PAINTI '
ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPE
Dryer
'
QTY.
1
1
'OPE
Outlet, Appliance
QTY.
TYPE QT1'.
Service Repair
A/C Central 1-3 Ten
Condensate Drain
Fan
Soakage Pit
Outlet, Wall
Heating Strips, each
Service, Temporary
A/C Central 4-7 Ten
Miscellaneous Repairs
Fire Pump
Solar Water Heater
Outlet, Switch
Paint Booth
Signs
A/C Central 8-15 Ton
Pool Piping
Fixture - Fluorescent
Sprinkler Repair
Oven
Piping, Flammable Liquid
Space Heater kw)
(
A/C Central 16-20 Ten
Pump and Abandon
Fixture Light
Sprinkler System
Parking Lot Lights
Process/Pressure Piping
Spas/Hot Tubs
A/C Central 20+ Ton
Pump, Domestic
Flood Lights
Supply, AC Well
Plugmold/Strip
Pressure Vessel
Subfees, No. of Amps
AIC Window
Pump, Fire Stand
FPL - Load Central
Temporary Toilet
Posts
Swim Pool, Commercial
Mr Conditioners
Pump, Re-circulate
Garbage Disposal
Temporary Water Closet
Range/Range Top
Swint Pool, Residential
Chiller
Pump, Replace - Pool
Generators, etc.
Urinal
Receptacles
Switcnoards I
Clear Violations
Heat Il'
. :efrigerator, Comm. (It I'l()
It ischarge Well
Temp Serv., Construction
Compactor
Low-volt, Burglar
Pump, Sump
Refrigerator, Domestic
Utility - Water
Temp far Test - 30 days 1
Weep Freezer
Low-volt, Fire
Renew - Temp Service
Vacuum Pump
Derr.oliticn
Low-volt, Intercont/Teleph.
linterceptor
':epair Circuits
Roof Inlet
Dishwasher
Low-volt, Television
Service, Number of Amps
Septic Connection
'1C1-1 1 L
ME i NICA
TYPE
QTY.
TYPE
11
QTv. TiyPE
Generator
!
QTY.
TYPE
Refrigeration, Tons
ifi
Minimum Fee
Condensate Drain
A/C Central, Tons
Soakage Pit
Cooling Tower
Heating Strips, each
Drinking Fountain
Vent Hood, Cost
Miscellaneous Repairs
A/C Wall/Win, Tons
Solar Water Heater
Dryer Vents, Number of
Paint Booth
Filter Replace
Ventilation, Cost
Pool Piping
Air Handler, Tons
Sprinkler Repair
Ductwork, Cost of
Piping, Flammable Liquid
Fountain
Period' c Inspections
Pump and Abandon
arbecue
Sprinkler System
Fire Sprinkler System
Process/Pressure Piping
Gas - Appliance
Pump, Domestic
4 ath Fan-Vented, 0
Supply, AC Well
Fireplaces, Number of
Pressure Vessel
Gas - Natural
Pump, Fire Stand
1
PIUM13fNG
TYPE
A/C Condensate
QTY.
TYPE
Drains, Roof
-
QTN'.
1
TYPE
Miscellaneous Fixture
QTY. TYPE
QTY.'
Soakage Pit
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
*entail Chair
Grease Trap
Pump, Sprinkler
Utility - Sewer
It ischarge Well
Hce Maker
Pump, Sump
Utility - Water
Dishwasher
:ndirect Wastes
Relay Repair
Vacuum Pump
Dispcsal
linterceptor
Roof Inlet
Water Closet
Domestic Well
La.undry Tray
Septic Connection
Water Heater
Drainfield, 4" Tile/Res.
Lavatory
Septic Tank
Water Heater New
Dra:r.s, A Tel.
Meier Set (Gas)
Sewer Connection
Water ':e-pipe
Drains, :7LOCT
Minim= Fee
Shower
Water Service
372113, French
Mr:see:i2mec.:.7s lEcii#7.22
Sink
Wel:, Supply 1
Page 3
PERMIT APPLICATICN
INS7RUCTICNS: Tease f.ndicate the type of work being performed and quantity(ies) in the space provided below.
RENEWED AND REVIEWED BY: DATE:
SECTION
BY
D TE
( ? TE
N!�
/ 2J
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
N
20t
Page 4
OFFICE USE ONLY
CHECKLIST
❑ 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)
PERNHT 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
( sq.ft. = x/1000
x ¢.60)
ISSUING OFFICIAL
REVIEWED AND PREPARED BY: DATE:
3
(¢.005 /sq.ft.)
(¢.01 /sq.ft.)
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $SOS • 6 O
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2"° AVE., MIAMI SHORES, FL ® (305) 795 -2207 FAX (305) 756-8972 http : / /www.miamishoresvillage.com
CONTRACTOR
New Construction
Na i c t, fit'( .:(14 0
Nr re co NIA._
License No. ESoo ,g._1
Alteration Exterior
, ,/
Address A70 41644119 .av is
/ut,�.;g4 ; S 5 �7
r ??
Alteration Intertior
QuaL flan Nay
7 ax -�
PROP '117 OWNER
New Construction
Nr re co NIA._
E
Alteration Exterior
Aedras 3e, ,j. 0. q 3 9 `<
Ii:cme 7e:a '_cv(3 70 vg, ko
Alteration Intertior
Demolish
7 ax -�
-
Shell Only
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
E
Alteration Exterior
Re ,s air
Alteration Intertior
Demolish
Relocation of Structure
-
Shell Only
Foundation Only
Add'I Attachment
Other
Add'1 Detachment
Other
I
II' I f l : I
INS RUCTIONS - The following steps must be taken to obtait hermit from the M
Step 1.
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.
APPP CATION
�
Job Address: 3o
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.
Address
Folio Number
Lot Block
Subdivision PB
Current Use of Property
Proposed Use of Property
Tenn': Information
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
q3 4129
Apt.
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARC
TECT
Name
Licece Ne.
, ?,a
Master Permit No. LAV
Subsidiary Permit RTo.
AZAAi
City State
ENGINEER
Name
License No.
Address
2S.
PERMIT APPLICATION
r�
anti Shores Villa e:
3 ;(3J
Zip
!' J ,�,
4 R l k� ' °
Description. of Work
PG Zoning Linear Feet
Square Feet �1 Units Floors
Value of Work MOO. 00 Bldg Value
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
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 Contractor.
STATE OF FLORIDA, COUNTY OF MIAMI -DADE
//
F'1 9-v -t 16 't (('
Signature of Owner
Oo ra.
Print Name
o n to and subscribed before me this
A 11
1 fission #DD2331984
� C es: Jul 13, 2007
Thru
I` Eloves
'�, °,?FObF• °r grlar
A day of 1
1o?
Personally known OR, Produced Identification
Type of Identification Produced:
TA��I A, COU Y OF MIAMI -DADE ideealf
S i lure of Contractor / u iffier
Q
� � T S (s CoU,,rr -
Print Name
Swo
A ,
igna ure r otary Pub tc tate of Fl . • • .
1 b i V
"`= Co ission #DD 1984
9 E ; . Tres: Jul 13, 2007
Bonded Thru
Atlantic Bonding Co., Inc.
Personally known OR, Produced Identification
SEAL:
and subscribed before me this day of
PERMIT APPLICATION
Type of Identification Produced:
Applicant:
Owner:
JOB ADDRESS: 30 NE 93 ST
Contractor VISCOUNT PAINTING & DECORATING
Local Phone: '305-751-7164
erv
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 -795 -2204 Permit Number: BP2O03 1740
Printed: 11/4/2003 Pane 1 of 1
Parcel # 1132060130200 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 9 & W1/2 LOT 8 BLK 2 LOT SIZE
Fees: Description Amount
FEE2003 -6881 Building Fee $60.00
FEE2003 -6882 Notary Fee $5.00
FEE2003 -6883 CCF $0.60
Total Fees: $65.60
Contractor's Address: 640 GRAND CONCOURSE
Permit Status: APPROVED Permit Expiration: 5/2/2004 Construction Value: $2,400.00
Work: PAINT HOUSE WHITE
er it
Total Fees: $65.60
Total Receipts: $0.00
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
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date Time
Type Insp'n 2 1 1 1 nrsl 1�
Permit No. 2 Pt l 3 940
Name c nca
Address 30 WE, q3 54-
Company ‘ J txi. c n4
Phone #
For Inspector: } a.. 004
Approved
Correction
Re- Insp'n Fee ❑
Name & Date
Date � ��
Owner's Name n S Ozo1 ti �1 , Phone #
Owner's Address
City State Zip
Job Address (where the work is being done)
City Miami Shores Village County Miami -Dade Zip
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
Fascia
Drip Cap /drip Edge
Soffit
Roof `�-
Flower bins
Shutters
applicable lames- ►lating construction
Signature
Miami Shores Village
Paint Color Approval and Agreement
APPLICATION APPROVED BY:
P&
cial
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
Attach Color Samples
With Numbers
*******************_********************************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
OWNER'S AFFIDAVIT: I certify that a)1 the foregoing information is accurate and that all work will be done in compliance with all
d zo`iling.
Date
Date k I 67
chc 6/18/03
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Ad css of
BL:' ding
MIAMI SHORES VILLAGE, FLDIRIGA
PERMIT N9 6578
Archi feet
Contractor
or Builder
Legal Lot
Dttscription. ;; Bl.
CONTRACTCiq OR BUILDER
Work to be performed under this Permit
Subdi-
vision
Value of
Project $
DATR 1 95 —
Contractor's
License No. 4--
Amcu t
Permi u
Thin permit _s canted to the contractor or builder named above to construct tho 3uilding or to install the equipment or device dcccrLLed in the aft,'::
hcrafor in strict co-np:.anco with all ordinances pertaining thoroto and with the understanding that tho work will bo performed in compliance with ar% 1: i r .,
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at c,y
time if thn , ...tor_. is not doze in compliance with such ordinances or if the plans are changed without authorization. A further conditon upon which this :_rn, t
aranied IL the undorritanding that the contractor or builder named above assumes the responsibility for a thorough knowlecge of tie ordinances and iccr.ict'.: ••
pertaining to the o* : covcrud heraby whether rhovm on tho plans or drawings cr in the statements or specifications and that he c sst.mes r 1 .:ns ci1i-i .c
dc,- by his agents, carvanto or employees.
Maned.
INS?ECTOR
In consideration of tho issuance to mo of this permit I agree to perform tho work covered her:3undor in compliance with cal ordinances and rogiia! c.
pertaining thereto and in strict conformity with tho plans, drawings, statements or s oocifications submitted to the proper authorities o iv iami Shores
canting this permit l assume rosponsibility for all work done by either, myself, my agent, servant or employee,
BY AUTHORITY
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
7 r
Application is hereby made for the approval of the detailed statement of the plans and specifications herewita submitted for the beild-
ing; or other structure herein described. This application is made in compliance and conforrnity with the Bualc ing 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.
,19
Owner's Name and Address.... ' - - � /!e .. ee „' _r -' No � Stree' ' './.� 2 2
Registered Architect and /or Engineer
Name and address of licensed contractor 1 , _. , 4_ _. K / 6 Y /_ - / / ' 2
Location and legal description of lot to be built on:
Lct Block Subdivision
Street and Number where work is to be done _:z?� c /' r - / u ; 9 v
State work to be done and purpose of building (by floors) %_.
zee
1
and for no other purpose.
New Building Remodeling Addition Repairs l No. of Stories
To be constructed of Kind of foundation Roof Covering
Esimated Total cost of improvements $ eeee � Amount of Permit $
Tone cubage required Plan Cubage
Distance to next nearest building Size of Building Lot
Maximum live load to be borne by each floor
1 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 5988, Compiled General Laws of Florida Permanent Su1plement,
and has complied with the rovisions 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 inspect :on cn the site of the work such ublic 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) _._ u Y
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 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 fees
therein by him stated are true.
Permit No e , ` Date i ' i ` • i Read, Sworn to and Subscribed before me.
Disapproved ' Date
Notary Public, State of Florida
( Signed)
Building Inspector My Commission Expires
PLANNING BOARD DATE
Cheinnan Member
Member Member
Member _ Member
Council Approved Date Disapproved Date
NOTE: 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- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.