SIDEWALK3
MIAN:* SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date �` 2 Time �--
Type Insp'n
Permit No. SP o .1 J ` ) -
2 z * (rtefl
Name
Address O2 •
! F_ "1a 5+
Company 1 C O ! & a XJ
Phone#
For Inspector: 4P 1 3
Approved
Re- Insp'n Fee
CONTRACTOR
L J
p
A
Name `-Q O F� a ,4 3L «
License No. CGtC� ; CZ/
— oo �'
Home Telephone 6,3Z:81 <' + ^ Sy a 10
!
Address 9o( S,., , A. ks„,Q 0 40.Q A cj -3_
cc Pc-re N .L 3S4-2,/
Telephon( 6- c.3 2G - 45 41 Fax
Qualifier N e €4 C- VA 432 x ; 0 i•
PROPERTY OWNER
New Construction
Name a P--5 . e0. (S eTTQ._ G C
k
Address 02 �V „ 1 ` z-, C� 2 s + asi _ A
∎ _0.; S� f '1.
Home Telephone 6,3Z:81 <' + ^ Sy a 10
!
Business Telephone
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 I.
Job Address:
o2
Address
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
MAY 11 . 4 2003
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
Master Permit No.
City
Folio Number
Lot Block
Subdivision PB PG Zoning
Current Use of Property Square Feet
Proposed Use of Property Value of Work
Tenant Information
Description f.,,IVorlt
Units
PERMIT APPLICATION
Subsidiary Permit No.
INSTRUCTIONS - The following steps must be taken to obtain a 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 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.
State
Linear Feet
Bldg Value
Zip
cam` IZS • tz) t`t C.
Floors
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
ENGINEER
Name
License No.
Address
Telephone
Fax
Page 2
IMPORTANT NOTICES
I. 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.
OR, Produced Identification
Type of Identification Produced: Type of Identification Produce
Personally known
PERMIT APPLICATION
SEAL:
Personally known OR, Produced Identification
ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPE
Dryer
QTY.
'I'1'1'1:
Outlet, Appliance
QTY.
TYI'I:
Service Repair
QT1'.
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
11'IECHANICAL
TYPE
Minimum Fee
QTY.
TYPE.
Condensate Drain
QTY.
TYPE
Generator
Q"I'1'.
11 PE
Refrigeration, Tons
Q'I'Y.
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
PLUMBING
TYPE
A/C Condensate
QTY.
TYPE
Drains, Roof
QTY.
Ill'1.
Miscellaneous Fixture
QIl.
IlPi:
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:
Page 4
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi - family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
$3.00 per page (Scanning Fee)
Miami Shores Village
Bond
Inspector State Educational Fund $
State DCA (Radon)
Code Enforcement Fine
Zoning Review
Notary
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
CI OTHER
(Specify & Attach)
PERMIT FEES
$ (60% 00
Metropolitan Dade County (C.C.F.) $ Q/ t (9 0
$
SECTION
Zonin
Electrical
Mechanical
Plumbing
Public Works
Structural
Building Official
(s .6. x/1000
x (¢.005 /sq.ft.)
(¢.01 /sq.ft.)
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
Cl CONTRACTOR REGISTRATION
(On File)
TOTAL $
ISSUING OFFICIAL
REVIEWED AND PREPARED BY: DATE:
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2"° AVE., MIAMI SHORES, FL c (305) 795 -2207 0 FAX (305) 756 -8972 0 http:/ /www.miamishoresvillage.com
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P= ATI ®N FDP BUILDING PERMIT
8 E MI SHORES TILLAGE
BUILDING INSPECTION DEPARTMENT
�.`. ss
Application is hereby made for the apjproyal 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.
Owner's Name and Address - . °� f f _
Registered Architect and /or r = gineer //
Name and address of licensed contra or_
Location and legal description of lot to be • uilt
Block . Subdivision.......
Shat and Number w h e r e w o r k is to ba done.... .. a ..
State work to be done and purpose of building (by floors)
Remarksfj..
STATE OF FLORIDA,
COUNTY OF DADE.
ss.
Disapproved �(� , Date._
(Signed) �9( _3
Building Inspec
Addition
ANNING BOARD DATE
....... ....... _..................
........
and for no other purpocsa.
Repairs No. of Stories
New Building Remodeling
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ 71®
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 5968, 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 der this
permit, a 'censed y rrl} Shores Villa v
- - ... l -------------- --- -- igned )
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take ac,' aowledgments, personally ap-
peared --- - - - - -- -
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.
Permit No / ( 4S - cc Date _ Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
to me well known,
Chainnan __._ _ Member
Member Member
Member _, _- Member -
Council Approved. _? ... _ Date Disapproved Date
NOTE: A charge of k1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board. t�
A re- inspection fee of $1.00�lwill be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
BUILDING / Vy.
ELECTRICAL
PLUMBING
Owner of
Building
Architect
Contractor a ._ . - .}
or Builder
Legal Lot Bl.
/
Description
Address of D ;
Building
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 appli-
cation 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 plane chan without authorization. A further condition upon which this
permit is granted is the understanding that the contractor or builder named above es 44 _re ibilityliot horough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans- awin s!or in tstatements or specifications and that he assumes respon-
sibility for work done by his agents, servants or employees. i� ' - /i:9 f /, !?P
Signed.
In coj ideration of the i "su ice to me of this ermit I agree to perform the work covered hereunder in compliance with - I1 Ordinances andiregulatkons
pertainin eretAan . strict tOnformniW,w th ' plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accept4n Hermit �- ass uixf responsibility nfork done by either myself, my agent, servant or employee.
1,
<< Work,to be performed under
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
DATE ' /, /
PERMIT N? 4864
this Permit
Subdi-
vision
Value of
Project
j
Contractor's
License No
Amt. of '
Permit -
d.
2' 194
'INSP By
AUTHORITY
lUILDING
LECTRICAL
'LUMBING
MIAMI SHORES VILLAGE, FLORIDA
DATE 194=
PERMIT N2 4 8 6 4 Contractor's
License No.
Work to be performed under this Permit
Owner of
Building
Architect
Contractor
Dr Builder
Legal Lot Bl.
I )escription
Address of
Building
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 appli-
cation herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work wil 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 respon-
sibility for work done by his agents, servants or employees.
Subdi-
vision
Value of
Project
Amt. of j
Permit
CONTRACTOR OR BUILDER BY AUTHORITY
Signed: By
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 responsibility for all work done by either myself, my agent, servant or employee.
Miami Shores Village
10050 NE 2nd Avenue
Building Permit
Phone: 305 - 795 -2204 Permit Number: BP2003 -800
Printed: 5/16/2003
Applicant:
Owner:
JOB ADDRESS: 302 NE 92
Contractor ICOA CONSTRUCTION
Local Phone: 786 - 326 -4041
Parcel # 1132060136480
ST
Permit Status: APPROVED Permit Expiration: 11/12/2003 Construction Value:
Work: SIDEWALKS REPAIR (CONCRETE)
$700.00
Page 1 of 1
Contractor's Address: 901 S. W. 4th Avenue, Apt. B1
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 11 & 12 BLK 48 LOT SIZE
Fees: Description
FEE2003 -2963 Building Permit Application Fee
FEE2003 -2964 CCF
Total Fees:
Amount
$60.00
$0.60
$60.60
Total Fees: $60.60
Total Receipts: $0.00
compliance with all ordinances and regulations pertaining thereto and in strict
ami Shores Village. In accepting this permit I assume responisibility for all work
uer) BY:
'STATE OF FLORIDA)
COUNTY OF DADE)
attached survey, performed by
Mew . Q N a c N-12 0(IL G.
The undersigned Affiant, , does hereby attest that the
(property owner)
(name of surveyor's company)
performed on , is an accurate representation of the existing conditions and
(date of survey)
locations of all structures on the property as of this date.
The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the
property without first providing a survey less than six (6) months old. The Affiant, as property owner, further
agrees to remove or obtain permits for any structures which now may exist on the property which are not
permitted or which may violate zoning or building code regulations. The Affiant further understands that the
existence of any such structures may affect final inspections as applicable to this or other permits..
Further, Affiant sayeth naught.
Wi si`' and print)'
SWORN TO AND SUBSCRIBED before me this /3 day of
Witness(sign and print)
Affiant is personally known to me, produced 2N -0o ' • Cs identification.
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
B uilding Inspection Request
Dat‘/ / j v3 Time
Type Insp'n lV
Permit No. P 7 °C 0 0
Name
ddd
Address _3 O *k o� .
Company \ /r."
Phone # ? U ` 3 17-L-)191)
For Inspector: W / b 3 me & Date
Approv
orrection
Re -Ins i'