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801 NE 92 St (7)MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date Time Type Insp'n L , / L f °� � ii' ( Permit No. o T \, Name a 7.1 Address Company Phone # For Inspector:, .pprovel4 Correction „ Re- Insp'n Fee ❑ 0 BUILDING ELECTRICAL PLUMBING ROOFING MIAMI SHORES VILLAGE. FLORIDA ❑ El r. DATE l 195 1 ❑ PERMIT N? 6151 Contractor's License No. Work to be performed under this Permit Owner of Building Architect Contractor or Builder Legal Lot Description CONTRACTOR OR BUILDER Bl. Address of Building Signed Subdi- vision Value of // II Amount of / ---- Project $ 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 potosiiics. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the pr1 ns are changed without authorizatio. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thoroug nowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications . that he assumes responsibility for work done by his agents, servants or employees. BY- INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work coed hereunder in compliance with all ordinanA regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores In ac- cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. BY AUTHORITY 6 MIAMI SHORES VILLAGE APPLICATION FOR BUILDING PERMIT Owner's Name and Address...!,1. /4 r.X10 ! n 74 2 4- BUILDING INSPECTION DEPARTMENT Application is hereby made for the approval 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. Registered Architect and /or Engineer Name and address of licensed contractor - -. - -�o n e. Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done J a 1 /' State work to be done and purpose of building (by floors) .. L2.1./G - -f. /- t"i Date OC..2(L6 e 1 No. ... Street./V 9 ...f P .. ' tx//7 G,t' and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation ve. Roof Covering Estimated Total cost of improvements $ - too 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 5966, 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 ublic notice or notices as are required by the Act. The undersigned agrees to employ only syclr bcon actors, on work to be • • . der t ih s1 pennit, as are licensed by Miami Shores Village. Remarks (Signed) STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared 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, 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 Date Read, Sworn to and Subscribed before me. Disapproved Date Notary Public, State of Florida (Signed) Building Inspector My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approved Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. PROPERTY OWNER New Construction ,` r � Name C Z (R. L . 0 is`z__C� 3 Enclosure ' \ i`-',-- q S± Alteration Exterior Home Telephone (3� S, GA cf / , - ?, 3 Business Telephone Demolish 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. Subsidiary Permit No. 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. 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. APPLICATION Job Address: PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other ?A 457' M5- Address Apt. City State Description of Work Folio Number Lot Block Subdivision PB Current Use of Property Proposed Use of Property Tenant Information PG Zoning PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Zip Linear Feet Square Feet Units Floors Value of Work 2 0 0 0 -2 Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. 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 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. SEAL: Oft a of ST TE OF FLORIDA, COUNT OF MIAMI -DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE Personally known 1 7 r1 day o e , Print tjl1me Swom to and subscribed before me this ature of otary Publ 7 ,S,fate o Fzl9114 a._ L , " u" V< AMC.c'LA M - vAcir a ` 0, j; Produced Identification Signature of Contractor / Qualifier Print Name Sworn to and subscribed before me this day of Signature of Notary Public - State of Florida SEAL: PERMIT APPLICATION Personally known OR, Produced Identification Type of Identification Produced: P")., Type of Identification Produced: ELECTRICAL •1 1'1:. Minimum Fee QTY. TYPE Dryer QT1'. TYPE Outlet, Appliance Q'fl. '1 rl•: Service Repair Q 11. 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 NIECHANICAI, "1 Minimum Fee QTY. TYPE Condensate Drain Q1'1'. TYPE Generator ()Ty. 11 IT Refrigeration, Tons Q11. 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 _ PLUI 1131NG •1'VpL A/C Condensate QTY. T1'1'i: Drains, Roof ()Ty. Tl Miscellaneous Fixture QT1'. '1'l pl.: Soakage Pit O) 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 Zoning G� i P � .E Electrical - Mechanical Plumbing Fire Public Works Structural ,,,,./ ....<0 9- 77- 4 2-- Building Official 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 Notary ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) $ C ( x . 60) x/1000 (¢.005 /sq.ft.) (¢.01 /sq.ft.) PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ 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 • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com A Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 10/21/2002 Applicant: BERYL BURKE Owner: ROBERTS JOB ADDRESS: 801 NE 92 Contractor Local Phone: Parcel # 1132060050110 Fees: FEE2002 -5933 FEE2002 -5934 FEE2002 -5938 Description Building Fee CCF Notary Fee Total Fees: Amount $120.00 $1.20 $5.00 $126.20 Total Fees: $126.20 Total Receipts: $0.00 Permit Status: Approved Permit Expiration: Work: Exterior painting as per agreement 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 callinn few DR. CHARLES DIXON 06-01 BERYL R. DIXON 801 N.E. 92ND ST. MIAMI SHORES, FL 33138 -2908 order of Pay to the 446 Date /01' &LAI /4. i 4 .....v -- L I e b Dollars Bank of America Advantage BankofAmeriC a ACH R/1'111000025 For ,: L L 30000 2 31: 005776005? u Building Permit Permit Number: BP2002 -1804 ROBERTS BERYL BURKE ST Contractor's Address: Legal Description: 6 53 42 GOLDEN GATE PARK ADDN PB 6 -130 LOTS 12 & 13 BLK 1 LOT SIZE 4/19/2003 Construction Value: $2,000.00 1048 he equipment or device described in the application herefor in strict compliance with all with any plans, drawings, statements or specifications that may have been submitted to 35-2/1130 TX ; not done in compliance with such ordinances or if the plans are changed without 1830 :tor or builder named above assumes the responsibility for a thorough knowledge of the ,gs or in the statements or specifications and that he assumes responsibility for work done compliance with all ordinances and regulations pertaining thereto and in strict conformity s Village. In accepting this permit I assume responisibility for all work done by either Page 1 of 1 8 BY: BY: MIAMI S HUKES VILLAGE Paint Color Approval and Agreement DATE: /U /61 OWNER'S NAME ° , -1 1 0 e �,_� PHONE: ADDRESS: / c ************************::********* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ADDRESS OF SITE: CONTRACTOR & LICENSE (if applicable) COMPANY NAME: PHONE: . ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All Elements on the site must be listed and indicate the color to be painted. Walls Cori - 1. Fascia Drip Cap/Drip Edge _ Soffit • i� «�� . �- c Roof n Flower Bins Rcikkit-4=0 ( r 3 Shutters ro Awnings . -cn Chimney Doors and door jams F L1 ^ Garage Doors Railings • Fences 56 A BPT ( n,� . z Decorative Metal "'All brick (simulated or regular) Stucco Banding Any other stucco features Accessory'Buildings Other • 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 the work stated. Furthermore , the paint colors will be as per the attached ample StiA)71 - o - g - . ture of Owner Date Signature of Contractor Date ************************************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED: WHEN PAINTING IS FINISHED, (D Building Official Date 4/23/01 CALL FOR FINAL INSPECTION