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46 NE 92 St (12)PROPERTY OWNER New Construction Name.�r, O M pt.s i s S E N KI N S Address Alteration Exterior Home Telephone 7 r1 7 541 60 7 ,_ Business Teleph • 7 5) k y p 7 , 5 u o COL / l XXi Fax Relocation of Structure 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 Master Permit No. 4/ V 909- 6 Subsidiary Permit No. 50 c INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: 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. APPLICATION Job Address: '1( N E C M. S t Address Folio Number Description of Work Pi11-lT X!, u-)A L LS Lot Of /0 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. 7+ E' // 8 Block Apt. Subdivision 141 S No t`eS I -14+N tPB PG Zoning Linear Feet Current Use of Property SIN CICU c4 i' 1L/ !4 ot14 e Square Feet Units Floors Proposed Use of Property X Value of Workik ( n() Bldg Value Tenant Information Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Q iAt-I 1st r PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Mr f}w►I SHORE City EC State PERMIT APPLICATION 3Sl8F Zip ENGINEER Name License No. Address Telephone Fax CONTRACTOR License No. Name Address Telephone Fax Qualifier Name 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 13E 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 II F FLORIDA, CO 4 Si ature of Owner Print ame Sworn to and subscribed before me this ) T day of ND V an) i . 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 PERMIT APPLICATION Signature of Notary Public - State of Flo(ida // Signature of Notary Public - State of Florida L FFICIANOtARY SE.AL SEAL: SEAL: O V- PU e ( BARBARA ANN FUGAZZi i 2 l j i CCP9Y: SSiOU NUMBER 1p :, Q 00723468 Personally know ��E ' g ,, \. C) OR t� 1 41j_tifitalion `• Personally known OR, Produced Identification Type of Identification Produced: F � C)V1 dCX 15Y t1 1 S Type of Identification Produced: LcceN.se_ 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 Ductwork, Cost of Service, Temporary Periodic Inspections A/C Central 4 -7 Ton Fire Sprinkler System Fire Pump Outlet, Switch Fireplaces, Number of 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 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. TYPI. - 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: SECTION BY DATE i/I -(�Vtr Zoning / 24 (/ Electrical Mechanical Plumbing Fire Public Works Structural Building. Official f ((77 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.) $ t 0 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) ❑ OTHER (Specify & Attach) $ z 0 5,0 0 (sq.ft. = x/1000 x ¢.60) (¢.005 / sq.ft.) (¢.01 /sq.ft.) REVIEWED AND PREPARED BY: PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ h 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 11'11.t1LiV11 1.J1xv _A_o...ALJ Paint Color Approval and A DATE: // =c:.; / OWNER'S NAME: --: //1,.n „ ,7 ,.k,' ”, c. S ADDRESS: r .t i , 9 ��= c- J xx xxxxxxxxxxxxVxxx ;axxx *xxxxxx )Cxxxx3A ADDRESS OF SITE: -- --- 1 CONTRACTOR 8: LICENSE (if applicable) COMPANY NAME: K* x 1) xx x**x xx xxx xxxxxxVx.4xxxxxxxxxxxxxxxA x All Elements on the site must be listed and indicate • Walls �� f) (- C7== =- -7 /76 '" Fascia _5. r� =v. <.._. %(; 0 0 Drip Cap/Drip dge ti Soffit - c �,' !? � = cn Roof r \' l) . cn Flower Bins ti P aonat r Shutters f •N P ti cn Awnings /`--) N" Chimney /► H C ' ) H ��-��- Doors and door jams /-% f Garage Doors ,ti-= " h Railings IC Svh �Cc JL • cn Fences W h -,-__=_ Decorative Metal x All brick (simulated or regular) ti A- Stucco Banding Any other stucco features ,'- P- Accessory Buildings A S Other q( • L.,L.,)--1 � • rn 0 �' a.—(10 ` � -B OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating to construction and zoning. I authorize the above -named contractor, if applicable, do the vorlsr tated. • rth ' pre , the paint colors will be as per the attached 1 Signature of i► wner Date Signature of Contractor Date APPROVED: WHEN PAINTING IS FINISHED CALL FOR FINAL INSPECTION 4/23/0 aen Building Official Date 6 / J1 y r' -/i3t ),(111 MIAMI SHORES VILLA Paint Color Approval and Agreement ,. �. // //3/ :c OWNER'S NAME: t ) S PHONE: - )S - 1/4/ G d 73, ADDRESS: F DATE: xche* x 3xx*** xxxx;c CO /),' Q E_ Decorative Metal All brick (simulated or regular) N A- Stucco Banding n� Any other stucco features la- Accessory Buildings Other Signature of i►wner Date * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED: ae1 ./l /%/ Building Official Date xxx xxxxxx * x x?Cxx )Cxx >4* xxxxxxxx *xxxxx x7c ADDRESS OF SITE: V A) - 9 L5A -= CONTRACTOR & LICENSE (if applicable) COMPANY NAME: PHONE: SC X x All Elements on the site must b listed and indicate the color to be painted. Walls Cc� ? /// Fascia (- C - -- (: — Drip Cap/Drip kclge . �% i Soffit �.- Roof Flower Bins Shutters ti 14 Awnings Chimney (L RiM Doors and door jams Garage Doors Railings Fences x OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. I authorize the above -named contractor, if applicable, to do th'vorkr tated. • urth pre , the paint colors will be as per the attached Signature of Contractor Date *** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION 4/23/01 E:. i iza& c ' eit/zi ,e, ftreeo ../fiiu u Lc P , ' 88/86 PAY TO ' THE ORDER OF U` ON PLANT � NK BAY HARBOR O 1132 KANE CONCOURSE $v BAY HARBOR ISLANDS, FL 33154 TOLL FREE (877) 848 -2265 FOR 1:06 70084 Loo: P6 2680008 380 L080 -841 6268 670 Vi 1080 $ h v O A F..... DOLLARS