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PAINT PERMITPROPERTY OWNER New Construction Name Cie E ,� / d�tl N /ATG Address Alteration Exterior Home Telephone 30s - ^ c 3 9 V Business Telephone ce a a 4. 6, - S-7 Y ( y Fax Demolish TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'l Detachment Other INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. v Job Address: 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 submit- ted 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 Address PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Pecs, fU& 99 S Apt. Folio Number Lot Block Subdivision PB PG Current Use of Property Proposed Use of Property Tenant Information Chg. Contractor Renewal Revision Extension Supplement Reinspection PERMIT CHANGE (✓ ) ARCHITECT Name License No. Address Telephone Fax Master Permit No. Subsidiary Permit No. PERMIT APPLICATION Y Y ua ; " t` rl v `z"rc -, P c 3 (3 r City State Zip `'ibescription of Work F.-KT E R.( () rZ ; ,,4f//(,JTj(l( ( - 14 0 t 4 -9e 0 NI-- \ f . C1tCC f 0f� ih5 ° eCir<a.i d' Rote. Zoning Linear Feet Square Feet �/ Units Floors alue of Work i (j/V- • /1( 11 Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax CONTRACTO Name License No. Address Telephone Fax Qualifier Name Page 2 IMPORTANT NOTICES Signat 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 Contractor. e of Owner STATE OF ` ORI n A, I `- Print Name Print Name Sw ;. and ubscribed before me this / 0 day of ignature of N. R ry Public • to of Florida • w P U ANGELA ^9 ENc� `11 II SEAL: Personally known R ldeayficaiion L/ Personally known OR, Produced Identification Type of Identification Produced:P1)L of Identification Produced: SEAL: Y OF MIAMI - DADE Signature of Contractor / Qualifier Signature of Notary Public - State of Florida PERMIT APPLICATION STATE OF FLORIDA, COUNTY OF MIAMI -DADE Sworn to and subscribed before me this day of ELECTRICAL TYI,l,, Minimum Fee QTY. . TYPE Dryer cm'. TY,l,l,. Outlet, Appliance ()Ty. TN . l , l ,, 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 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. T1'1'E Condensate Drain QTY. TYI'1? Generator QT1'. 'I'1'l'E 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 PLUM BING TYI'E A/C Condensate QTY. Tvl'l; Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. TYPI'. 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 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 v -� B ,,j DAT Zonin: /isD7&7dr,L Electrical Mechanical Plumbing Fire Public Works Structural Atillia MAW Building Official Arm A — Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi - family) O CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) PI RNIIT 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 Notary o ' � nn ISSUING OFFICI 1L pd A tix "1 'iv" -� /-7-3 1 c�1 $ a ° ( sq.ft. = x/1000 x0.60) VIEWED AND PREPARED BY: (0.005 /sq.ft.) (0.01 /sq.ft.) PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) 2 0 S TOTAL $ 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 —P IV Pay to the order of ACH H/T 083100277 Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Permit Number: BP2002 -1165 Printed: 7/25/2002 Applicant: DENNIS PRIME Owner: PRIME DENNIS JOB ADDRESS: 1263 NE 92 ST Contractor _ocal 4rone: Parcel # 113205027 0270 Fees: Description Amount FEE2002 -3640 Building Fee $120.00 FEE2002 -3641 CCF $1.20 FEE2002 -2642 Notary Fee $5.00 FEE2002-405C Miscellaneous $100.00 Total Fees: $226.20 Total Fees: $226.20 Total Receipts: $0.00 Permit Status: Approved Permit Expiration: 12/25/2002 Construction Value: . .$1,200.00 Work: EXTERIOR PAINTING & ROOF AS PER MR BENTON 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. II the equipment or device described in the application herefor in strict compliance with all 182 :e with any plans, drawings, statements or specifications that may have been submitted to is not done in compliance with such ordinances or if the plans are changed without Date / - /(' U �— 63-4/630 actor or builder named above assumes the responsibility for a thorough knowledge of the vings or in the statements or specifications and that he assumes responsibility for work done GRETA RONNINGEN 06 1263 N.E. 92ND ST. MIAMI SHORES, FL 33138-2936 Bankof America. For 1:06300004?1: 00548433666 0 L8 2 Contractor's Address: Legal Description: BAY LURE PB 44 -63 LOT 16 I $ 2 Dollars 8 Building Permit c BY: BY: Page 1 of 1 BLK 2 LOT SIZE 75.000 X 125 OR in compliance with all ordinances and regulatidns pertaining thereto and in strict conformity res Village. In accepting this permit I assume responisibility for all work done by either MIAMI SHORES VILLAGE Paint Color Appsouaf ai4cE'A� DATE: GI-6 - U OWNER'S NAME: 6, 714/vmt, eft : • ADDRESS: f 2.6 3 it/ 9s '""° ********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** •• • • • •• . ••• •• ADDRESS OF SITE: , -v+n. • ' ' • ,5 CONTRACTOR & LICENSE (if applieable} • • / e c•lr',C.. per. N 4 COMPANY NAME: h,t,cC4f PHONE: • 332.0 ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All Elements on the site must be listed and indicate the color to be painted. Walls Fascia l c � U w I Drip Cap/Drip Edge' f'1ke Soffit t v > ()WI raJN Roof n Ro Flower Bins W j ✓� Shutters E }elg 111 ray 6 S 7it.144 (Gus Deck -) Awnings eilds4706 N(.4 Chimney Ni A Doors and door jams /4 is 7 Garage Doors Railings rk)l Fences M ice. Decorative Metal ro /ft All brick (simulated or regular) av 1A Stucco Banding Any other stucco features ' /A- Accessory tV (A Other - NIA APPROVED: rJ(A ./.170A Building Offi4l Date • • • ••• • • • • . . • • • . • 1: 3oc -7 S -•S 0 0 cr cn r t!1 gray owl 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 Signature of Owner Date Signature of Contractor Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION 4/23/01 1564 4 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 6 '1 W ( [ S Job Address P 3 V e Z 'S fi Tax Folio Legal Description Historically Designated: Yes No Owner/Lessee / Tenant T 'YY? A G P r A- • Cr0 r Master Permit # e) �' — Owner's Address (? 6U E 92_ S Contracting Co. ( }3A/F Signature of owner and/or Condo President Date FEES: PERMIT qa• RADON C.C.F. Address Phone 7G I `M- Phone Qualifier SS# State # Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION ptl avi- ok toy- a -C Knit- Q - k 1 10(01A11/? 11(1 UI/� Square Ft. Estimated Cost (value), 000 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 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). 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 -named contractor to do the work stated. Y O Signature of Contractor or Owner- Builder Date Notary as to Owner and/or Condo President Date 4ot• as to Contractor or Owner-Builder Date My Commission Expires: M Cor i'is 5xFll i NOTA F SEAL r ‹i SANDRA DA MONTIEL w ; * COMMISSION NUMBER ic Q CC401261 yl F n 0 , . M' COMMISSION .EXP. `i :�.m ..,...... . °� . 17 L NOTARY �. TOTAL DUE C �f 6 - APPROVED: Zoning Building Electrical Mechanical Plumbing Engineering MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 B ildg Inspection Request Dat ' 1 Type Insp'n Permit No_ G3(Q( � 24 3 a7 .� Name Address Company Phone # Inspection Date J . p p v e� orrection ❑ Re- Insp'n Fee ❑ Miami Shores Village 10050 NE 2nd Avenue Phone: 305- 795 -2204 Permit Number: BP2005 -106 Printed: 2/8/2005 Applicant: TOMAS SUAREZ Owner: SUAREZ TOMAS JOB ADDRESS: 1263 NE 92 ST Contractor Local Phone: Parcel # 1132050270270 Signed: (INSPECTOR) Building Permit Contractor's Address: Legal Description: BAY LURE PB 44 -63 LOT 16 Page 1 of 1 BLK 2 LOT SIZE 75.000 X 125 OR Fees: Description Amount FEE2005 -971 Building Painting Fee $60.00 FEE2005 -972 CCF $0.60 FEE2005 -973 Notary Fee $5.00 FEE2005 -974 Training and Education Fee $0.20 FEE2005 -975 Technology Fee $1.50 Total Fees: $67.30 Total Fees: $67.30 Total Receipts: $67.30 Permit Status: APPROVED Permit Expiration: 7/24/2005 Construction Value: $200.00 Work: PAINT HOUSE EXTERIOR 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: Building Permit Miami Shores Village 10050 NE 2nd Avenue Phone: 305- 795 -2204 Permit Number: BP2005 -106 Printed: 2/8/2005 Applicant: TOMAS SUAREZ Owner: SUAREZ TOMAS JOB ADDRESS: 1263 NE 92 ST Contractor Local Phone: Parcel # 1132050270270 Contractor's Address: Legal Description: BAY LURE PB 44 LOT 16 Fees: Description Amount FEE2005 -971 Building Painting Fee $60.00 FEE2005 -972 CCF $0.60 FEE2005 -973 Notary Fee $5.00 FEE2005 -974 Training and Education Fee $0.20 FEE2005 -975 Technology Fee $1.50 Total Fees: $67.30 Total Fees: $67.30 Total Receipts: $67.30 Permit Status: APPROVED Permit Expiration: 7/24/2005 Construction Value: $200.00 Work: PAINT HOUSE EXTERIOR Page 1 of 1 BLK 2 LOT SIZE 75.000 X 125 OR Signed: (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 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 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 2/8/2005 Applicant: TOMAS SUAREZ Owner: SUAREZ TOMAS JOB ADDRESS: 1263 NE 92 ST Contractor Local Phone: Parcel # 1132050270270 Signed: (INSPECTOR) Building Permit Permit Number: BP2005 -106 Contractor's Address: Legal Description: BAY LURE PB 44 -63 LOT 16 Page 1 of 1 Fees: Description Amount FEE2005 -971 Building Painting Fee $60.00 FEE2005 -972 CCF $0.60 FEE2005 -973 Notary Fee $5.00 FEE2005 -974 Training and Education Fee $0.20 FEE2005 -975 Technology Fee $1.50 Total Fees: $67.30 Total Fees: $67.30 Total Receipts: $67.30 Permit Status: APPROVED Permit Expiration: 7/24/2005 Construction Value: $200.00 Work: PAINT HOUSE EXTERIOR BLK 2 LOT SIZE 75.000 X 125 OR 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: Building Permit Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Permit Number: BP2005 -106 Printed: 2/8/2005 Applicant: TOMAS SUAREZ Owner: SUAREZ TOMAS JOB ADDRESS: 1263 NE 92 ST Contractor Local Phone: Parcel # 1132050270270 Signed: (INSPECTOR) Contractor's Address: Legal Description: BAY LURE PB 44 -63 LOT 16 Permit Status: APPROVED Permit Expiration: 7/24/2005 Construction Value: $200.00 Work: PAINT HOUSE EXTERIOR Page 1 of 1 BLK 2 LOT SIZE 75.000 X 125 OR Fees: Description Amount FEE2005 -971 Building Painting Fee $60.00 FEE2005 -972 CCF $0.60 FEE2005 -973 Notary Fee $5.00 FEE2005 -974 Training and Education Fee $0.20 FEE2005 -975 Technology Fee $1.50 Total Fees: $67.30 Total Fees: $67.30 Total Receipts: $67.30 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: BUILDING PERMIT APPLICATION FBC 2001 City Tenant/Lessee Name tarril 5 / State rt- EX Ori fair/ Miami Shores Village Building D epartment 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Master Permit No. Total Fee Now Due $ 07' t e 1 (3.49 (Continued on opposite side) pP ) Permit NoPOS" 10o Plumbing Mechanical Roofing Permit Type (circle): Buildin: Electrical Owner's Name (Fee Simple Titleholder) I4 IJt Phone # 3t15 eo7 52 V8 Owner's Address r2 (93 / %J q2 9� `� Zip 33138 Phone # alto Job Address (where the work is being done) d63 Ale 92 61 City Miami Shores Village County Miami -Dade Zip 3 is Building Historically Designated YES NO i Contractor's Company Name 4.�4 Phone # Contractor's Address City State Zip Qualifier State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # $ Value of Work For this Permit 900- 0 0 Square Footage Of Work: Type of Work: ['Addition ['Alteration ❑New ❑ Repair/Replace ❑ Demolition Describe Work: * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ COO. e� V n CCF $ , � CO/CC S Notary $ - w Training/Education Fee $ . 0 Technology Fee $ 1- S Scanning $ Radon $ Zoning Bond $ Code Enforcement $ Structural Plan Review. $ Bonding Company's Name (if applicable) Bonding Company's Address r-- City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC 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. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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 RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspe lion w ich occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will no a qp .ved and a reinspection fee will be charged. Signatur Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this OS The foregoing instrument was acknowledged before me this day of 2003 by fl 4.x p 0 1 & , day of , 20 , by who is. . rsonally k • ' n o me or who has produced 7 who is personally known to me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUB IC: , NOTARY PUBLIC: • Sign: L .. r� Sign: Print: I I I I I I I I I I ng.'`" Print: 4 t;xpilcr. J:, , 211 ndrd ! ling * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ** * * * * *t►1iq I****************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** My Commission - xpires: ************************************ * * * * * * * * * * * * * * * * * * * * * * * * * ** * * ** APPLICATION APPROVED BY: Chc 05/13/03 My Commission Expires: JAN 2 Plans Examiner Engineer Zoning • ZS /L'S Miami Shores Village Paint Color Approval and Agreement Date ,,ff�� ,` Owner's Name /`"(�,e ft/1 Phone # �O5 6 7 52 ? 6 Owner's Address /f,63 RZ 5f City toM► S . 1;14Veg , State Zip 33 /36 Job Address (where the work is being done) 1263 o(c 92 91 ��22 City Miami Shores Village County Miami -Dade Zip 3 3 CJ Is Building Historically Designated YES NO Contractor's Company Name (if applicable) Phone # ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All elements on the site must be listed and indicate the color to be painted Walls S1/Od► Fascia /JU tr3 r0 Drip Cap /drip Edge Soffit Roof Flower bins Shutters Awnings Chimney — Doors and door jams Garage doors Railings -- Fences Decorative metal All brick (simulated or regular) — Stucco banding Any other stucco features Accessory Buildings Other ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** 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 reilating and zoning. Signature APPLICATION APPROVED BY: Owner or Agent A les IJavaiD Date 2 Date /A15 chc 6/18/03 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date // J' 9 7 Job Address n4 9 Tax Folio Legal Description � Historically Designated: Yes No � n b C ee / Tenant , i\_ , Mk.) 1.--- Master Permit # 93 Owner's Address 1J ' - Phone Contracting Co. e�� Address Qualifier SS# State # Municipal # Competency # Architect/Engineer Address Bonding Company Mortgagor Address Permit Type (circle one): Address Phone Ins. Co. Gray Beige 1 UIILDIING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCIRIP'dIrN C� �jl(�T AGL *\ i" ` . oA a )4(c 3 e Square Ft. Estimated Cost (value) Notary as to My Com et 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 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). 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. ;A.- • 9 ' ' ;.. ^. er and/or dent xp a FFICIALN• ARYS CLADYS J VILLAR NMAIIV PUBLIC STATE OF FLORIDA COMMISSION NO. CC7I4I03 -MY COMMISSION EXP. MAR. l?CQ)2 OWNER'S AFFIDAVIT: I certify that all the forego' construction and zo ` - - - , I autho • FEES: PERMIT 0 RADON information is accurate and that all work will be done in compliance with all applicable laws regulating the above -named contractor to do the work stated. gnature of Contractor or Owner- Builder Date 2 3 -$ y Date Notary as to Contractor or Owner- Builder Date My Commission Expires: C.C.F. NOTARY ,�� BOND APPROVED: TOTAL DUE ,57.5 `-. ) Zoning Building \ '` Electrical Mechanical Plumbing Structural Engineer (r AMO S =OR[EE V LLASIE BUILDING INSPECTION DEPARTMENT A F P L U C AT O N F of f-' f_, LJ L D O N S P E R M U T Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. Date `1 C'_Y1_r ., 19.7 Owner's Name and AddressMC: A. 1116..1_...1._t- 11_a__v...0. No.A'Q. ( Street -__k -_E..- 9 i- Registered Architect and /or Engineer Name and address of licensed contractor d 2 — Location and legal description of lot to be built on: Lot i f Co Block Z_ Subdivision Street and Number where work is to be done .3 )' _ State work to be done and purpose of building (by floors) ___C5..C`!\ Permit No Disapproved / / (Signed) '� h Date Date._ 1 L _t i a STiz / -231 ° -. 1 o Repairs No. of Stories Roof Covering New Building Remodeling Addition To be constructed of C evYadell _. Kild of foundation Estimated Total cost of improvements $._.__ _ 6 . 0 - ,_ Gam) Amount of Permit $ Zone cubage required plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) C.k. - i -`'� STATE OF FLORIDA, COUNTY OF DADE. ss Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared _ to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the. of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. /3 Y ? Read, Sworn to and Subscribed before me. Notary Public, State of Florida and for no other purpose. Building Inspector / My Commission Expires PLANING BOARD DATE Chairman Member Member Member Member ...... Member Council Approved Date Disapproved Date NOT :,: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re-ii.pection fee of S1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. :1, .5 A 1' Mr N1a P� Ns rte- - lb T o e I v [1;7 S