PAINT PERMITMIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request n
Date 4 1 2•0 Time
Type Insp'n cC' \, 1'uf t i
Permit No. bP ZWL-� () 33
Name lvleU ln •
Address I sec. 3\
Company
Phone #
For Inspector: 6Q 1
Approved
Correction
Re- Insp'n Fee ❑
• Name & Date
�o�
0
A ?e)1 Wel be_
PERMIT APPLICATION FOR MIAMI SHORES VILLAG
Legal Description Historically Designated: Yes
� Owner/Lessee/Tenet
Owner's Address
I '
e _ f ;
3 '
blaster Permit #
\ \i ;
Ph9a '
No
Contracting Co. Address
Qualifier SS#
State # Municipal # Competency #
Phone
Ins. Co.
IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY,
THERE WILL BE NO INSPECTION. RE— INSPECTION FEE IS $50.00 AND MUST BE PAID IN ADVANCE
BEFORE CALLING FOR ANOTHER INSPECTION.
Permit Type (circle one): ; BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING
' WORK DESCRIPTION:
Square Ft. /mated Cost (value) � 7
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 ANY 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). 1 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 all disciplines.
OWNERS AFFIDAVIT: 1 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. Furthermore, 1 authorize the above named contractor to do the work stated.
1 f
� t
Signature of owner and/or ond0 sidknt
Zoning
t n
ary as to
My Commission
FEES: PERMIT
APPROVED:
Cdnd
wner an
Expires
FN. Angela M Becker
6 . '
‘1 il
f
1
c„.
sident
r° My Commission D0150048
; VD. ' Expires November 15, 2006
6 RADON
2/ C.; Building
Mechanical Plumbing
f
Date Signature of Contractor or Owner Builder
C.C.F -:
Notary as to Contractor or Owner Builder
My Commission Expires
Date
Date
NOTARY 23 t BOND
e
TOTAL DUE.
4 \)3v - 7 Electrical
Structural Engineer
MIAMI SHORES VILLA
l nMiti64,pproval and Agreem;,
APR 200
DATE:
OWNER'SN•�ioi : 4 Yri 2y'I PHONE:
ADDRESS: I ILI-t
************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE: CI �t,j `r✓
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME: PHONE:
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted.
Walls C6u-%1? »nil , )j1- 1 1
Fascia 1,C)1 f T'
Drip Cap/Drip Edge LA - (-) , t r'
Soffit LC. (i- sf
Roof L,c -► I I- ,lob- be' Aar ,r0---G(
Flower Bins 4 ( ►'ZC nC A> / r )
iL
Shutters
Awnings
Chimney
Doors and door jams
lA r iyk
(' t 17o r1 C, �I win I't '62
Garage Doors R 74
Railings id
Fences P.1-PCI
Decorative Metal I ' L
All brick (simulated or regular
Stucco Banding
Any other stucco features
Accessory Buildings
Other
C 9-t-e-2C
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 as per the attached
sample$: -�
4)51 -1 6 if Signature bf O Date Signature of Contractor Date
* * * * * * * ** *********************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED: WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
il°
Building Offi al Date 4/23/01
l5OC-1"
K8usiue|M�t
.
16OC-2u
Hawaiian Shell
Arizona Sunrise
'~�
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 4/23/2003
Applicant: ALAN
Owner: MAJOR
JOB ADDRESS: 105
Contractor
Local Phone:
Parcel # 1131010330730
NW 94
This Permit is granted to the contractor or builder named above to cor
ordinances pertaining thereto and with the understanding that the work vt
and approved by the proper municipal authorities. This Permit may be rt
authorization. A further condition upon which this permit is granted is the
ordinances and regulations pertaining to the work covered hereby wheths
by his agents, servants or employees.
Signed: (INSPECT(
In consideration of the issuance to me of this permit, I agree to perfom
with the plans, drawings, statements or specifications submitted to the p
myself, my agent, servants or employes.
Building Permit
Permit Number: BP2003 -653
MAJOR
ALAN
ST
Contractor's Address:
Page 1 of 1
Legal Description: MIAMI SHORES SEC 6 PB 10 -39 LOTS 23 & 24 BLK 132 LOT SIZE 106.40
Fees: Description Amount
FEE2003 -2413 Building Permit Application Fee $60.00
FEE2003 -2414 CCF $0.60
FEE2003 -2415 Notary Fee $5.00
Total Fees: $65.60
Total Fees: $65.60
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration: 10/20/2003 Construction Value: $150.00
Work: EXTERIOR PAINTING AS PER AGREEMENT
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.
//TO T�fZ n
1 r-, OZER OF 10k-t/
BEVERLY MAJOR 12 -91
105 N.W. 94TH ST. 305- 751 -6021
MIAMI SHORES, FL 33150
BANK • F AMERICA
02992 FL
ACM Fla 063100277
Ogin torni;"1
63-27
s
4251
PATE
r/ / ar $ 6o&z ;
RS 8
Yeah .m Derlo
PROPERTY OWNER
New Construction
Name &� a CI e_1(<_ 1—
°eed Al 1 e
Address
/.a-10D A-) e
3 S
Home Telephone 3 ® s--- 96
/
1 c/ r' ' c
7 /
Business Telephone 3 6 s— 7
<- 7f77
Fax
Fax
Demolish
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
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
ob Address: /t212c
Address
Folio Number
Lot Block
Subdivision PB PG
Current Use of Property
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
P9111C NEST.
• X02 s t / / $ * ir5 3
Apt. City • Zip
Description of Work,
fir& ki07.-e_12‘
Zoning Linear Feet
Square Feet
4 Value of Work
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
Units Floors
/60 Bldg Value
ENGINEER
Name
License No.
Address
Telephone
Fax
CONTRACTOR
Name
License No.
Address
Telephone Fax
Qualifier Name
Page 2
PERMIT APPLICATION
IMPORTANT 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 (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 tol 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.
Signat
pp,
l
of Owne
•
Y Q U �jl • l/ V t/! SNfIJ
Print Name ""�� 2
Swo . to and sub ribed before me thi2 • • y of
r ere_
A AA li • - _
iiF
7 • I 'ature of (, 1 - tate of onda
STA
FLORID
CO
I' DADE
OFFICIAL 1,10'id;Y$1 L '
SEAL: 1P' P O ee ANGELA A9 NECi(SFI
!� ( 0 COIALIISOA Wul9BEn
y�p Q
dy. 0 4706697
o �
TAY N CIS ; .. 1 . 0 0r+ ,
Personally known -
STATE OF FLORIDA, COUNTY OF MIAMI -DADE
Signature of Contractor / Qualifier
Print Name
Sworn to and subscribed before me this day of
Signature of Notary Public - State of Florida
SEAL:
Personally known OR, Produced Identification
Type of Identification Produced:
ELECTRICAL
T} , ' , ' ,
Minimum Fee
QTY
Tv.l,r,
Dryer
Q.Q.Y.
.
Outlet, Appliance
Q ' I \
TYPE
Service Repair
Q . 1 . } .
A/C Central 1 -3 Ton
Dryer Vents, Number of
Fan
Ventilation, Cost
Outlet, Wall
Ductwork, Cost of
Service, Temporary
Periodic Inspections
A/C Central 4 -7 Ton
Fire Sprinkler System
Fire Pump
Outlet, Switch
Fireplaces, Number of
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
NIECHANICAL
TyI,I,: QTY.
Minimum Fee
T,.I,I,.
Condensate Drain
()Ty. Tv QTy.
Generator
Typi.; QTy.
Refrigeration, Tons
A/C Central, Tons
Cooling Tower
- Heating Strips, each
Vent Hood, Cost
A/C WaWWin. 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
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
PLUMBING
TYPE.
A/C Condensate
QT\.
'nil.:
Drains, Roof
QTY.
TYPE
Miscellaneous Fixture
()Ty.
TVPI:
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
BY
DA E
Zonin:
' -41%
/,
Electrical
_/i
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
` 29C'
Y
Page 4
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
❑ CONCURRENCY
(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
ISSUING OFFICIAL
$
❑ RROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
((Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
go
0
$
(sq.ft. = x/1000
x ¢.60)
(¢.005 / sq.ft.)
(¢.01 /sq.ft.)
REVIEWED AND PREPARED BY:
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ bs c L D
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
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 3/29/2002
Applicant: GRACIELLA
Owner: NIESEN
Contractor
Local Phone:
Parcel # 1132050270470
Job Address: 1200 NE 92 ST
Fees:
FEE2002 -1849
FEE2002 -1850
FEE2002 -1851
Signed:
Description Amount
Building Permit Application Fe$60.00
CCF
Notary Fee
Total Fees:
Building Permit
Permit Number: BP2002 -653
Address:
Cellular:
NIESEN
GRACIELLA
Legal Description: BAY LURE
$0.60
$5.00
$65.60
Permit Status: Approved Permit Expiration: 9/25/2002 Construction Value: $1,000.00
Work: EXTERIOR PAINTING AS PER AGREEMENT (OWNER BUILDER PERMIT)
Page 1 of 1
PB 44 -63 LOT 9 BLK 3 LOT SIZE 75.000 X 125 OR
Total Fees: $65.60
Total Receipts: $0.00
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.
(INSPECTOR) BY:
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.
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:
MIAMI SHORES VILLAGE
• Paint Color Approval and Agreement
,
DATE: 2 �7 / id�e C)
OWNER'S NAME: c-r' e-/ rG . Tbdot PHONE: 36. 3 --- 76z- 7 5
ADDRESS: 4400 /l) E 9 S —
* * * * * * * * * * * * * * * * * * * * * * * * ** *** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE:
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME: PHONE:
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted.
Walls
Fascia
Cap/Drip Edge Uf .• -ci./2_
Soffit
Roof 0
Flower Bins
Shutters
Awnings
Chimney ' //9-
Doors and door jams
Garage Doors 1/0
Railings
Fences
Decorative Metal
All brick (simulated or regular)
Stucco Banding
Any other stucco features
Accessory Buildings
Other
l 4
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
cons ction and zoning. I authorize the above -named contractor, if applicable, to
d• ork stated urthermore , the pa t colors will be as per the attached
3 a74 7/
Si: ture of Owner Date Signature of Contractor Date
** ******************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED: WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
7 ALF/Ck'
Building Offie Date
4/23/01