BP2002-498Nov 07 03 07:14p DESIGN OFFICE
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MIAMI SHORES VII.T AGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date .t r Time •
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Type Insp•n 4,-;44/ � �t4 t ..�.rsr .�, A .0 t
Permit No.
Name 61/5
Address r/G 4/
Company rl 1 :r La4- rtd
Correction ❑
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Phone #
For:lnspector:f _/ ,V Name & Date
954 4915978 p•1
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Approved
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BUILDING DEPARTMENT
10050 N.E. SECOND AVENUE
MIAMI SHORES, FLORIDA 33138-2382
TELEPHONE (305) 795 -2204
FAX (305) 758-8972
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CONTRACTOR
Name /
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Name .�-
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License No.
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Address /Ao A/0 1.7 S'7�c7"
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Telephonepy y9 /7J Fax ri 7/ l
Qualifier Name /PC y 5/6.,- Cc
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PROPERTY OWNER
Name /
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Addresss , y " R` s -�� ,
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Home Telephone far 7f7 7/7 /
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Business Telephone
Fax 7 f( '
TYPE OF MANAGEMENT (✓)
New Construction
Enclosure
Alteration Exterior
Repair
i'
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'I Attachment
Other
Add'l Detachment
Other
Page 4
OFFICE USE ONLY
CHECKLIST
O 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)
PERMIT FEES
(sq.ft. = x/1000
x ¢.60)
$ (¢.005 /sq.ft.)
g
BY
D TE
3 64
SECTION
Zonin
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
/ v
(¢.01 /sq.ft.)
REVIEWED AND PREPARED BY:
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ V o c)
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
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami 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.
A PPLICATION
v` Job Address:
Address Apt. City State
Folio Number /'3 /// O0.2Q description of Work
Lot . 3 y. X f �. 000:7,(4,,v4/ SubdivisionI 7 g1 / Sir. 3 PB 4 / 9/ PG 3' Zoning
Current Use of Property Ri Ss •
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
Master Permit No.
Subsidiary Permit No.
PERMIT APPLICATION
Zip
/FCA //2 i i � ®r /�G—< tlifir/.?
/
Linear Feet
Square Feet Units Floors
Value of Work <7 49° Bldg Value
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
ENGINEER
Name
License No.
Address
Telephone
Fax
ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPE
Dryer
QTY.
TYPE
Outlet, Appliance
QTY.
TYPE
Service Repair
QTY.
A/C Central 1 -3 Ton
- Heating Strips, each
Fan
Outlet, Wall
Service, Temporary
- Paint Booth
A/C Central 4 -7 Ton
Fire Pump
Outlet, Switch
Piping, Flammable Liquid
Signs
A/C Central 8 -15 Ton
Fixture - Fluorescent
- Process/Pressure Piping
Oven
Space Heater (kw)
A/C Central 16-20 Ton
- Pressure Vessel
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. TYl'E
Refrigeration, Tons
QTY.
A/C Central, Tons
QTY.
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
Pump and Abandon
Bath Fan - Vented, #
Fireplaces, Number of
- Pressure Vessel
Gas - Appliance
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
I. 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 PROTECT ED 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 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, 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.
STAT F FLORIDA, _ OUNTY OF MI
4 // �. ✓t_
gnature of Owner
/ a v Ira /Ail
Print Name
Sworn to and subsc
?DD2..
AL:
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17' 6 day of
e of No
i' • _ i . .TARP SEAL
O
JULE F PAULK
B <�
.
`ts OF Ft.
,. COMMISSION NUMBER
00066088
MY COMMISSION EXPIRES
OCT. 21,2005
Personally known V OR, Produced Identification
Type of Identification Produced:
PERMIT APPLICATION
STATE OF ! RI ' . CO IAMI -DADE
tractor /
K o
Print Name
Sworn to and subsc ' i d before me this / day of
POD 1 _
AL:
e of No
ARY SEAL
_ /.;�/
...41T2f1111.AC!siis:41
O �� (tY /3-
(/ JULE F PAULK
* COMMISSION NUMBER
T -'TIP ' 00066088
7 / e ~ �� MY COMMISSION EXPIRES /
OF FL OCT. 21,2005 V/ /
Personally known OR, Produced Identification
Type of Identification Produced: Flan 44 4. l begs 1/ eee.ft 2s
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:
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 3/11/2002
Applicant: LAURAINE
Owner: GLISPIN
Contractor ROY SIEGEL INTERIORS INC
Local Phone: 954 - 491 -5940
Building Permit
Permit Number: BP2002 -498
GLISPIN
LAURAINE
Address: 120 NE 51 ST
Cellular:
Parcel # 1131010200020 Legal Description: 1 53 41 EL PORTAL SEC 3
Job Address: 68 NE 91 ST
Fees:
FEE2002 -1437
FEE2002 -1438
This Permit is granted to the contr.
ordinances pertaining thereto and
and approved by the proper municipz
authorization. A further condition up(
ordinances and regulations pertainint
by his agents, servants or employees
Signed:
In consideration of the issuance to
with the plans, drawings. statements
myself. my anent. servants or employ
Description
Building Fee
CCF
Total Fees:
Permit Status: Approved Permit Expiration:
PAY
TO THE
ORDER OF
Security :� n
Amount
$125.00
$3.00
$128.00
9/7/2002 Construction Value:
Work: REPAIR DAMAGE WOOD OVERHANG SOFFITS PAINT EXTERIOR
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- callina.fnx.annt►toe.%n+ ne.min
- c T rcar51S_rru iiy nh_a_nrrd Anru__�1 Sr bar In _drlail•.
ROY SIEGEL INTERIORS, INC.
DBA SIEGEL DESIGN GROUP
120 N.E. 51ST ST. 954 -491 -5940
FORT LAUDERDALE, FL 33334
111/R /A9 5;44i
$5,000.00
Page 1 of 1
Total Fees: $128.00
Total Receipts: $0.00
DATE
Main Office
1450 South State Road 7
. .. North Latuferdale, Florida 33068 ./%
II 0 L 2 2 20" 1:06 LO 5 L 21: 0 LOO LOB 278
PB 9 -148 W1/2 LOT 2 ALL LOTS 3 & 4 & E1/2 LOT 5
•
1. Legal description of property and street address:
6. Lender's name and address:
5. Surety:(Payment bond required by owner from contractor, if any)
Name and address:
Amount of bond $
WITNESS in
7. Persons within the State of Florida designated by Owfrty
by Section 713.13(1)(a)7., Florida Statutes,
Name and address:
hr: Notary Public
Print Not - ; 's N - • e ( (e
My Com : on Expires:
P a
OFFICIAL NOTARY SEAL
JULE F PAULK
A * COMMISSION NUMBER
r.l Ili DD066088
Q: MY COMMISSION EXPIRES
OF FL° OCT. 21.2005
CEMENT
PERMIT NO. TAX FOLIO NO. 1 V ei 0 - '�`�
STATE OF FLORIDA:
COUNTY OF DADE:
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
xi, 9/ . -57%44 /0/.4.,t; .S ne:r, 1,
1.4
2. Description of improvement: /7.e��f <t — --C % / / 'C.
bJ ' /1 f /.1- ,..jj /�� . /
3.Owner(s) name and address: h A 4 is j4- i n/ rr / ' $
& � vu 1 5t Si-f e er ! ' M r( „, a v 5.170( ef pi., Z;2)00
0 P
Interest in property:
Name and address of fee simple titleholder: S/l-•
4. Contractor's name and address: c J2ff
STATE OF FLORIDA, COUNTY OF DADE
I HEREBY C RT /FY that this is I c • py of the
ongin,.r ra
II t
02R 147786 2002 MAR 11 12:47
8. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in
Section 713.13(1)(b), Florida Statutes.
Name and address:
9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a
different date is specified)
,. ign.3tlre of Owner f
'°
Print Owners Name L4 v r4 . ye "" '► - G� rS ; !•� Prepared by: .)1 Q ..cig c `�
Sworn to and subscribed bef • e m 7 day of _, A!O �.
Address: L2G N t 7 sr
G�.� GC. my y
MIAMI SHORES
Paint Color Approval and Agreement
DATE: Z-
OWNER'S NAME: ,4mo sell "e <lAJ PHONE: 7'f -7 - ? /7
ADDRESS: 6i ' /tJ /,l'/__
********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE: -53,0YL
CONTRACTOR & LICENSE (if applicable) G f'' v5'I7I
COMPANY NAME: „fy &AU/ -44 PHONE:R y9 /- )t7
* * * * * * * * * * * * * * * ** *************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted.
Fascia �e foevv
Drip Cap/Drip Edge �� ow,✓
Soffit 8A 04,J
Roof 4,ij,
Flower Bins
Shutters 4)/fire
Awnings
Chimney
Doors and door jams / 1
Garage Doors
Railings
Fences
Decorative Metal
All brick (simulated or regular) may}
Stucco Banding T;-
Any other stucco features --
Accessory Buildings
Other r--
Walls
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 a� the attached
samples.
Signature of Owner Date
*** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
e : ontractor Date
* ** * * * * * * * * * * * * * * * * * * * * * * **
APPROVED: WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
3%4
Building Of ' ial Date 4/23/01