DRIVEWAYMIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date J - - 0 ) 3 - oz Time
9 I' - r
Permit No.
Type Insp'n
Name 54zizt / /,2 ,
1 Zdd f3 (57 ddr
Company /
Phone # 3,0,c a 6 /'6f
For Inspector: S Name & Date
Approved
Correction
Re-Insp'n Fee ❑
;UILDING
:LECTRICAL
'LUMBING
iOOFING
Jwner of
;uilding `)
.rchitect
i ontractor
r Builder
.egal Lot
)escription —
address of
• uilding
MIAMI SHORES VILLAGE. FLORIDA
PERMIT N° 6610
'!
Bl.
Work to be performed under this Permit
Value of
Project $ -
DATE 195
Contractor's "'-
License No.
Subdi-
vision
Amount of
Permit $ -- -
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
erefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans
rawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
me 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
ranted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
ertaining 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
one by his agents, servants or employees. r• A, 1 / /'•
Signed BY •
INSPECTOR
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
ertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authprities of Miami Shores Village. In ac-
pting this permit I assume responsibility for all work done by either, myself, my agent servant op- mployee.
,
s4
)
CONTRACTOR OR BUILDER BY AUTHORITY
CONTRACTOR
Name
�j aim t /'4 -% .
License No. 9 , 00 2
Address
Telephone .30 �� 8 2 b— fC/ x
Qualifier amen ,cs 0 it9A ,
PROPERTY OWNER
N a m \. AGE :--k t t I . aUt c Z •
Address
Home Telephone
Business Telephone
Fax
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'I Attachment
Other
Add'I Detachment
Other
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
Job Address: 1 2 S R 3 a S�
Folio Number • of Work 04a ; >�� 5c'ia f Gm v �e-V e.—
Lot Block
Subdivision PB PG Zoning Linear Feet
Current Use of Property Square Feet �d Units Floors
Proposed Use of Property . )/alue of Work, al-5M Bldg Value
Tenant Information Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
Address Apt.
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
PERMIT APPLICATION
Master Permit No.
Subsidiary Permit No. 'P'c9-OOc 1
City
State
Zip
ENGINEER
Name
License No.
Address
Telephone
Fax
Page 2
IMPORTANT NOTICES
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 (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/eummencement. 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.
S'I,ATE OF FLORIDA, COUNT' I MIAMI -DADE
V..,. 1) .
Signature Signature of Owner
419@K Eob)il(w
Print Name
j),, Sworn to • . s .scribed before me this
SEAL:
PUN(FIC /CION i:; Rti M
' "' C h CC 933061
1 o i^ ^ E XPIRES: i,iay 2, 2004
' I
OR, Produced Identification
Personally known
STATE OF FLORIDA, CO Y OF MIAMI -DADE
Signa�ntractor / Qualifi r
19219e/ �o.�1ect s
Print Name
Sworn to and subscrybed before me this
• • J -
Signature of
PUAIFICACION WI RENO
CO1MISS1ON # CC 933061
EXPIRES: May 2, 2004
Uond_d 7mu No;ery Public Undrywn.ers
Personally known OR, Produced Identification
SEAL:
otar)
li
PERMIT APPLICATION
day pf
Type of Identification Produced: S L /S.Z T Z U -Lam/ - 1 (e ° v Type of Identification Produced:
BEVERLY HILLS DESIGN CONCRETE INC
840 WEST 51ST PLACE
HIALEAH, FL 33012
PAY �� Ali I �/
3
w y OR THE / / ,M $14/6'
1� v f60
ORDER OF -� �D
/ ,3 c - 7
<s Vri.) 7O!'E ,U /9,1)4 .5 �rTKG�� irki14R y G ` DOLLARS 8 07
AUN l ON PLANTERS BANK
FOR ��. 7 / i •
11'003 26011' I :0670084 L4': 11' L8500 & 274 L11'
3260
63-841/670
BRANCH 6215F
f �
DATE Oa,
DATE
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 4/11 /2002
Applicant: JACK
Owner: SCHILLINGER
JOB ADDRESS: 1225 NE 93
--H? Ils
Contractor
Local Phone:
Parcel # 1132050270030
Building Permit
Permit Number: BP2002 -741
SCHILLINGER
JACK
ST
Contractor's Address:
Legal Description: BAY LURE
�..flH7 M�11TlJf[w'�3 �!"4• !�'L
Owner is Responsible for of
All Village Sidewalks as per Village of
�•es C-de ^f
Orrlin.ncPs In ^ivdina D iiew ys,
C • ';00 :,
PB 44 -63 E5OFT LOT 3 & W25FT OF LOT 4 BLK 1
Fees:
FEE2002 -2131
FEE2002 -2132
FEE2002 -2133
Description
Building Permit Application Fee
Buildier's Bond
CCF
Total Fees:
Amount
$60.00
$300.00
$3.60
$363.60
Total Fees: $363.60
Total Receipts: $0.00
Permit Status: Approved Permit Expiration: 10/8/2002 Construction Value: $5,200.00
Work: STAMPED 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 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.
Signed: 6/ `' (MSPECTOR) 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 responisibHity for all work done by either myself, my agent,
servants or employes.
Signed: (Contractor or Builder) BY:
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
WHEREAS, N.1i� 'Sc -�-t I .',. Cam} bra hereinafter referred to as the Owner of the
(owner)
following described property:
Legal description /folio #:
Lot Block Subdivision
Tax Folio #:
requests pernyssion to install:
Asphalt, concrete, brick pavers
[ ] Landscaping
[ ] Other
within the public road right of way of ' 2 2. N �� • czO
(address)
IN CONSIDERATION of the approval of this permit by the Village, the Owner agrees as follows:
I. To maintain and repair, when necessary, the above- mentioned item(s) installed within the dedicated right
of way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said
items within public right of way including restoration of street by reason of the Owner's failure to do so,
such expense shall be paid by the Owner or shall constitute a lien against the above described property
until paid.
2. The owner does hereby agree to indemnify and hold Miami Shores Village or dade County harmless from
any and all liability, which may rise by virtue of permitting the installation of these items within the public
right of way.
3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days
notice by the Village to do so. Failure to comply with this notice will result in the Village causing the
item(s) to be removed and a lien being placed on the property and/or assessed against the Owner for all
costs incurred in the removal and disposal of the item(s).
4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and
shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such
time as this obligation has been canceled by an affidavit filed in the Public records of Dade County, Florida
by the Village Manager of Miami Shores Village (or his fully authorized representative).
SIGNED, SEALED, EXECUTED AND ACKNOWLEDG on this day of
SIGNED, SEALED AND DELIVERED in the presence o
i mam i SIior (/iCfac�e
10050 N.E. SECOND AVE.
MIAMI SHORES. FLORIDA 33138 -2382
Telephone: (305) 795 -2207
Fax: (305)_756 -8972
�pRluEcv�-y
f� PPR0✓i-ctf
Fl CI
OR IDENTIFICATION CARO EX IINS1ON
NAP JACK SCNILL
nt" 5452-420•
1225 NE 93 ST
,,T
MIAMI f L 33133-'2940
. ,, r stw
M 31WC110MC s I ,,.404* tl *, r
4.s
.i I M' 1• i 1 �. 4 Y.I q
. ,i M.,,.a M.._.N V 1Y1. y, SIN,.V�rir, 40441.4.9,
! r.l , rM, 41 I...I,r..1
4 . W
�s 4.' n ,N
1 r' , :. AL rai.. ■
too for 369 2388
t ;( iV;ti
RIHTHf`AV
'r
tMIMS uN
2004
031898
OPERATOR
0
STATE OF FLORIDA)
COUNTY OF DADE)
The undersigned Affiant,\Mc re. S CI-j, LL— , st"0 does hereby attest that the
(property owner)
attached survey, performed by =1 , t S pc' ,5::%-) L am -` ,.
(name of surveyor's company)
performed on 8 Z, is an accurate representation of the existing conditions and
date o 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)
SWORN TO AND SUBSCRIBED before me this
AFFIDAVIT
day
Witness(sign and print)
200
Affiant is personally known to me, produced as identification.
APR -1 -2002 09:41A FRAM:
. .. r • • • • 000 • • • • 000
P:2
ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPE
Dryer
QTV.
TYPE
Outlet, Appliance
QTY.
TYPE
Service Repair
TY.
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
PLUMBING
TYPE
A/C Condensate
QTY.
TYPE
Drains, Roof
QTY.
TYPE
Miscellaneous Fixture
QTY.
TYPE
Soakage Pit
TY.
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:
SECTION
B
D T
Zoning
Q� i
y�9 Q
Electrical
Mechanical
Plumbing
Fire
Public Works
S
#L..
Building Official
j_
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)
Cl OTHER
(Specify & Attach)
REVIEWED AND PREPARED BY:
(sq.ft. = x/1000
x0.60)
(¢.005 / sq.ft.)
(¢.01 /sq.ft.)
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
PERMIT FEES
TOTAL $3 L � t -0
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