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DRIVEWAYCONTRACTOR SuPcie S+arnp Go nc•R -Qre 7.141c NameSueg R stamp Concrete, wnc License No. E 98 19 O 2, Address + 542 oy so i 3y et •A i A.-% i ) Cr1 33115 Telephone ,OS- ZZ0• 1 F ax 3CS.. , 22o -t((03 Qualifier Name W 1 1 k Aryt J.. Sans PROPERTY OWNER New Construction Name J oh A ?A 44-Av c r .1 "P i a ne. Address 1 1 .1 n E 9 3 S'r- fr %Amt Sllores in 331 32 Home Telephone 40S . 15 ( _ 4 G 0 0 Business Telephone < License No. Fax '; ARCHITECT New Construction Enclosure Name Repair - < License No. Demolish '; Address Foundation Only • Add'l Attachment Telephone Other Add'l Detachment 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 !_lctLi • 0 . . ! �� moo V�� o o \®Qti . 0 INSTRUCTIONS - The fo steps must h e t to o lita m a'p o m "t th e ( ' '' or Shores Vtllae: Step 1. Job Address: 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 ►�� nE. cast Address Folio Number 1 (- 3206-01'3-3140 Description of Work S I AMP Cbl1Cre Ie dr ■V et )o Lot 1 3 4 t y Block a 3 Subdivision •Shoris Sell PB t0 PG O Zoning Linear Feet Current Use of Property (NES • Square Feet 1 59 !o Units 1 Floors i Proposed Use of Property R ES • Value of Work .i 5213 Bldg Value Tenant Information Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Apt. PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection PERMIT APPLICATION Master Permit No. 31 0 - 31 Subsidiary Permit No. M . S%•,ore City FL State 33 13g Zip ENGINEER Name License No. Address Telephone Fax Page 2 INIPORTANT 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 (AERM) and/or Miami-Dade-Water and Sewer Department (MJ.)WASD) approval is required for applications involving sewers. AFFIDAVIT - Please read carefully. • Application is hereby +made tt' obtain a permit lt• do'work and installation as indicated. 'I, the OWNER attic property, certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdirtipn. I understand thati eparate permits are required for ELECTRICAL, PLUMBING, POOL, EXTERIOR DOOR, MIyCHANICAL, WINDOW, FENCE, 'DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencieA. ' • I, the OWNER of the property, have disclosed: all bretiation 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. STA E F FLORID ignature of Owner n e Rek-4 A v i n A Print Name Sworn to and subscribed befyre -&pe this DAo day o x eC a4 �-. Signature o Notary Public - State of Florida '' `gyp ���� I Iola F'rt11�C,o /Sans SEd� �.`pp�Pp�,�' ' ; #CC�„92$828 . `: , - '• • %'• � o _ Expires April '6,2004 ond�.T Lie! Atlantic B Bondingg Co: )ne. Personally known OR, Produced ldentifjcatign, OF MIAMI -DADE Type of Identification Produced:!" ,' L ; ` >r. i Sigure of Contractor / Qualifier LC • Am 3= 5c1n6 Print Name Swom to and subscribed before me this of I 110 day of 9—.4-0 2 Signature of Notary Public - State of Florida SEAL: ''oat. Yeline Sans c * * MY CQm is on CCt343290 , i j� r i s .. 99 r• ti i` •,,.,,,,� Expires June 3, 2003 3ft ,',', Per .pally kno. . •. • r •OR,- Pioduced'Identificatjon Type of IdentificationtProdpeed; • ..;;:r _ 7 PERMIT APPLICATION er 0 V /.j1 MI 0 3 0 0 5 �� wood peuic � 7_ S' RAo■ v• ` PLAN OF SURVEY a- - 9.0S‘ fre STORY C• BS• ( L ra I SO r11 t4P\1 S !AA) cL • 33 \38 i -so • . 4., tar _ u . E C3 err cS359 R = asoo' S 1 — 20' 110 /V-& LS Miami Shores Village 10050 NE 2nd Avenue Phone: 305- 795 -2204 Permit Number: BP2003 -31 Printed: 1/13/2003 Applicant: DIANE PATTAVINA Owner: PATTAVINA DIANE JOB ADDRESS: 112 NE 93 ST Contractor SUPER STAMPED CONCRETE Contractor's Address: 5204 134 CT Local Phone: 305 - 220 -1163 Parcel # 1132060133140 Fees: Description Amount FEE2003 -145 Buildier's Bond $300.00 FEE2003 -146 CCF $3.60 FEE2003 -227 Building Fee $100.00 Total Fees: $403.60 Total Fees: $403.60 Total Receipts: $0.00 Permit Status: APPROVED Permit Expiration: 7/7/2003 ork: STAMP CONCRETE DRIVEWAY 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 bui ordinances pertaining thereto and with the under and approved by the proper municipal authoritie. authorization. A further condition upon which thi ordinances and regulations pertaining to the wor by his agents, servants or employees. PAY Signed: i TO THE 3 ORDER OF 3} z In consideration of the issuance to me of this ; I with the plans, drawings, statements or specific myself, my agent, servants or employ Signed: a" • Building Permit Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 13 & 14 BLK 23 LOT SIZE FO Construction Value: $5,273.00 SUPER STAMP CONCRETE, INC. 305 - 220 -1163 OR 305 - 729 -1726 d7 Bank of America. � ACH R/T 063100277 Page 1 of 1 nt. S r r b a r k for d v l a i l s. L] t ,soiauamn... — .mnuy.. �,uv.,.�._ .� DATE 1/13/03 I $ 839 6732 63 -4/630 FL 1622 DOLLARS H 1 1 19.6 oi s A WOOD \‘') • d 9.05 3 t PLAN OF SURVEY I 10' 8 39 4S' 1 STORY C tb.5. It 2N 93P 111 oom S ra.oaes, FL . 33138 - � �C [_ ' L- + \ 1 2.:70 N E. to A5? N NOTICE OF COMMENCEMENT Notice of Commencement must be filed If the job valuation of $ 2,500.00 and/or more In labor and material. Please file at 22 NW 1st Street, 1st Floor, Miami, Florida (305) 275-1155 Permit Number: Tax Folio Number: 11- 3 2.0 L -013 - 31440 State of Florida 0 28809619 2002 DEC 27 09 :56 The undersigned hereby gives notice that imporvements will be made to certain real property, and in accordance with chapter 713, Florida Statute, the following information is provided in this Notice of Commencement. dj egal description of property and street address: /J 3 , / ' � 2 3 A ; t' 2 2 4/�i Jai Sic . . I' zof )escription of improvement: )wner(s) name and address: / / ?/Y 3/ 3 nterest in property: / lame and address of fee simple titleholder. :ontractor's name and address: �v .5 /3c/ r'' Ifl� surety: (Payment bond required by owner from contract lame and address: ,mount of Bond: $ ender's name and address: 'ersons wi the State of Florida designed by Owner upon notices or other docu ection 713.1 a)7., Florida Statute: \ ame and address: i addition to h • self/herself, Owne ection 713.13(1)(b ame and address: , Igtida Statute: f any) designates the fo ing permit(s) to receive a copy of a Lienor's Dice as provided in xpiration date of Notice of Commencement: th expirations d /is • / fferent date is specified) _ P U;. � sro F r . ,� �= Ex 828 X / f�a i 9 � .• , pirer► I �?9ature of Owner) 'fl " aUcBondin int Owner's Name: e I'a n e Pt 44 A too g Co., � " Prepared by: Nom to and subscribed before me this 17 Address: 1) yea from the date of recording unless a ty of RC , 2002. Personally Known, or Notary Public: Produced Identification Print Notary's Name: Mar-WO Oath taken !/ Oath not taken Commission Expires: t f' i o y SPATE Of= FLORIDA, COUNTY, OK BADE I HEREBY CERTIFY that this is a ue co y of the Original fry this office on wt r HAR By , A D 20 SS my hand and Official Seal. RUV C a . •I Or ,t and County Courts c. ay be served as • ovided by q araki F.Jq ls S�o gsw i31lct STATE OF FLORIDA) COUNTY OF DADE) % e/a� The undersigned Affiant, ///a /�Q'� QV/7 , does hereby attest that the (property owner) attached survey, performed by _ L G i - ef� �.v GT name of surveyor's company) performed on /�,d2_ , is an accurate representation of the existing conditions and (date survey) locations of all structures on the property as of this date. The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property without first providing a survey less than six (6) months old. The Affiant, as property owner, further agrees to remove or obtain permits for any structures which now may exist on the property which are not permitted or which may violate zoning or building code regulations. The Affiant further understands that the existence of any such structures may affect final inspections as applicable to this or other permits.. Further, Affiant sayeth naught. Witness(sign and print) Affiant is personally known to me, AFFIDAVIT Witness(sign and print) SWORN TO AND SUBSCRIBED before me this 11 day of 'Dec as identification. PERMIT NO. - ADDRESS: . MIAMI SHORES VILLAGE BUILDING / ZONING DEPARTMENT' SECTION BY DATE ZONING ELECTRICAL MECHANICAL PLUMBING FIRE PUBLIC WORKS STRUCTURAL BUILDING OFFICIAL 1. Subject to compliance with ell Federal. State. County.W age rues and regulations. Village mums no responsibility tor accur#cy odor resutts trove these plans. 2. This copy of plans must be available on butding site or no Inspection will be conducted. CRITIQUE SHEET JOB ADDRESS )J /� ( 3 S APPLICANT PHONE f# APPUCATION SHEET OF • MISCELLANEOUS DATE ZONING • COMMENTS u / 4Ic I 5r 7 -z INITIALS 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'I'Y. 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 A/C Condensate QTY. TYPE Drains, Roof Q TYPI; 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 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) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) $ I OQ st) d $ 3. 0 (sq.ft. = x/1000 x0.60) $ (¢.005 /sq.ft.) $ (¢.O1 /sq.ft.) REVIEWED AND PREPARED BY: SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) PERN1IT FEES TOTAL $ ()3 ISSUING OFFICIAL 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