DRIVEWAYMIAMI SHORES VILLAGE
BUILDING DEPARTMEN
305- 795 -2204
Building Inspection Reques
Date g Time
Type Insp'n
Permit No. • Ai
Name
Address
Company
Phone # g - 3a4—
1 o 7
For InspectarJ / 7 ( P3 ame & Date
Approved
Correction
Re- Insp'n Fee
7t,
Date
Type Insp'n
Permit No.
Name
Address f
For Inspector:
Approved
Correction
Re- Insp'n Fee
MIAMI SHORES VILLAGE
BUILDING DEPARTM
305 - 795 -2204
Building Inspection Request
Company (-- --15C - 4
Phone # ?g,0 A L- °
10 Name & Date
Time
CONTRACTOR
New Construction
Name - TOAD
,.1 rg)t.S 0.- •1 an_ �°
License No.
Alteration Exterior
Home Telephone (30 5) .1,' C - 1 2 -4
/
G o .332
Address
o f
=-3,..4.
S . 4 Lk w.t-Q , -
Telephone(
Relocation of Structure
6)
/
.3 26 4,044 Fax
Qualifier Ne
Foundation Only
PROPERTY OW ER
New Construction
Name ex Jac_
Enclosure
Address ar i g 61.E. 9 2.
„`, 'Lsu?'\ 4L .-18
Alteration Exterior
Home Telephone (30 5) .1,' C - 1 2 -4
/
Repair
Business Telephone
Alteration Interior
Fax
Demolish
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'I Attachment
Other
Add'l Detachment
Other
Step 1.
Folio Number
Lot 1 dock
Subdivision v t640 G r- PG
Current Use of Property S • *
Proposed Use of Property S °
Tenant Information
Address
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
Apt.
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
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• • • • • • •
• •••••••
City
Zoning
Square Feet
Value of Work
97
•
• •
• •
• ..•
• Master Perm °
it No.... � �
• tt�bsi;iiah 'en uC N0.
• • •••.
... ••• • • • .
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Complete the attached permit application which must be sigrelby1he;.propestyownesand qualifier. Both signatures must be notarized. Please
print or type to allow for a more accurate processing of your 'dpplir'Strpn; If ropfrng work will be done, a roofing application must be submit-
•
ted along with this permit application. • • • • • • • •
•• • • • • • •.• ••
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
Job Address:
► g 4.E. 92 S 6.0_0 J
State
Description of Work 0 .` ^t its
°
�
Zip
Linear Feet
Units Floors
20"
Bldg Value
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
ENGINEER
Name
License No.
Address
Telephone
Fax
Page 2
1.
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PERMIT APPLICATION
IMPORTANT NOTICES
DO NOT BEGIN ANY WORK WITHOUT RAVING RE €EIVE1 YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant
the right to begin construction. HOURS O?CON §TRUCTIMI are Gmited't8:' 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 11 MA,MI'AIN I •A CLEAN, e tl EAT AND SANITARY CONDITION free from construction debris.
3. STREETS AND NEIGHBORING PROPERTIES SHAi,L33ESK1WIbFRE6FROM DIRT AND DEBRIS.
4. SWALES MUST BE PROTECTED FROM EING D!M.4C4ED Be' F•QIiIPI NT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is
required for work in or near the street/sidewalle • ••• • • • • : : • ..
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°I Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in
accordance ith Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and
Choosi ._� ( ontractor.
JI .
Sign . e o
ersonally
ozik
before me this
Print Name
Sworn tto�d subsc
2 5 ,
AL:
o .O
At R / vi $ • , %- OF MIAMI -DADE
• er
otary Public 4,ar
11 � N 1 l���.i�
* : } ft d ice ,118e iiifica ion
STA . ; FLORIDA, u'• UNT O MIAMI -DADE
gnature o tractor/ Q
Print Name
Sworn to and subscribed
Signature of
SEAL
0411141- ( S �� S � �y' L ELI' 3 Ai:
Mqk ` 0=5
M
ersonally know OR, P r uce " e
n n
pe of Identification Produced: Type of Identification Produced:
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: BP2003 -349
Printed: 3/3/2003
Applicant: RAFAEL
Owner: DURAN
JOB ADDRESS: 918 NE 92
Contractor ICOA CONSTRUCTION
Local Phone: 786 - 326 - 4041
Parcel # 1132060060080
Fees: Description Amount
FEE2003 -1280 Buildier's Bond $300.00
FEE2003 -1281 CCF $1.80
FEE2003 -1282 Building Permit Application Fee $60.00
Total Fees: $361.80
Total Fees: $361.80
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration: 8/30/2003 Construction Value: $2,200.00
Work: PLAIN CONCRETE 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 built
ordinances pertaining thereto and with the understanding that the work will be perform€
and approved by the proper municipal authorities. This Permit may be revoked at any
authorization. A further condition upon which this permit is granted is the understandin
ordinances and regulations pertaining to the work covered hereby whether shown on th
by his agents, servants or employees.
Signed:
In consideration of the is nce to me of this permit, I agree to perform the work cov€
with the plans, drawings u or specifications submitted to the proper authoritie
myself, my agent, serva iiimen
employes.
TJ I!
Building Permit
(Contractor or Buik
DURAN
RAFAEL
ST
Page 1 of 1
Contractor's Address: 901 S. W. 4th Avenue, Apt. B1
Legal Description: AMD PL GOLDEN GATE PK PB 7 - 54 LOT 10 & N7FT OF LOT 9 IN BLK 1 OF
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WHEREAS,
following described property:
Legal description /folio #:
Tax Folio #:
COVEN NTOF CONSTRUCTION WITHIN RIGHT OF WAY
(owner)
Lot Block Subdivision
requests permission to install:
t iti Asphalt, concrete, brick pavers
[ ] Landscaping
[ ] Other
gig A. E, q2 thko4 - e'Pk V &LI awei)
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.
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 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 ully au , orized representative).
SIGNED, SEALED, EXECUTED AND ACKNOWLE
IGNED, SEALED AND DELIVERED in the p
flh jami SIlorQ� WVCtQ
10050 N.E. SECOND AVE.
MIAMI SHORES. FLORIDA 33138 -2382
Telephone: (305) 795 - 2207
Fax: (3051756 -8972
, hereinafter referred to as the Owner of the
L) K R) to
/} PPe O►4•ct
nce of:
owner
c L 62063
! GE ''this
� dayof
t/
_ _
-r VERIMo
s
BOUNDARY SURVEY
01.1.4, • • • • • • • • .
l•-•• ,....
• • • • ••• • • • • •
• • • • • • • . • • •
• • • • • • • • • • •'•
• • • • • • • • • • •
Lot 10 o)
Plat there
the Publi(
North 7
according
39, at Pa
Florida.
• Commune
Suffix: J
Field Woi
• Certified
Rafael Du
Insurance
successor.
Properly,
918 NE 9;
Miami Slit
Survey Nu
PERMIT NO. •, •
ADDRESS:
MIAMI SHORES VILLAGE
BUILDING / ZONING DEPARTMENT•
SECTION
BY
DATE
ZONING •
ELECTRICAL
MECHANICAL
PLUMBING
FIRE
PUBLIC WORKS
STRUCTURAL
BUILDING OFFICIAL
1. Subject to compliance with alt Federal. State.
Cocmty,Wlage rates and regulations. Wage tsstxstes
no retponsibWQty for accuracy otlor mutts (rosy
these plans.
2. This copy of plans must ba available on
building site or no Inspection will be conducted.
CRITIQUE SHEET
JOB ADDRESS
__7/C‘ /, 7,;1
APPLICANT
PHONE It
APPUCAT1ON j C L V L
SHEET OF
MISCELLANEOUS
DATE
} 1° ) iv 3
ZUNING
COMMENTS
seAme-k_
J
p lit s rvk QIc r 6ho/ s
INITIALS
t Miami ,Siz.or "0„itta
. AFFIDAVIT
• • • •
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• • • • • • • • •
•
• • • •
• .• • •
• •
• • •
• • ••
• • •
••• ••• ••
STATE OF FLORIDA) • • . . • • • • • • • • • • • • • • •
COUNTY OF DADE) •
• The undersi°nea Affiant, ca,,cL/ •
9 , does hereby attest that the
(property owner)
attached survey, performed by
performed on
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 applic..le to this or other permits..
Furt , Affiant sayeth naught.
sign and prin
••
(name of surveyor's company)
is an accurate representation of the existing conditions and
(date of survey)
r
Cet &Cott
Affiant/Pro owner
Witness(sign and print)
SWORN TO AND SUBSCRIBED before me this / 7 day of ,' 13
Affiant is personally known to me, produced as identification.
Az '
41(.../OP
471
ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPE
Dryer
Q1 .-.
•
'1 t•l.l:,
0 t . 4•Appliale • • •••
QTY.
(NIT
Service Repair
Q'rY.
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
Temporary Toilet
PLUMBING
TYPE
A/C Condensate
Q .1.1
TYPE
Drains, Roof
QTY .
TYPE
Miscellaneous Fixture
QTR•
TYPE
Soakage Pit
(yF Y.
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
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• . •
PERMIT APPLICATION
• ..
• • • •
INSTRUCTIONS: Please indicate the type of work being.I?erform$d acid quatayNie ;) in the space provided below.
RECEIVED AND REVIEWED BY: DATE:
Page 4
OFFICE USE ONLY
LI 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
••• •
•
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• •
••• •
••• •
• •
• •
• ••• • •
• • • • •
• • • ••• •
• • ••
•
•
•
•
•
•
•
CHECKLIST
• • •• ••• •••
❑ PROOF OF OWNERSHIP
(Attach)
•• •o• •• • • • • ••
• • • • • • • • •
• ❑•
•
• (Septic P Se*Vet) • •
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
$3D0
$ / �- 0 (sq.ft. = x/1000
x ¢.60)
$ (¢.005 /sq.ft.)
$ (¢.01 /sq.ft.)
SECTION
Zoning
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
PERMIT FEES
TOTAL $
ISSUING OFFICIAL
REVIEWED AND PREPARED BY: 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
BUILDING
ELECTRICAL
PLUMBING
ROOFING
MIAMI SHORES VILLAGE. FLORIDA
❑ PERMIT N° 6696 Contractor s
❑ License No.
Work to be performed under this Permit ` ' f ` '
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
Bl
DATR 195
1
Subdi-
vision
Value of II Amount of
Project $ I! 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 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 cr in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees.
Signed•
•
BY •
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 ac-
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
CONTRACTOR OR BUILDER
BY AUTHORITY
6 *: