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482 NE 93 St (10)ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. TYPE Outlet, Appliance QTY. TYPE; Service Repair QTY. A/C Central 1 -3 Ton Dryer Vents, Number of Fan Ventilation, Cost Outlet, Wall /Q Service, Temporary Periodic Inspections A/C Central 4 -7 Ton Fire Sprinkler System Fire Pump Outlet, Switch q Signs A/C Central 8 -15 Ton Fixture - Fluorescent Oven Space Heater (kw) A/C Central 16-20 Ton Fixture Light 11 Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights -- / Plugmold/Strip Posts Subfeeds, No. of Amps( Swim Pool, Commercial /DO A/C Window FPL - Load Central Air Conditioners Pump, Re- circulate Garbage Disposal Temporary Water Closet Range/Range Top Clothes Washer Swim Pool, Residential Gas Piping Chiller Pump, Replace - Pool Generators, etc. Urinal Receptacles Dental Chair Switchboards Grease Trap Clear Violations Pump, Sprinkler Heat Recovery Utility - Sewer Refrigerator, Comm. (p/PH) Discharge Well Temp Serv., Construction Ice Maker Compactor Pump, Sump Low -volt, Burglar Utility - Water Refrigerator, Domestic Dishwasher Temp for Test - 30 days Indirect Wastes Deep Freezer Relay Repair Low -volt, Fire Vacuum Pump Renew - Temp Service Disposal Interceptor Demolition Roof Inlet Low -volt, Intercom/Teleph. Water Closet Repair Circuits Domestic Well Laundry Tray Dishwasher Septic Connection Low -volt, Television Water Heater Service, Number of Amps Drainfield, 4" Tile/Res. Lavatory MECHANICAL TYPE QTY. Minimum Fee TYPE Condensate Drain QTY. TYPE, Generator QTY. TYPE QTY. Refrigeration, Tons 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 Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel 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 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) 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) ❑ OTHER (Specify & Attach) ( sq.ft. = x/1000 x0.60) $ (¢.005 / sq.ft.) $ (¢.01 /sq.ft.) REVIEWED AND PREPARED BY: SECTION Zonin Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ 1 ISSUING OFFICIAL 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 Page 2 1i\-lPOR'I'A NOTTICES 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 - Plea'se 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. .4 t_ AIP Signal of wne nt Name O Yt.6 t� Illt r. NI% ' u . ry Public S :, j9. , NO NOTARY STATE OF FLORIDA COMM ION NO. CC897164 MY COMMISSION EXP. DEC. 202003 wo to nd subscribed befo s 10 day of e. ST Signature of SEAL: Personally known IAMI -DADE OR, Produced Identification C/ / Type of Identification Produced: . 17,11--1 7 4>C 1 " -, 4-1 c--0 STATE OF j I ri , COUNT ! F MIAMI -DADE Signature of Contr . ctor / Qualifier A 0--'&;,e /Z . LorY►7 as Print Name PERMIT APPLICATION 411.—,..4 AIL r .7177. ture of N '.I Mary PU !':.a SEAL, �ADG LI NOTARY • : • .. OF FLORIDA COMMISSION NO. CC897164 MY COMMISSION EXP. DEC. 20 2 Savor . nd subscribed before S i SEAL: day of Personally known OR, Produced Identification f Type of Identification Produced: d/''/ ✓01"4 L- PROPERTY OWNER Name Awe I Man- , J0 %L -6 c;t 6.03A-c..; -I Address 4-1.- w, Cr, 9 3 S7' r-i /."., i 5 00 o h. os yam' 33)3, Home Telephone /�� 7 ,r 6.S -3'Z. Business Telephon SZ -- - Fax CONTRACTOR Name L/6 N T 6,o ray' ,"c. License No. :`,/ 6 /5 Address I7 72 t o / CL) , a 67 :31% L, tvbe 4141 33/gh Telephone( 6 .... 3 .- 51 __ of Fax Qualifier Name �/1„4„ /) 1(c.c. n. LC,),,, as ENGINEER New Construction Name 12.e• G dot, 'W,1 I/4 JL4I A License No. Address '7 :L11 S & :31% L, tvbe Telephone C' &:t) zzg. —. 3 F-7 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'l Detachment Other INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores !'iiiage: Step 1. Master Permit No. Subsidiary Permit No. 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. A PM! CATION S�lr Z ,t /. d . ?3 S T Address Apt. Folio Number // 3 i'O 6 " v / 0170 Description Lot / CIE 7z.-3 Block 3 /2 Subdivision PB / 0 PG 3'7 Zoning Current Use of Property n U — / Square Feet Job Address: Par /.e 11 SNonaCS City Units State PERMIT APPLICATION .?3 / 3J' Zip f Work ,",o f'" ) I V K-e.ru itT / s) c v1 Linear Feet Floors Proposed Use of Property )Z ei ' / Value of Work Bldg Value Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Chg. Contractor Renewal Revision Extension Supplement Reinspection PERMIT CHANGE (✓ ) ARCHITECT Name License No. Address Telephone Fax Tax Assessed/Appraised Value Flood Zone Base Floor Elev. BUILDING ❑ / ELECTRICAL 1T3 DATE 195- PLUMBING ❑ PERMIT N? 7858 Contractor's . , License No ROOFING ❑ Owner of Building Architect Contractor or Builder Legal Lot Description Address of Building MIAMI SHORES VILLAGE. FLORIDA ❑ Work to be performed under this Permit CONTRACTOR OR BUILDER Bl. Subdi- vision Sq. Ft Value of Project $ Amt. of Permit $ C 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 application 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 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 responsibility for work done by his agents, servants or employees. i Signed: BY INSPECTOR In consideration of the issuance to me of this permit I agree to pe :;form 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. i BY AUTHORITY BUILDING ELECTRICAL PLUMBING EtOOFING Owner of Building Architect ` ontractor Dr Builder Legal Lot Description Address of iuilding CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE. FLORIDA DATE ( 195 - PERMIT N? 7 412 Contractor's , c License No. y �) Work to be performed under this Permit o B Subdi- vision Value of Project $ Amount of Permit $ 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 application 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 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 tl}orough knowledg, %ot the ordinances and regulations :.ertaining to the work covered hereby whether shown on the plans or drawings or in the "'tatements or specifications and that he assumes responsibility for work one by his agents, servants or employees. 1 Signed ' 13Y:' INSPECTOR �\ In consideration of the issuance to me of this permit I agree to perform the work covered h reunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications sub fitted to the proper authorities of Miami Shores Village. In ac• =epting this permit I assume responsibility for all work done by either, myself, my agent, servant - or employee. BY AUTHORITY Permit No Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building 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 wi h, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work.. , l Owner's Name and Address Registered Architect and /or Engineer & Employing Electrician's Name B. & W° ELtCTRIL Street and Number where work is to be performed —No.. Amount of Permit $ a9 MIAMI S H ORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT FPLICATI N FOR ELECTRICAL PERMIT Date vv No Ya No Location and Legal Description Lot Block Subdivision Iv 'ex e • f3 / - Street A/. Jr- Street /77' 3 /o. Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs Nt Stpries / Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation— Conduit Tubing B.X.L Metal Moulding (Signed) - Electrical Inspector. 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 subcontractors 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. (Signed) Master Electrician. STATE OF FLORIDA, } COUNTY OF DADE: ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared 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, and he has carefully read the foregoing application, and that he did sign the same, and that all fact, therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re• inspection fee of $1.00 will be made when such re' inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. SWITCH OUTLETS LIGHT OUTLETS PLUG RECE'P'T'S FIXTURES NO. LAMPS REFRIO. OUTLET t»nR.. OLIXtVII RANGE OUTLET RANGE CONN. WATER HEATER W. HEAT. CONN. SPACE HEATER DRIP R TOTAL. CONTR. LIST / / ° a yJ CHECK /eV II ®'O 1. oa ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. MOTORS 0.1 HP MOTORS 1.5 HP NEON TRANS. RADIO TOTAL CONTR. LIST / r 1 { / 3, / CHECK Permit No Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building 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 wi h, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work.. , l Owner's Name and Address Registered Architect and /or Engineer & Employing Electrician's Name B. & W° ELtCTRIL Street and Number where work is to be performed —No.. Amount of Permit $ a9 MIAMI S H ORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT FPLICATI N FOR ELECTRICAL PERMIT Date vv No Ya No Location and Legal Description Lot Block Subdivision Iv 'ex e • f3 / - Street A/. Jr- Street /77' 3 /o. Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs Nt Stpries / Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation— Conduit Tubing B.X.L Metal Moulding (Signed) - Electrical Inspector. 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 subcontractors 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. (Signed) Master Electrician. STATE OF FLORIDA, } COUNTY OF DADE: ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared 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, and he has carefully read the foregoing application, and that he did sign the same, and that all fact, therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re• inspection fee of $1.00 will be made when such re' inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. PERMIT APPLICATION FOR MIAMI SHORES VILLAGE 585gr7 Date Owner/ Lessee / Tenant Job Address v8Z / / E Q.3 i ' . Tax Folio..r "*Oi 077/6 Legal Description Owner's Address ` A/ E Master Permit it 24b5-. Phone 7,50 i Contracting Co. Address Qualifier State i�64 Ii0 Q 17 Municipal fit Competency it Ins.Co. Architect /Engineer \ .Address Bonding Company Mortgagor Permit Type(circle one): BUILDING WORK DESCRIPTION e a,' ure o e abo • er • r f , *. t�. . ' i M pC re bo n M ON NUMBER '►I� Q CC7140 p 1 a • 1iN" i Y OWNER'S AFFIDAVIT: be done i authoriz Si D tart' as My Commis ** * APPROVED: Zoning :n /or Condo President d' 1 esident FEES: PERMITX j RADON Address Address PLUMBING MECHANICAL ROOFING PAVING PENCE SIG Square Ft. Estimated Cost(value) ` — WANING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO D 30 MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEN TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOU NOTICE OF COMMENCEMENT). Application is hereby made to obtain a permit to do work and installation as indicated above, ar on the attached addendum (if applicable). I certify that all work will be performed to meet t` standards of all laws regulating construction in this jurisdiction. I understand that separat permits are required or ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. certify that all the foregoing information is accurate and that all work wi` mpliay'e with all applicable laws regulating construction and zoning. Furthermore, e -named contractor to do the work stated. * * C.C.F. 6 ft Sig ature of Contractor,or Owner- Builder Date: a.:.. .!.1 N•.. a as C. '" My Commiss NOTARY t c t8 ►rdh�- 5I � P-1R1NA M HIRSCH • co - ON NUMB h � c.q 14091 ` - r 06to sslot4 ex *1 #,2002 �.. ].der * TOTAL DUE Fire Other . JJ Building Electricale-OfP Mechanical Plumbing Engineering ELECTRICAL i TYPE Minimum Fee QTY. TYPE Dryer QTY. TYPE 1 Outlet, Appliance QTY. TYPE Service Repair QTY. A/C Central 1 -3 Ton Heating Strips, each Fan Outlet, Wall Service, Temporary Paint Booth A/C Central 4 -7 Ton Fire Pump Outlet, Switch Piping, Flammable Liquid Signs A/C Central 8 -15 Ton Fixture - Fluorescent Process/Pressure Piping Oven Space Heater (kw) A/C Central 16 -20 Ton - Pressure Vessel 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 Dishwasher Compactor Indirect Wastes Low -volt, Burglar Relay Repair Refrigerator, Domestic Vacuum Pump Temp for Test - 30 days Il isposal Deep Freezer Interceptor Low -volt, Fire Roof Inlet Renew - Temp Service Water Closet Domestic Well Demolition Laundry Tray Low -volt, Intercom/Teleph. Septic Connection Repair Circuits Water Heater Drainfield, 4" Tile/Res. Dishwasher Lavatory Low -volt, Television Septic Tank Service, Number of Amps Water Heater New Drains, Area MECHANICAL TYPE Minimum Fee QTY. TYPE Condensate Drain QTY. TYPE I Generator QTY. TYPE Refrigeration, Tons QTY. A/C Central, Tons Drains, Roof 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 Cap - Fixture Bath Fan - Vented, # Fireplaces, Number of - Pressure Vessel Sprinkler System 1 PLUMBING TYPE QTY. TYPE QTY. TYpE QTY. � TYPE QTY. A/C Condensate Drains, Roof Miscellaneous Fixture 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 Dental Chair Grease Trap Pump, Sprinkler Pump, Sump Utility - Sewer Utility - Water Discharge Well Ice Maker Dishwasher Indirect Wastes Relay Repair Vacuum Pump Il isposal 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 BY D ' TE Zonin: /.; Electrical Mechanical Plumbin_ AMIWIIIIIIIIM ANN �� y am_ j� .-Z--d Alo P — "Z•° Fire r Public Works Structural /, 9 ZD D 1 Building Official 4 �� \ Page 4 OFFICE USE ONLY CIII:CKLIS'I' ❑ 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 Metropolitan Dade County (C.C.F.) Inspector State Educational Fund $ State DCA (Radon) Code Enforcement Fine Zoning Review $ ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) O OTHER (Specify & Attach) PERMIT FEES $ S �� $ 300, o o (sq.ft. = x/1000 x 0.60) (¢.005 / sq.ft.) (¢.01 /sq.ft.) PERMIT APPLICATION TOTAL $ go- 3_ qS d ?� 1 REVIEWED AND PREPARED BY: ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) DATE: CONDITION OF APPROVAL 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com Revised July 2001 Page 2 IMPORTANT NOTIC 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 13Y 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 - Pleasel 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, tl: -c 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 accorda ith S : _ • s 13 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and ire Sign ure o Ow int Name and subscribed before me this 0 day of Signature of SEAL: Personally known tary Pub rida I -DADE Oy P,Q Y Po OFFICIAL hi 'OYAIRY SEAL 2 'ti B <, ANGELA M BECKER cn 9 / / 1 r'} ,} COM NUOBEFI CC 786697 ( t C7Y CO, s in:4 OF ra Prodildedrlcergti ica ., ' Type of Identification Produced: \ i, A (ci�dro Gr &a.o -9-f' 60-16f1 -6 STATE O�IDA, COUNTY OF MIAMI -DADE Signature of Contractor / Qualifier A v�rv✓u� .. °6fl.0 - L. Print Name Sworn to and subscribed before me this 'F day of O) PERMIT APPLICATION SEAL: • • Personally known V OR, Produced Identification Type of Identification Produced: n. Or • LiceaSP / ®OV` �r�a r•oPe *c°z �'YC!'O CONTRACTOR Name / A- Io ea evaruc_. 6-0 License No. — 6 c _ . 0 5'0 3 Address 9 Lei/ „6W s •• $ / �Fj /t/ta ,, p 33// / Telephon( ,V _tp /33 Fax (34s)24 , 2 — VV 1 Qualifier Name PROPERTY OWNER Name K0l 7..9 y._ C/ var rt q P 6 .. , Nam41U a— f i2EZ (Iv 7.2 C- f -r -G /e Address fig2 itAE. q3 >>4 idea n,,s #CEES .Cr 3 3 2? Home Telephone (3Vs) 75/ Gs3 — Fax Business Telephone 4 0.5 ). z 7- 270_5" Repair Fax Alteration Interior ENGINEER - Name K0l 7..9 y._ C/ var rt q P 6 .. , License No. D S © 7 / 2- Address 93 0 5 u.) a Tit (- A A, E /t.( /A.` 1 3 3 17 Telephone (30$) 2 z9 - 3 g ; 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 INS'I'RUC'I'IONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. 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. APPLICA'T'ION Job Address: Address Apt. Folio Number / /°-" J 2oG v /4./ D/ 74t) EAST /Z- Lot o Block l/F►�l 51 ES Subdivision S Ec7c7 - LL 1 Current Use of Property Proposed Use of Property Tenant Information k d ;Z Tat 9 PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other PB / U PG\ 31 Zoning PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Master Permit No. S O 0 Cam Subsidiary Permit No. 141` 14Cg City Description of Work State PERMIT APPLICATION 3'la Zip -F.40 / J+/ 6-04i1/4)s-4A-k. Linear Feet Square Feet SODO 7 Floors Value of Work /t� 4 .o. w Bldg Value - Tax Assessed/Appraised Value Flood Zone Base Floor Elev. NO. STREET PART OF LOT LOT BL'K TOWN, ADDITION, OR SUBDIVISION Signs ig Other Apparatus. Permit Fee .,d Outlets Motors Receptacles Generators Stoves Water Heaters Signs Billboards Other Apparatus. Permit Fee .,d ELECTRICAL PERMIT N. B. —This Permit must be on display on the premises during the construction. Owner of Building Contractor or Electrician....iw%. ;:'.;,:.5 :._ Town of Miami Shores OFFICE OF ELECTRICAL DEPARTMENT • . i. .'._- Miami Shores, FloridaZ4i. , ....�. 193...x. PROPOSED LOCATION DESCRIPTION OF WORK NUMBER OF N° 117 This Permit is granted upon the express condition that all facts stated in the Application are true and that the construction complies strictly with the plans and specifications submitted and are in accordance with the Electrical Laws of the State of Florida and with the Electrical Ordinances and Code of the Town of Miami Shores and the rules and regulations of the Electrical Department of the Town of Miami Shores. This Permit may be revoked at any time upon the violation of any provisions of said laws, ordinances, or rules and regulations, or upon any change in the plans and specifications unau- thorized by this Department. In consideration of the issuance to me of the foregoing Electrical Permit, 1 hereby agree to do the proposed construction in strict conformity with the Application and the plans and specifications thereof heretofore by me submitted, and in compliance with all provisions of all Electrical Laws of the State of Florida, all the Electrical Ordinances and Codes of the Town of Miami Shores, and all rules and regulations of the Electrical Department of the Town of Miami Shores. Dated 192 STRANGE PRINTING CO., MIAMI, FLA. , Electrical Inspector. 4 (Seal) PIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Type Insp'n // / Permit No. S O<[ h b Name Address Company Phone # S For Inspector JS / 0 Name & Date Approved L Correction Re-Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 ilding Inspection Request Da = £ , 0.2—Time Type Insp' .,. / • J Permit No. S 0 �C / 1 Compan Phone? - ForInspecto3 1,r19Z Approved Correction Re- Insp'n Fee 1)1 L Name & Date 19 � � 'f /AO /f /�� //9 ice' /' -eat /� f�' 01- 4,7 /IL-