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1216 NE 93 St (4)Date r / °✓ Job Address /2/ � • ' ,ekrL /, Legal Description ' " e -/ ems WORK DESCRIPTION ? PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Owner / Lessee / Tenant Owner's Address loll; , q _3 Phone /5/ ° 59,`5 Contracting Co. �,��,, Qualifier ` 1�,0 -1 . /1 _SS4� - �� - State itifi 0 unicipal # Competency # Ins.Co 4 !J, Architect /Engineer Address Bonding Company Address Mortgagor Addres Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN Address Square Ft. Estimated Cost(value) Signature of owner and /or Condo President Date: APPROVED: Tax ,CJt G Master Permit #J 2V 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 6 )&e p e -- �its are requ' ed for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. — ' � ' AFFIDAVIT: _I certify that all the foregoing information is accurate and that all work will iii in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated. Signature of Con ractor or Owner- Builder Date: Notary as to Owner and /or Condo President otary as to Contractor or Owner- Builder My Commission Expires: My Commission Expi�e�ARY PUBLIC STATE QF fLORIOA NY COWMISSION EXP. MAR. 1,1994 BONDED THRU GENERA!. IMS. UMD. ** * * * * * * * * * * * * * * * ** PEES: PERMITS V RADON C.C.F. / 1 C6 NOTARY TOTAL DUE J Fire Other Zoning Building Electrical Mechanical Plumbing Engineering Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Building hermit Permit Number: BP2003 -519 Printed: 6/16/2003 Page 1 of 1 Applicant: DONNA GUSTINGER Owner: GUSTINGER DONNA JOB ADDRESS: 1216 NE 93 ST Contractor QUIRINO CONSTRUCTION CO Local Phone: Fees: Description Amount FEE2003 -1931 Building Fee $460.00 FEE2003 -1932 CCF $18.00 FEE2003 -2923 Builders Bond $300.00 FEE2003 -2924 Inpector State Educational Fund $2.50 FEE2003 -2925 Notary Fee $5.00 Total Fees: $785.50 Signed: (INSPECTOR) Contractor's Address: 1987 NE 119 RD Total Fees: $785.50 Total Receipts: $0.00 Parcel # 1132050270160 Legal Description: BAY LURE PB 44 -63 LOT 3 & W25FT LOT 4 BLK 2 LOT SIZE IRREGULAR Permit Status: APPROVED Permit Expiration: 11/30/2003 Construction Value: $30,000.00 Work: ADDITION OF DEN AND BATHROOM 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: SECTION BY DATE Zoning 4 zi , / 5 5" a Electrical e'-',__:_--AG.IMINI ' 4047 Mechanical `✓j MIII f• (..,)./ Plumbin _ EMPTIM� .— • 0 : Fire Foundation Only Public Works Add'1 Attachment 1, Structural I I I I I I J+A Er ©Q 3 Building Official IIIIW -' i,■ AP ' CONTRACTOR Name �'R'ND CAWS-7. C' License No. Address /987 AI E. 1/ 9 TY Sr. A/ M„4.*. F • Telephone , A ./917 Fax 30s. t n. 77= Qualifier Name 4 9 J/ . / �f ) (��l y� Ai. ii2N A . PROPERTY OWNER `Name / )&7 / c rwGE/2 / ( s Address /2/. N 93 ST. 5. FL, Home Telephone 3o5 79/ • 555-4 Business Telephone Fax TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'1 Attachment 1, Other APP /r /LN `' Add'I Detachment Other 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 Notary Aug •.. • • • • • • • • • ••. • • • • • • • • • • • • • • • • • • • • • • • • • • .•. • • ® 1 of OA/NERSHIP (Attach) •• • • • • • • • • ••. •• • • • •• • • • •Ca Hits Z l Ig1CAP'PROVAL • • • ..: : (1e6t0 / �ewer�). • ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) $5,oD -2'03 . 1 1 is PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) PERMIT FEES $ L i l6 0 •- - ( 90®;. - -- cCa6 $�3 00- $ I 0 V (sq.( = x/I000 5 x ¢.60) 5 $ ` (¢.005 /sq.ft.) t / $ 01 /s .ft. / V v �cc (¢ 9 ) 1)0( 4so, O O 4c 47-03 'Zb4• °o Vp."1„uv,14, ISSUING OFFICIAL TOTAL REVIEWED AND PREPARED BY: DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2 AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com INSTRUCTIONS - The following steps must he taken to obtain a permit from the Miami Shores Village: Step 1. Tenant Information Complete the attached permit application which must be signedpylh4oraperttiool1t; atgl ciGatiftet. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your app}licati h I; rdpfin tvojl.• will 1 done, a roofing application must be submit- ted 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. A PPLICATION 1211 ^/ E. 73 sr Address Folio Number 1/ 3265 027 0140 Lot Lam' 3 kbia 10 Block Subdivision SA/ Q PB 4� PG 43 Current Use of Property Rei/1 Proposed Use of Property 45 /0eMTi4L 4019/71 PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Zoning PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax • - -_ -� • •• •• • • • • • • • • • • • • • • • • • • • • • • PERMIT APPLICATION • • ••• • • • • ••• escription of Work • jtaste>: Permit No •• P2_00 '3 - 51 Subsidaiy Termil;No. • • • • • • • • • ••• ••• • • N/A'!/ 5- Neet City / 50)(M/4 Linear Feet Square Feet 7 � Units Floors Viue of Work 5C,/ 000 ° O Bldg Value Flood Zone Base Floor Elev. 8 • Od Assessed/Appraised Value • • • • • fL . State JOD, a 4J 33/31 Zip )7E4/ / A /WPM', ENGINEER Name License No. Address Telephone Fax � ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. TYF 1: , Cltitjgt„Abljai t. ; • QTY. TYPE: Service Repair QTY. A/C Central 1 -3 Ton Cooling Tower Fan t butret, • • • • • • • Service, Temporary A/C Central 4 -7 Ton - Paint Booth Fire Pump Ventilation, Cost Outlet, Switch Air Handler, Tons Signs Ductwork, Cost of A/C Central 8 -15 Ton Fixture - Fluorescent Oven Space Heater (kw) - Process/Pressure Piping A/C Central 16-20 Ton Fixture Light Bath Fan - Vented, # Parking Lot Lights Fireplaces, Number.of 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 Bath Tub Cooling Tower - Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of - Paint Booth Filter Replace Ventilation, Cost Pool Piping Air Handler, Tons Sprinkler Repair Ductwork, Cost of - Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System - Process/Pressure Piping Cap - Water Gas - Appliance Bath Fan - Vented, # Pump, Domestic Fireplaces, Number.of - Pressure Vessel Cap - Sewer 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 2 IMPORTANT NOTICES DO NOT BEGIN ANY WORK WIT}D1,1T DA'ING RrCEIVFp YODDR.VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURSDOF CONSTRPJCTIONare 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 PRoPtitr SrIA0.33E.IZ6PI;FItEE ROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROjvf BEIlsra D A4E1: Bre01,1,IPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidevalk. • • : : • • • : : • • • 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, F,ENCE; DRIVEWAY, ROOFING and SIGNS and there may be additional'pernlits required from other govemmentaragencies. • I, the OWNER of the property, have disclosed" ti11' 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- egrals 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 must be recorded at: N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in T 2. with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. • J a _1. r • • Signa ' e of Owner 1 nt Nam a worn to and subscribed before me this v day # - State o TATE Signature SEAL: Personally known • • • Notary ORIDA, C Pub Florida "R.N Angela M Becker 4 • My Commission DD150048 'j or t Or Expires November 15, 2006 OR, Produced Identification • •. •• • • • •• •• • • • • • • • • • • • • . ••. • • • • • • • • • • • • ••.. ••••••• • MIAMI -DADE Type of Identification Produced: 7 EF ti alifier Print Name S ws It o and subscribed before me thiRl day of A ►O_ i to , 1. .4 / I Sign' n'at ur7 tary _ �r Angela M Becker My Commission DD150048 Expires November 15, 2008 Personally known OR, Produced Identification SEAL: ature of Contractor / blic PERMIT APPLICATION Flon 06 Y OF MIAMI -DADE Type of Identification Produced: Page 3 • • • • • • • • • • • • • • • ••• • • i • • • • • • ••••••• • •• ••• • • • ••• PERMIT APPLICATION - - -• • • INSTRUCTIONS: Please indicate the type of work being p e e e rmecj u d quantihes.) • i t the space provided below. • ••• ••• RECEIVED AND REVIEWED BY: DATE: a Date: City of:_2j1.,±4 L St�ri�j OWNER'S AFFIDAVIT 1, _Ali (1J C6i/1 that I am the owner of the property described as: 41/ /f41 / S 7 e S F Address: / Z J, 2 5 3 3�" Legal Description: Lt 3 4/1/00 j7// BverS -6 Czs o 9, J Cc- � VA L c/4c Folio Number: 5 I authorize Kertz Security Systems, Inc. II as my agent to obtain a building permit for the following work: ignature a' y" cV Z at/ Driver's License Number STATE OF FLORIDA COUNTY OF DADE of 3 Witness Signature Driver's License Number Before me personally appeared who by me being duly sworn upon oath says that the statements set forth above are true and correct. Subscribed and sworn to before me this day of 19___ . NOTARY PUBLIC FOR COUNTY, STATE OF