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875 NE 92 St (8)SECTION BY DATE ( ://‘14. Zoning ,� ® Electrical Mechanical Plumbing Fire Public Works Structural Building Official ?f 12 Page 4 ONFICE 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 Notary ❑ PROOF OF OWNERSHIP (Attach) O HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) O OTHER (Specify & Attach) $to $ D $ c C (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 TOTAL ISSUING OFFICIAL REVIEWED AND PREPARED BY: DATE: Revised July 2G01 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 I Dryer QTV. T\'PE Outlet, Appliance ()Ty. TYPI.: 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 1 TYPE 1 Condensate Drain QTY. TVP Generator OTT. TITE 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: TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'l Attachment Other Add'I Detachment Other e INSTRUCTIONS - 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 he submit- ted 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 ob Address: ' g 0 5 1 9 5 Address Apt. Folio Number description of Work Lot Block Subdivision PB PG Zoning_ Linear Feet Current Use of Property Square Feet p Units Floors C..l Proposed Use of Property Value of Work 7 17® r 0 Bldg Value Tenant Information Tax Assessed/Appraised Value Flood Zone Base Floor Elev. 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 PROPERTY OWNER Name Home Telephone Businsss Telephone Fax h p-s. /‘-') Master Permit No. Subsidiary Permit No. d ,,/L City State .iP;i.t -e 16 PERMIT APPLICATION Zip ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License o. 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. 0 - i ature of er STATE 0 Print Name / ' wom to and subscribed before me this 4 / day o 11L ir i . , I 1,A ature of N Pry Public - tate of Florida Po r Personally known Ott I e Ide ttification Personally known OR, Produced Identification Type of Identification of Identification Produced: SEAL: R DA OUN F 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: PERMIT APPLICATION STATE OF FLORIDA) COUNTY OF DADE) The undersigned Affiant, C does hereby attest that the (property owner) attached survey, performed by performed on ( too survey) Further, Affiant sayeth naught. AFFIDAVIT name of surv''or's company) is an accurate representation of the existing conditions and 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.. KAffi . Notary owner Witness(sign and print) Witness(sign and print) SWORN TO AND SUBSCRIBED before me this day of Affiant is personally known to me, produced as identification. /d1fl��f/,bJ� -- WHEREAS, following described property: Legal description/folio #: Lot Tax Folio #: requests permission to install: COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY ( Block Csphalt, concrete, brick pavers [ ] Landscaping [ ] Other Q�1 within the public road right of way of 1 5 N. + / S (address) IN CONSIDERATION of the approval of this permit by the Village, the Owner agrees as follows: 1. 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. 2. 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 banding 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 representative). SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE SIGNED, SEALED AND DELIVERED in the presence of: Mini SIior (/iCCccge 10050 N.E. SECOND AVE. MIAMI SHORES. FLORIDA 33138 - 2382 Telephone: (305) 795 -2207 Fax: (305).756 -8972 , hereinafter referred to as the Owner of the Subdivision f owner) DR[uECutiv A PPR or}ct . s0 ' /2 - / / .., /• 1 /. .I i. - / /R, y., Z rY V ,• ; t . Y y r , • t' . _ C LEGAL : • aESC1 iV 7 06"LO1'4 BL4G/4" / SUBDIVISION GO G� • .. /t/. • • • • • • • • ACCORDING TO THE PLAT THEREOF AS.liggaRDtip. O `AT WOK AT PAGE /moo OF THE PUBLIC RECORDS OF D�� COUNTY, FLORIDA. .... • •• ••• •• • • • • • • • • •• • • • • • • •• • • LOCATION SKETCH SCALE I " = /DO CARIBBEAN LAND SURVEYORS, INC. 7175 S. W. 8th STREET, SUITE 216 MIAMI, FLORIDA .33144 TELEPHONE 264 -9151 WE HEREBY CERTIFY:That the attached SKETCH OF SURVEY of the above described properly Is true and correct to the best of our knowledge and belief os recently surveyed under our direction, also that there are ' no encroachments unless shown. FOR: , ORDER No. BZa6 :..9 PROFESSIAL IIND SUR .' OR NO ' " 60 STATE OF FLORIDA NOT VALID UNLESS EMBOSSED SEAL� /Q�� / —�� QATt. FDG.ciO Jiiv� Ox/ L/N6. - O4/ .G//1.4E O. /NE O. /5 • GG.'" .. z /2,e- fr7.Vw4 7' � 7 SKET io. O ' pg Y tN ' • tki x x G #A /.v L //i/,4 .C�A/GG /V69.9L a' 0.05* 662 OA/ L 1A/5 , /OTC • IaD0_ 720 >.-9 - O.� 70 79: / SCALE: I "= Miami Shores Village 10050 NE 2nd Avenue Building Permit Phone: 305 -795 -2204 Permit Number: BP2002 -1094 Printed:6 /13/2002 Page 1 of 1 Applicant: RAFAEL BARBA Owner: BARBA RAFAEL JOB 875 NE 92 ST Contractor Local Phone: Contractor's Address: Parcel # 1132060050030 Legal Description: GOLDEN GATE PK ADDN PB 6 -130 W1/2 OF LOT 2 & 3 & E6.05 FT OF LOT 4 BLK 1 Fees: Description Amount FEE2002 -3366 CCF $0.60 FEE2002 -3367. Building Permit Application Fee $60.00 FEE2002-3368 Buildier's Bond $300.00 FEE2002 -3369 Notary Fee $5.00 Total Fees: $365.60 Permit Status: Approved Permit Expiration: 12/10/2002 Construction Value: $700.00 Work: DRIVEWAY 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. 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, ss or employees. In consideration of the issuance to me of this permit, I agree to perform 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 responisibility for all work done by either myself, my agent, servants or employes. Sign Total Fees: $365.60 Total Receipts: $0.00 (INSPECTOR) BY: (Contractor or Builder) BY: r•, r;�. r77.1.7./ 7 .65_ 6 n