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PERMIT APPLICATION NE FOR MIAMI SHC Date _ 7 - j %Job Address )- 5O E 13 ro r &+ "ax Folio Legal Descriptions p Lo 12 to 3 /( Z- WORK DESCRIPTION Signature of owner and/or Condo President My Commission Expires: Date Address My Commission Expires: Historically Designated: /7 . Owner/Lessee / Tenant t C- e-- ` F�-q �� / /1 1 t c ° Taco ster Permit # r ✓ p- Owner's Address )'5O / " G 5j ? `co S - { - Phone 7 5 O ^ q a Contracting Co. 0\A-t i (= p_ Address Qualifier SS# Phone State # Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN Square Ft. Estimated Cost (value)' ./ OO, V gna of Contracto or • wner- Builder Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner - Builder 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 R:3CORDING 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 permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. 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. Furthermore, I authorize the above -lamed contractor to do the work stated. Date 6,at Date 7- /2 - FEES: PERMIT Y. 0 0 RADON C.C.F. © NOTARY 5®, TOTAL DUE . c APPROVED: Zonin g Building 4 1 )?' G J Electrical Mechanical Plumbing Engineering PROPERTY OWNER ^ Name (AV. Address Home Telephone `- o cc cI -o 712 Business Telephone t c I N t e W r g i 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 Step 1. R INSTRUCTIONS - The following steps must be taken to obtain permit from the Miami Shores Village: 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. APPLICATION Job Address: Folio Number X escription of Work c- Ce trJ4 \� N Lot Block � Subdivision PB PG Zoning Linear Feet PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Address Apt. Current Use of Property Square Feet Units Floors Proposed Use of Property Value of Work O (C ' 4' K<, Bldg Value Tenant Information Tax Assessed/Appraised Value PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone 'Fax Flood Zone Base Floor Elev. Master Permit No. Subsidiary Permit No. PERMIT APPLICATION City State Zip - ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. Address Telephone Fax Qualifier Name Page 2 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 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 Contracto rzture f Owner Print Name Swo and subscribed before IM Si SEAL: Personally known OR, Produced I Type of Identification Produced: OUNTY OF MIAMI -DADE tification 1/ STATE OF FLORIDA, COUNTY OF MIAMI -DADE 'ignature of Contractor / Qualifier Print Name Swom to and subscribed before me this day of Signature of Notary Public - State of Florida SEAL: PERMIT APPLICATION Personally known OR, Produced Identification Type of Identification Produced: a PAY TO THE ORDE 0 FOR Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 4/11/2002 Applicant: IJ E IREt4E Pit ! w, ( - Owner: JACOBS JOB ADDRESS: 1250 NE 93 Contractor Local Phone: Parcel # 1132050270200 Fees: FEE2002 -2106 FEE2002 -2107 FEE2002 -2108 Amount $60.00 $0.60 $5.00 $65.60 Tata: Fees: $65.60 Total Receipts: $0.00 Description Building Permit Application Fee CCF Notary Fee Total Fees: Permit Status: Approved Permit Expiration: 10/8/2002 Work: EXTERIOR PAINTING OF HOUSE r If tf1P_rA i!i nn narmit narkann 301 - 71st Street; Miami Beach, Florida 33141 ; M e% n" at. i n 1+ ..•■.. So.. • �- -- Fn(•] sern i rnhan ed dueu nr se - fu MILLENNIUM PICTURE GROUP, INC. 1100 BAY DRIVE MIAMI BEACH, FL 33141 1 $ Cc,Co .ft 6.0 1000 0149t1' 406700 L 2 ?51: Building Permit • Permit Number: BP2002 -734 c=: ALICE IRENE ST Contractor's Address: Legal Description: 5 53 42 BAY LURE Construction Value: DATE 225L56230611' sip.00 PB 44 -63 LOT 8 • •w rw • :L.. AL. EIS 4.. .- - - - - -._ . _ .. • 4, 1449 63- 127/670 02 BLK 2 LOT SIZE 75.000 X e- inspection for in strict compliance with all ordinances been submitted to and approved by the out authorization. A further condition upon :es and regulations pertaining to the work iervants or employees. tg thereto and In strict conformity with the I work done by either myself, my agent, Shutters Awnings Chimney Paint Color Approval and Agreement DATE: L i d (0 fo OWNER'S NAME: ft; rrc,C�i (1 \ic ( PHONE: SOS - ADDRESS: `2 S ******************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ADDRESS OF SITE: \2 c� C ( C PA( CONTRACTOR & LICENSE (if applicable) COMPANY NAME: PHONE: MIAMI SHORES VILLAGE ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All Elements on the site must be listed and indicate the color to be painted. Walls k �L� , Fascia �. %'��fi c..Jc- �.� Drip Cap/Drip t /Drip Edge 3 V Soffit � c....�J c _' o Roof Flower Bins APPROVED: Decorative Metal \(% oors and door jams Garage Doors `lN Railings Fences V� All brick (simulated or re ular) k Stucco Banding t- Any other stucco features 0 Accessory Buildings Other 0 th 0 navajo white 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 a i d zoning. I authorize the above -named contractor, if applicable, to do th- irk st : t d. Furthermore , the paint colors will be as per the attached Olt L Signature of Own -r Date Signature of Contractor Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** (d/a WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION Building Offio1 Date 4/23/01 The Sunshine State -- LICENSE NUMBER F423-747-69-110-0 RICHARD G FOLUGUET 16711 COLONS AVE APT 2808 N MIAMI BCH, FL 33160-0000 BIRTH DATE SEX HGT. REST. 001II=. 034049 M 6-02 ISSUED EICPIRES OUPUGTE 10 -4798 03-30-06 00-00-00 WE DWYER 10270212 Operation of a motor vehicle constitutes consent to any sobriety teat required by taw. ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. T ' PE Outlet, Appliance QTY. TYPE Service Repair QTY. 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 Pasts Swim Pool, Commercial Air Conditioners Garbage Disposal Rs.nge/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 Pracess/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 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 Rcof 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 per.. °ormed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: SECTION BY DAVE 0 / CYO Zoning Zoning Electrical Mechanical Plumbing Fire Public Works Structural r l6 Building Official 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 0 PROOF OF OWNERSHIP (Attach) HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) LI OTHER (Specify & Attach) Ai' ir ISSUING OFFICIAL 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) 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