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585 NE 93 St (11)STATE OF FLORIDA) COUNTY OF DADE) Witness(sign and print) Angels M get . Ails, • My Commission 669 500 '1/4,1 Expires November 15, 2006 • • • • . •• • • s ' . • • • • • • • ••. • •• • • •�. • • ••• fl t 44 . -• • ••• • •••• .•• • • • • • • •• •• • • • • • • • • • • • . • • • • • • • • • • .• • r :• { A It ' • •• • • •I, • • • •. •• • •• • •• •••• •••••• ••• •• The undersigned Affiant, „767 r-fat2,7 , does hereby attest that the (property owner) attached survey, performed by (name of surveyor's company) performed on' Z 24 Zfa < 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. Witness(sign and print) SWORN TO AND SUBSCRIBED before me this t7 day o . Z 0 0_3 Z,3D -- 7�5 q ~ a i cation. Tax Folio #: following described property: requests permission to install: • • • •• ••• • • • •• • • • ••• WHEREAS, (owner) ••• • .. .•: ..:• • .•. ..• . • ••• • • • •• • •••••• • • •• •••• ••••••••• a • • • •• • • • • • • * • • ••• Asphalt, concrete, brick pavers [ ] Landscaping [ ] Other SIGNED. SEALED AND DELIVERED in the presence • /iorp� 4� C • to Q N p' SECOND AVE. IC I Sl D .E,S. f LORIDA 33138 -2382 t Telephone! (305) 795 -2207 Fax: (305) -756 -8972 • • • • ; •• •'• • . • • • • • • • • • •• • • • •• • • • ••• I . • COVENANT G�OIJST RUCTION WITHIN RIGHT OF WAY , hereinafter referred to as the Owner of the DR (U Etu t1 fPPeot ccf Legal description /folio #: Lot 2 'Z Block 5 Subdivision / O 1, ' ' .....< 4 7 4 e,& " 3 1 1//(/9PRe07)o( within the public road right of way of (address) IN CONSIDERATION of the approval of this permit by the Village, the Owner agrees as follows: I. To maintain and repair, when necessary, the above- mentioned item(s) installed within the dedicated right of way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said items within public right of way including restoration of street by reason of the Owner's failure to do so, such expense shall be paid by the Owner or shall constitute a lien against the above described property until paid. The owner does hereby agree to indemnify and hold Miami Shores Village or dade County harmless from any and all liability, which may rise by virtue of permitting the installation of these items within the public right of way. 3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days notice by the Village to do so. Failure to comply with this notice will result in the Village causing the item(s) to be removed and a lien being placed on the property and/or assessed against the Owner for all costs incurred in the removal and disposal of the item(s). 4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such time as this obligation has been canceled by an affidavit filed in the Public records of Dade County, Florida by the Village Manager of Miami Shores Village (or his fully authorized r- . - sentative). SIGNED, SEALED, EXECUTED AND ACKNOWLE IGE on thi O day o i.,- 6 s 0 rovl4C S PiPm 0 ln h N FOUK4 R e - )(441//9-7. 2v ) 1A 7 Uz, fd /2 4', p tr • • ••• •• •• •• • • • • '. • ,p • • ••• • • -••••• ••• • ▪ •. • • 11.25' 'Bo -30 y. B.5' Psalm Eurr ••• • • • •• • ♦ • • • 0041 • iaLV r- i1 mUN IZ oo F STZ.PS ' � 21 P PI c •z , eLoc∎c 11vCca Ls.tc : Co' c�>r a � ° • 1 ' o v $ 0 ' P "' C. 0a' t"Ov NO'�L " P CPC G,61pt4tot_v 117i 5 f. .J V �l N 5;.)1 l r • 1 • I. Il . cr !. • • ••I• • • • : 1 1 1 .! IO, i : ,, 1 • • • • • • X11•• • • • - 1. • • Q u - 5 .1 '. 1, 7 - 6 14 11 14 Sr. 1: 1. 2 C7 - tSA� .1 . ,S•L2 O tf 1 _ F ,. r' 1'. N S ; 1 .. 14 , r. 15 = ":. = 11 , ,. 1 ,. j. 1• 1 - _ ,. 1. 2 C7 - tSA� .1 2 i\11%6143 1 I :01-6170 IIJ 1 . 1ED TO: 36 431:1:Z• • • ••• • • • • .' • i- -tee • - • • • k©CATI • •• • • • • • • • •• •• • • . r . •ti • • • • • •' r ,416 L =N • i• • • • •• •• r4- • ••• • • ••. s• • 8.• •• • 4 25 0' GENERAL NOTES SURYEYING,INC. L.B. No. 3333 167 ALHAMBRA CIRCLE No. 241 CORAL GABLES, FLOR1DA ,33134 phone: D OM -84819 THIS IS A BOUNDARY SURVEY NOT VALID UNLESS SEALED WITH AN EMBOSSED SURVEYOR'S SEAL • SCALE •I = 1 00 • V, AZARO D. ALONSO PROFESSIONAL LAND S 1RVEYOI CERTIFICATE NO. 3590 STATE OF FLORIDA LEGAL. I)ESCRIPTION:1,ot 22 and the East of Lot 2] ,Block 56,MIAMI SHORES SECTION NO, '?, according to the Plat thereof as recorded in Plat Book 10,Page 37 of the Public Records of Dar County ,Florida.- 1) OWNERSHIP IS SUBJECT TO OPINION OF TITLE. 2) EXAMINATION OF THE ABSTRACT OF TITLE WILL HAVE TO BE MADE TO DETERMINE RECORDED INSTRUMENTS, IF ANY, AFFECTING THIS PROPERTY. 31 (2.22) DENOTES THOSE ELEVATIONS REFERRED TO N DATUM. 4) LOCATION AND IDENTIFICATION OF UTILITIES ON AND /OR ADJACENTTO THE PROPERTY WERE NOT SECURED AS SUCH INFORMATION WAS NOT REQUESTED. 5L THIS PROPERTY IS W I T HIN T .ME LIMITS OF FLO ZONE X cER R ark •m m rrA IMS WPTP tln e V 1S .- agV 1.. TO• Home Financin center,l u ccessors and /or Assigns,Ho) t1e AgencvJ • :'., Jerry S.1Woorefiead,National 'nth Comp. U A 1 :April 20,2: (1 . ! • 141 APPLICAOLEZONING. UNDERaaOURD. ZONING AND OuILDING SET IACKS . Mo9T a1E CI4ECKED DT owNER. ARCHITECT OR !BVILDKR 'cr'one DEHI GPI OR CONSTRUCTION 'COINS ON THIS •ROPC•TV_ I HEREBY CERTIFY: Thin the •lurched Plan of Survey of the oho.. dasrW.d property I t rue ,•d cornet to the but of my knowledge, inform,tion end ballot, a vacantly .Irv•yad 11d Waned ender my direction, too that there are not abpwgound encroac othe 1 10 1 Moue shown. This anew newts the minimum tec nilal atenda•da on forth by the Ficw i:1 Board of Land Surveyors Pura+ ■m to Chapter 61G17-- 6,Florida • •-"•' twat) .'It Code,Section 472-027 ,Florida Statutes.- 01/17/03 08:42 FAX 0 N FOUND 5 /8 1 RE- bocz -L„, r rn PLAN OF SURVEY scALE i~' 2 �1 1 — C. %.-N NC. . 0 49 0 s , c ) c • • 0 4 11.25' h 7 5 /4.1_11 T'l I NIUP1 R bo F BPS Z �S� 1 sro - qC•D•= 5 B5 93" SNOae$, rrL. 33+38 11.40' In In � } 6.5' 5b3Er16■s 0 0 R1 13.40 ' }•� rc 9.90' 160 S% 0,1C- 6 S� ` to • 1f � r') FooNo ?14� t-O .) NVIh .P? PM. •�J. '�61 ��u(D trk )- -- 16 2 1 P r., N/ rt C NCI � , a. 9 3 1Zn %Iv Cc. C.tiCI 00 C ETC (o3 302 01/17/03 08:42 FAX To: Miami Shores Village Altn: Al Berg Date: Friday, January 17, 2003 Re: Permit BP 2003 -51 M r. Berg, 1 have a driveway approach that Arrow Asphalt is working on. Fadel 17amdan suggested that 1 contact you, because I would like some help with this My Building permit allows 8 feet by the sidewalk and 12 feet by the street. I would like to have this amended to he 12 feet by the sidewalk and 16 feet by the street. My neighbors across the street recently had a driveway approach installed and 1 know theirs is much larger than mine. The current permitted approach looks so narrow compared to the other on my street, so 1 would like for it to look similar to the other homes on 93r Street.. 1 am attaching a copy of my survey with this new dimension drawn on it. Please if possible, allow me to have this additional width paved. 1 would appreciate your prompt altenLion, as Fadel of Arrow Asphalt is waiting to hear back from me. 1 am al work, and will not be able to leave until around 4PM this afternoon, so I cannot come in to see you personally. 1 would appreciate any consideration you can give me! Thank you, Work 305 -593 -1 1 19 Fax 305 - 593- 8240....ernail jrtropicals @att.net Jerry Moorehead 585 NE 93r Street Miami Shores, FL 33138 URGENT P ly - f oci-oW E01 3 . Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 1/13/2003 Applicant: 'JERRY Owner: MOORHEAD JOB ADDRESS: 585 NE 93 Contractor - " Local Phone: 0 (A3 �S vl Parcel # 1132060141030 Legal Description: ARROW ASPHALT & ENGINEERING, INC. DB /A DIGGER O'TOOLE 14799 NW 117 AVE. HIALEAH, FL 33018 (954) 963 -2381 (305) 556 -5702 PAY TO THE ORDER OF Fees: FEE2003 -220 FEE2003 -221 FEE2003 -222 FEE2003 -223 Description Building Permit Application Fee CCF Notary Fee Buildier's Bond Total Fees: DATE — a ;6 ��'' �j / A 9 / 4 il'00008 9 ? Sll' 1 :0 6 30000 2 LI: 9 98 L ? ? 7 2 20e Building Permit Permit Number: BP2003 -51 MOORHEAD JERRY ST Contractor's Address: 5742 SW 7 ST FIRST UNION NATIONAL BANK 63 -2 -630 AMOUNT, 42 7‘C. t 49 SIGNATURES REQUIRED Page 1 of 1 102 MIAMI SHORES SEC 2 PB 10 -37 LOT 22 & E1/2 LOT 21 BLK 56 LOT SIZE 75.000 Amount $60.00 $0.60 $5.00 $300.00 $365.60 Total Fees: $365.60 Total Receipts: $0.00 8975 inspection J[ )n herefor in strict compliance with all o ions that may have been submitted to if the plans are changed without ibility for a thorough knowledge of the he assumes responsibility for work done staining thereto and in strict conformity r isibility for all work done by either • • • • • • • • • • • •• • • • • •• • • • • • • • • • si • • • • • • • • • • •• •• • • •••• • • • • •• • _• • • FLORIDA — The Sunshine State JERRY STANLEY MOOREHEAD 585 NE 93-8T MIAMI - SHORES, Fl. 331'3872843 01 -18 -49 M 6 -00 14630-437-49-018-0 °d''01 -1Q- 1999 CLASS: E �l SAFE DRIVER : 1 ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer • • • • • • • ; • : • • ■ yT v. _ • - T 0'E • 1' tlet, Appliance QTY. TYPE: Service Repair QTY. A/C Central 1 -3 Ton Fan Ou 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 QTY. T1'PE Generator QTY. 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 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 Pum 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 • • • •• •;.; •• • g • • . • • • • • • • • • • • • • • PERMIT APPLICATION • •.• • • • •• • • • • . t•t • ■•• • ••• • • • •• • ••• • ••• �• }• .. • • • INSTRUCTIONS: Please indicate tlie type o f we -1. being teZirnid 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 • • ••• • • •• •• • • •• ••• • ••• ••• • ••• • • • • 11 ❑ PROOF OF OWNERSHIP (Attach) •• •••••_•••) . •. ❑ HRS / DtRM OR0 . Sid: (Septic/eSeeer) " *• =$••••• ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY D T • • • •• • ••• • ( sq.ft. = x/1000 x ¢.60) (¢.005 /sq.ft.) (¢.01 /sq.ft.) •. .. ••• • • •• • • ••• • • • • . • •. •• • • REVIEWED AND PREPARED BY: PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL • • • (Attach) •• • • • ••••• • •: C� iPR.4PPROVAL (Restaurants) • • • ❑ CONTRACTOR REGISTRATION (On File) TOTAL $3K-S (t 0 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 CONTRACTOR Nam e f® ,76,9017-1c4.36; , License No. 7 ..... ?�v0 Address / y ■ 79 9 A."54.) //7 ,q. /" � � # r6, ZIA! 4 Telephone��_/�7 Fax 3 t , Z 3 Qualifier ame / i1�jt� �6 [. , 3 L . PROPERTY OWNER d Name l��:i /ijC/' ,64., 4 4/ ,4 . Address s- / / 3 3.-, / /i 71/' �. Home Telephone 757--- / c /, Business Telephone Fax _r 7 ----g7 -- 7 ? e/ 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 • • ••• in • • •••••. .. • II- • 0%.10- • •••• •••••. • • • • •' ' ' PERMIT APPLICATION 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: cO / ` ' t 9 .7-7 PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other ARCHITECT Name License No. Address Telephone F • • .. Mastev�etmit No. ( • • •• • • •• •• • •. •• •• • • • • o r N3uts> lia2y Permit No. • ••• • • • •• •• • •• • • • ••• • •• • • • • • • R • • • ••,,,, •..• •• Complete the attached permit app ?iaatioa u� u bS signed tw the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more acciira't� pioc�ss n' oa a p e1 i c a mo n. If roofing work will be done, a roofing application must be submitted along with this permit application • • • .' • • • • • • •... • • •' Address Apt. City Folio Number �r r Lot 2-Z- Block 56 /� /49( /�f � OG �/ / & W I4e7 Subdivision H(A t i9t PB /0 PG 3 7 Zoning Current Use of Property Square Feet Proposed Use of Property Tenant Information PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection Description of Work Linear Feet o C ''-�[Jnits Floors • Value of Work 4 e7e?, Bldg Value Tax Assessed/Appraised Value State Zip Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax S 13--S 1 07 --eccoGP Page 2 INIPORTANT NOTICES DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED IRR N�L'IDA'I1 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 MAINTAINEI W ACJAAN. jv.E.AT AV ( Co4DITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE K$PT F444 tRoADIVT NERT •• 4. SWALES MUST BE PROTECTED FROM BEING DAMAG;D BY EQUmtr R 11113S,l1NtD WAY 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. STATE OF FLORIDA, C 11: Y OF MI • -D 'i E wner Print Name Sw to and subscribed before me this SEAL: ry Public �Statei f F10nda V0,01 ►t, Angela M Becker `F• My Commission 00150048 Expires November 15, 2006 Personally known OR, Produced Identification L SI�O ✓lat,`X COUNTY OF MIAMI -D E Signature of Contractor / Qualifier Print Name Sworn to and subscribed before me this 3 day of c - 6-^ 20 ©3. Signatur of Notary Public - State of Florida SEAL: pFr r -� 5HAVY My r'0MMISSION # o0 026739 Nut, EXPIRES: July 10, 2005 7 9 OFF�a�\ Po Thru Bu'gat Notary Services Personally kno w e = ° ---- ..... _.�.:. Type of Identification Produced: r / Y ) 3 0 `� ` " r ype of Identification Produced: • • PERMIT APPLICATION Page 4 OFFICE USE ONLY • • • • • • • • • • • • • • • • • • • • • • • • ••• • ••• • • • • • • • • • • • PERMIT APPLICATION 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 ISSUING OFFICIAL 0 \1t'1tz'W5 VIEWED AND PREPARED BY: SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE • • ❑ PROOF OF OWNtRSI-1IP (Attach) ••• • 0 CONDO ASSOCIATION APPROVAL (Attach) •• •• • • • •• • ❑ HRS / DERM APPROVAL • • • .Q I3 ,4PPROVAL (Restaurants) (Septic / Sewer) • • • •• : ❑ IMPACT FEE (New Construction) LI OTHER (Specify & Attach) $ (sq.ft. = x/1000 x0.60) (¢.005 / sq.ft.) (¢.01 /sq.ft.) 5 ( 3 P ot .d e r raV6 4 • • • • • • • • • • • • • • ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ 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. • TYRE. Dryer • � ' • C TYPE. Outlet, Appliance QTY. TYI'1: 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 QTY. TYPE Generator QTY. 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 _ PLUNIBING 'FITE 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 f ern p €rformed and quantity(ies) in the space provided below. • • RECEIVED AND REVIEWED BY: DATE: CONTRACTOR Name c/ Name L2ia 4.679 l-as .00.- License No. Business Telephone Address Fax 30(/ Telephone Fax Qualifier Name PROPERTY OWNER Name c/ "(OKE��I/ f'Y r1 ' . Address $ Home Telephone ey) 2 co / ao f-j4 Business Telephone Repair Fax 30(/ 593-- Wive, ENGINEERR Name �/�/ /.� 3/' 4R eed 7 Lam/ 6�Cr�✓ 2 t 4 / Ne License No. �1, 7 ?-oo Address / Y 7 9 Ask) 1(7 / fr t ' ` c 33 2t g Telephone 079 cr6 , f Fax (37 ..... 0�13g , TYPE OF MANAGEMENT ✓ ) New Constructions //Enclosure Alteration Exterior k Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'l Detachment Other "PP,eO/c • Step 1. Job Address: • • • • • • • • • • • • • • • • • • • • • • ••••••• •••• INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Complete the attached permibaopliiattnwlichinust Ge signegUy the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a moreacaurate Qrocessina o: !tour 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 PPLICATION ore 3 S� ��j'� -� ° ��'✓ �& Address Apt. City State Folio Number / Description of Work Lot ,o2,,,2 ,o2,,,2 ff 2 / Block 74 ti Subdivision / tP4 Si /9 PG 37 Zoning Current Use of Property ,6.-9r Square Feet /O Proposed Use of Property Value of Work y Bldg Value Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence ARCHITECT Chg. Contractor Renewal evision Extension Supplement Reinspection Name License No. Address /0j- Telephone Fax 4 •••• PERMIT APPLICATION • . • • • Master Permit No. • • • • • • • • • • • • • • • • ; • Subsidiary Permit No. • •• • . • Zip Ar ar Feet Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT CHANGE (✓ ) Page 2 Signature of Owner � o W Print Name I Swc o and subscribed before me this day �. , -.' tary Public Ignature o SEAL: tate of Florida -,,r n Angela M Becker • My Commission D0150048 1 Expires November 15, 2006 Identification known OR, Produced dentification �// • • • SEAL. Personally • • • • ... • • • • • • • • ..... • INIPORTANT NOTICES 1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIOA:TED PER AND P611tIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through cray 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., tlEA.TAND §4■NI TARY free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DL IT D�B�I .: •' 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VBNC ILE/, ?tight 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 ST OF RIDA COU =MIA -DADE Signature of Contractor / Qualifier / / 4-4/9 � 1 /A/ Print Name Sworn to and subscribed before me this day of 2_00 g gnature of Notary Public - State of Florida v °4`Y °�'; (SHAWN 0T00LE k MY COMMISSION # DD 026739 EXPIRES: July 10, 2005 9 Q . of Ro Bonded Tnr d t No ry S knew r __ _ - uceu.` -1`u s e • • • • Type of Identification Produced: F-4.jL, 1 11 6 3 t7 ' L137 " /3 .. &pe of Identification Produced: PERMIT APPLICATION MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date Type Insp'ly Permit No.L , T Q Nz J Address J a Company Vgd aAXt ki(1,1 z' I Phone # OS - Ci'� 5 ? ° Inspection Date / /2a/ U \-(1 Approved I ("R Correction ,/ ❑� Re- Insp'n Fee ❑ Inspection Date 7 / .)d/ ( r - Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspecti.oriRequest Date / f i ? 0 \( .✓ OU c ,vv -`�J�j -..i / '� I Type Insp'h A 1 J Permit Nol P © _ Nayrfe 1 /i' ti� Di_9 Address S35 f) f) , 7 Company . A . i.0,0 Phone # Ci) c - (._ 5 9 0 �-- s co Correction MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Dat Type Insp'n Permit No. Nam( Address Compan Phone # For Inspector 2 / Name Re- Insp'n Fee ❑ 'Zo - 3�6 h Sct" ``S U'eQ4 S 4. f, a rE Q