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BP2002-67T ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. TYPE Outlet, Appliance QTY. TYPE Service Repair QTY. A/C Central 1-3 Ton Drinking Fountain Faun Miscellaneous Repairs Outlet, Wall Solar Water Heater Service, Temporary A/C Central 4 -7 Ton A/C Wa00/Win. Toats Fire Pump Dryer Vents, Number of Outlet, Switch Paint Booth Signs A/C Central 8-15 Town 'Fountain Fixture - Fluorescent Pump and Abandon Oven Sprinkler System Space Heater (kw) A/C Central 16-20 Town Periodic Inspections Fixture Light li arbecue Parking Lot Lights Fire Sprinkler System Spas/Hot Tubs A/C Central 21)+ Ton Gas - Natural Flood Lights Pump, Fire Stand Plugmold/Strip Temporary Tci :el Subfeeds, No. 02 Amps A/C Window Pressure Vessel FPL - Load Central Posts Clothes Washer Swim Pool, Ccnn erciw Air Conditioners Garbage Disposa0 Range/Range Top Dental Chair i Swim Pool, Residential Chiller Pump, Sprinkler Generators, etc. Utility - Sewer Receptacles :ce Maker Switchboards Cear Violations heal Recovery Dishwasher I Refrigerator, Comm. (p/Pili) Temp Serv., Construction Compactor Disposal j Low -volt, Burglar Refrigerator, Domestic Temp for Test - 301 hays loan esl'_c We I Deep Freezer Low -volt, Fire Renew - Temp Service larainfie :c',' " T"ile es. I:,ava ^cry Demolition Low -volt, intercom/Teleph. Drains, Area Repair Circuits Sewer Connection Dishwasher Drains, s, Flaor Low -volt, Television Service, Number of Amps Water Service Drains, Fre:tc_° r MECHANICAL TYPE Minimum Fee Q'I'Y. TYPE Condensate Drain QTY. TYPE Generator QTY. TYPE Refrigeration, Tons QTY. A/C Central, Tons Drinking Fountain Cooling Tower Miscellaneous Repairs Heating Strips, each Solar Water Heater Vent Hood, Cost A/C Wa00/Win. Toats Dryer Vents, Number of Paint Booth Cap - Fixture Ventilation, Cost 'Fountain Air an .i''er, Tons Pump and Abandon Ductwork, Cost of Sprinkler System Piping, Flammable Liquid Periodic Inspections li arbecue Fire Sprinkler System Cap - Sewer Process/Pressure Piping Gas - Natural Pump, Fire Stand ath Faun - Vent{ i., #3 Temporary Tci :el Fireplaces, Number of Gas - Propane Pressure Vessel Pump, e- circulate Temporary Water C =:yet 1 PLUMIlING TYPE A/C Condensate QTY. 'TYPE Drains, Roof QTY. 7fY11.: Miscellaneous Fixture QTY. TYPE QTY. Soakage Pit 3atln Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Vdet Filter r eplace Pool Piping Sprinkler Repair Cap - Fixture 'Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Wel: Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Tci :el Catch IEasin f Gas - Propane Pump, e- circulate Temporary Water C =:yet 1 Clothes Washer Gas Piping Pimp, Replace - Pool Urinal Dental Chair i Grease Tap Pump, Sprinkler Utility - Sewer Discharge We :ce Maker Pump), Sump Il i'" ly - Water Dishwasher I Lctdirect Wastes Relay :lepair Vacz-z_-^i Pump Disposal j Interceptor Roof Il nlet Water C:^scl loan esl'_c We I 'Lau:rmry Tray Septic Connection Water Heater larainfie :c',' " T"ile es. I:,ava ^cry Septic Tank Water Heater Kew Drains, Area Meter se (Gas) Sewer Connection Water Re -pipe Drains, s, Flaor Minimum Fee Shower Water Service Drains, Fre:tc_° Miscellaneous IEgauu;pinnent Sink We : :, Supply Page 3. ]INSTRUCTIONS: Pease indicate the type of work being performed and quantity(ies) in the space provided below. YP g P q Y(� )� P P RECEIVED AND REVIEWED BY: DATE: PERMIT APPLICATION SECTION BY DATE Zoning - - - D/ Electrical Mechanical Plumbing Fire Public Works Structural Official 1 _. . , Page 4 OFFICE USE ONLY WW UXI LIST ii OWNER - BUILDER FORM (Attach) © FIRE DEPARTMENT APPROVAL (Commercial / multi - family) ( CONCURRENCY (New Construction) ® OTHER (Specify & Attach) PROOF OF OWNERSHIP (Attach) • HRS / DERM APPROVAL (Septic / Sewer) ® IMPACT FEE (New Construction) OTHER (Specify & Attach) PERMIT FEES $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 $ 3.-S a $ ISSUING OFFICIAL (sq.ft. = x/1000 x ¢.60) (¢.005 /sq.ft.) (¢.01 /sq.ft.) REVIEWED AND PREPARED BY: PERMIT APPLICATION 0 CONDO ASSOCIATION APPROVAL (Attach) • BPR APPROVAL (Restaurants) O CONTRACTOR REGISTRATION (On File) TOTAL $ 9 06 DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2N5' AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756-8972 ° http : / /www.miamishoresvillage.com 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. 1. A FFIDAVIT - 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 .OB S 1''E. in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. STATE OF FLORIDA, COUNTY OF MIAMI -DADE Ahi Signature of Owner 01 /a,/ fe,2y Print Name Sworn to end s� 5scribed before me this I 11ia7 �11g ° ✓�' a e mar / 4 r:,' Canmission # CC 940219 co Expires June 28, 2004 S:gnatur SEAL: f 6 8lGiCl ®jam of Notary Public - State of Florida Personally known OR, Produced Identification Type of Identification Produced: Sigma Print Name PERMIT APPLICATION of Contractor / Qualifier STATE,6F FLORIDA, COUNTY OF MIAMI -DADE Sworn to and subscribed before me this JJ, day o SEAL: Personally known OR, Produced Identification � CONTRACTO i' Name 57 /' (421/- &4sj - (.c_ x ] Name (Gt/Z.. fi (GLJ ,..-6,-4,4-_,#2.14,4/ License No. . 6 ( 1 `1---- Address ; ) ,,,,Cy Yi u ' 2.,,,,,-,,,, r Telephone ..3,:,,i l Gl j ?> � i 2 f Fax .( 9 E j y.3 Qualifier Name Alteration Itnte¢•ior PROPERTY OWNER Name 57 /' (421/- &4sj - (.c_ x ] Address r /,"/4 -- - (ST Hi MC-, (( Home Telephone 3c 7 i ' _! f 6p' Business Telephone Fax TYPE 4a IF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Itnte¢•ior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'I Detachment Other 'INSTR'UCTIONS - The following steps must be taken to obtain a permit from tile Miami Shores Village: Step 1. Job Address: Complete the attached permit application which ust be _i ned b the .ro.ert owner and .ualifier. Both -i natures must be n.tarized. 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. PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other 7 �” 4( Address Folio Number) 3O' 0T1 y 0 ,; Lot Block Ch r. Contractor Renewal Revision Extension Supplement Reinspection PERMIT CHANGE (✓ ) ARCHITECT Name License No. Address Telephone Fax PERMIT APPLICATION Master Permit No. Subsidiary Permit No. ° c ' LeJ 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 f r4,4 ( Sik-k �L 3 i Apt. State Zip l - Description of Work I -s5 � 6 ! > �,r e- t City Subdivision PB PG Zoning Linear Feet Current Use of Property (� C Square Feet Units Floors Proposed Use of Property Value of Work �Z r Bldg Value Tenant Information Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGIINIEE Name License No. Address Telephone Fax is 0 0 w in ru B IN w 0' -n 0 a " z 0 M � n oc0n 0 m 00c:i )< "V /- flan Z Z 0 Z 0 co 0 Date Type Insp'n Permit No. — Name f (2 Lf. Address Company Phone # Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request For Inspecto 2 � Name ate Time MIAMI SHORES VILLAGE Paint Color Approval and Agreement DATE: OWNER'S NAME: -CAty It 24 C HONE: CCU 2 a7v 0' ADDRESS: - 7Yr lie qi-C/ kfm / 33/51 xxxxxxxxxx�xxxxx *x14 1 414%4 xxxxxxxx *x ADDRESS OF SITE: 7 JW 9/ sr Af& S 6 24 CONTRACTOR & LI (if applicable) ei / a q /y� ,j%' �= ,.`�,�'"�' COMPANY NAME: r' e ,4 47iv PHONE: .� d �.3 _1 ***,**v ,..=**** xxxxx xx x xxx x; ex xxxx 0 x xxx*x ;e a All Elements on the site must be listed and indicate the color to be painted. Walls /l1 He S' Fascia t-%li ! 7-4 o � Drip Cap/Drip Edge h /7" o Soffit 6m gc - r Roof (A)A / .ft- Flower Bins Ai / li Shutters A/ Pr Awnings Ailit Chimney N /Pc Doors and door jams OA i 7 Garage Doors Ai/or ( � f Railings �/ l7 \ weston flax Fences .Nl ii Decorative Metal Aif/rr All brick (simulated or regular) /1-/ /iT Stucco Banding A./ /,\-' Any other stucco features /r' Accessory Buildings /4 Other A -- 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 colo will be as per the attached sple ,) / /� am Signature of Owner Date f P 4 i 1/n�ature�o fContracto � * ** *Day * *M * * ** ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION APPROVED: G& 61-i a/ Building fficial Date 4/23/01 ) Date Type Insp'n Permit No. MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Name C 5 N�/1�� Address / /5 /\- // ( . Company 2 Phone # (305j” 3 335 For Inspector: / Name : ate Approved —3 4 --Z Correction ❑ Re- Insp'n Fee ❑ Time oze