
Building Permit
Permit Number: BP2003 -397
— X4VFE
ST
Contractor's Address:
Page 1 of 1
Legal Description: PARK MANOR HOMES PB 86 -52 LOT 5 BLK 1 LOT SIZE 7088
Fees: Description Amount
FEE2003 -1480 Building Permit Application Fee $60.00
FEE2003 -1481 CCF $1.20
FEE2003 -1482 Notary Fee $5.00
Total Fees: $66.20
Total Fees: $66.20
Total Receipts: $0.00
Construction Value: $1,600.00
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.
(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.
REG COI 03140; 1036 maw 005487 CHARGE $66.20
(Contractor or Builder) BY:
MIAMI SJIORES VILLAGE
Paint do1kAlh3rceval and Agreement
DATE: ° �_2
..
OWNER'S NAME:
Soffit t)
Roof
Flower Bins
Shutters
Awnings
Chimney
Doors and door jams
Garage Doors
Railings
Fences
d • •
Decorative Metal
All brick (simulated or regular
Stucco Banding
Any other stucco features
Accessory Buildings
Other
••
•
. . •
•
• • ••
•. •
• •
• . .S
l i I.. • •
PHONE:361- 75x} 1Y -I
ADDRESS: 5 E 5
**** * * * * * * * * * * * * * * * *,6* *** * * * * * * s� ** * * * * * * * * * * * * * * * * * * * * * * * ** •
ADDRESS OF SITE: : : •
CONTRACTOR & LICM E (if applicable)
COMPANY NAME: PHO
**************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * **
All Elements on the site mus be listed and indicate th : color to be painted.
Walls
Fascia �� o
Drip Cap/Drip Edge
s
s"
W
0
0
w
0
w
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
sa . sle
ignature of Owner ' Date Signature of Contractor Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED:
0
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
Building Of icial Date 4/23/01