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