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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.