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DRIVEWAY
MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date A 43-4/ -® 2 ° Time Type Insp'n Permit No. Name Address Company Phone # For Inspector: - / i me & Date A pproved Correction Re- Insp'n Fee 0 MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date -4 `AZ) Time Type Insp'n 41 6°.2,0 ,& / /e41.: � 2 jj II" Permit No. 13 6°. ® Name ?O /Pfri,, Address 95-3 f� Company i 7 � Phone # 3 /X /U 7r6 For •ector: Name & Date Correction Re- Insp'n Fee ❑ - 1?/ 11. 1 tapAd 4 J24 Z-c.) As ) /44i PROPERTY OWNER New Construction Name /e_jp0 n ,, i/t ,g6�., / f Address #.. /4 9,)% / Repair Home Telephone 6 g . ^ (.,2_ / 9 Business Telephone 3©5 P- e 6/ 37 (c I O Fax 3 _ ` 2 — 63- - 7 TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add '1 Attachment Other Add 'I Detachment Other of INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Villhge: Step 1. 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 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. APPLICATION Address PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Apt. '1 Master Permit No. Subsidiary Permit No. 8 City Folio Number > Description of Work Lot Block Subdivision PB PG Zoning Linear Feet Current Use of Property Square Feet Units Floors Proposed Use of Property ,k Value of Work dO - Bldg Value Tenant Information PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Tax Assessed/Appraised Value PERMIT APPLICATION 32/3P State Zip ANE7,2 ?;02.iur` -,u, Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. Address Telephone Fax Qualifier Name Page 2 I1\'IPORTANT NOTICES 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. 1. 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. ST 1 Signature of • wner \Print Name 6AG- . /6) 2 -A/1 nd subscribed before me this ( day of -l--C 0 _ '0* COMMISSION NUMBER qr. a CC786697 ISS O pn COFAMION EX PIR 9r F OF F� .. NOV. 15.20 SEAL: ature of No Personally known OR, Produced Identification L� Type of Identification Produced: Y OF MIAMI -DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE Signature of Contractor / Qualifier Print Name Sworn to and subscribed before me this day of Signature of Notary Public - State of Florida SEAL: f. a PERMIT APPLICATION Personally known OR, Produced Identification Type of Identification Produced: 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 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) $ (0.ad $ cSooIoo $ /A g V REVIEWED AND PREPARED BY: B SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official DATE yf� (sq.ft. = x/1000 x ¢.60) (¢.005 /sq.ft.) (¢.01 /sq.ft.) • PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) PERMIT FEES 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 ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. TYPE Outlet, Appliance QTY. TYPE 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. TYPE Condensate Drain Q'T'Y. TYPE Generator Q'T'Y. 'TYPE 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 PLUMBING TYPE A/C Condensate Q'T'Y. '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: Village of Miami Shores 10050 NE 2nd Avenue Miami Shores, FL 33138 Phone: 305 - 795 -2204 Printed: 2/4 /2002 Applicant: FRANCES Owner: ROLPH Contractor Local Phone: Parcel # 1132060140260 Job Address: 453 NE 92 ST Fees: FEE2002 -664 FEE2002 -668 FEE2002 -669 FEE2002 -670 Description Amount Buildier's Bond $300.00 Building Permit Application Fe$60.00 CCF $1.80 Notary Fee $5.00 Total Fees: $366.80 This Permit is granted to the contractor or builder named above to construct th ordinances pertaining thereto and with the understanding that the work will be per and approved by the properr municipal authorities. This Permit may be revoked a: authorization. A further condition upon which this permit is granted is the underst ordinances and regulations pertaining to the work covered hereby whether shown by his agents, servants or employees. Signed: (INSPECTOR) In consideration of the issuance to me of this permit, 1 agree to perform the work with the plans, drawings, statements or specifications submitted to the proper auth myself, my agent, servants or employes. Signed: (Contractor or Building Permit Permit Number: BP2002 -218 Address: Cellular: ROLPH FRANCES Page 1 of 1 Legal Description: 6 53 41 MIAMI SHORES SEC 2 PB 10 -37 E1/2 LOT 18 ALL LOTS 19 & 20 Total Fees: $366.80 Total Receipts: $0.00 Permit Status: Approved Permit Expiration: 7/31/2002 Construction Value: Work: PAVER DRIVEWAY (OWNER BUILDER PERMIT) • 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. $2,300.00 `� 0174 RODNEY H ROLPH FRANCES H ROLPH 453 NE 92 STREET MIAMI SHORES, FL 33138 Pay To The Order Of _ ,5/6/415 V5 I ��E° • �0 /�f!/ Ce . WACHOVIA Wachovia Bank, N.A. Hollywood, FL 33021 m . it72 -f -flT/ 'a 1:0670 L3564 2 L 1,37 63-1356/670 o �L BRANCH 6 03 Date G!7 Dollars ><y 8 0.101. en Wc.. nr L E 4'34E04 WIRE HENCE CTYPJ ' • TqEW 61E • • ••• • • • ••• •• • • • • • • • •• ••• • • • • • • • • • • • • • • • • • • • • ••• • • • • • • • • • • • • • • • • • ••• • • • • • • • ••• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •• 1 • • • • • • • • • j. • • • • • •• • •, • ••• I •• • • • ,•• ••• •• • • • • .' • • • • • ••• •''• • • •• • • • • '• • • • • • • • • • • • • ••• •• - Pavers, Inc. gf1A Q IA/ 1 of r f NO/10 Installation, Repair, Pressure Cleaning & Sealing Brick Pavers CARLOS MACEDO, President T_. ,nn n_n1 .n 24 STAN.Ed6 NEU 6TEPe MPG= cONC, nix wa_ EE ELSVATlatfORttErAti O 0. • • • 410. • • • 0* 00 • • • 00 .. • • • • ... • • • • • • • • • • • 000 • • • • .00 • • • • • ■ • • • • • • *SO • • • • • • • • • • • • • • ... • • • 000 • 00 000 .. • • • .. • • • • • • 41 • 0* 4100 • • • • • 00 AO