DRIVEWAYCONTRACTOR
b,.4 S4 c�^
Name ZLD. C J C. Q ` ''\ e. \
°
Name
License No.
's C o w :1 2
. .
(2
1
Address CIV (
,
14,4 N,,,_q
Telephone A
2. _ t 4 1, Fax
Relocation of Structure
Qualifier N. s e
Foundation Only
PROPERTY OWNER
New Construction
Name ZLD. C J C. Q ` ''\ e. \
°
Address 9 4 g e E . `1 9 2. 5 + s-
M. CAA ° mot. aitk//
Alteration Exterior
/
Home Telephone (�3 J S) f/ 6 q 3 3 2._ b
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'I Detachment
Other
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Step 1.
Step 2.
Complete the attached permit application which must be signed by the prapetypWper ahjl cpaltfiek•Both signatures must be notarized. Please
print or type to allow for a more accurate processing of your appliatjpn: Y;ropfipg Mill be l e, a roofing application must be submit-
ted along with this permit application. • • • • • • • • •
•• • • • ••• ••• ••
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: 14g '`\-E. 3 C-A.N■ '42,) +�
Address
Folio Number
Lot 44V �es� C Blo
Subdivision 1-31
Current Use of Property %Y c
Proposed Use of Property 1,3
Tenant Information
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
Apt.
PG a
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
City
Description of Work
Zoning
Square Feet
Value of Work
.. . . • • • • • •
• • • • • • • • • •
• • • ••• • • •
• • • • • • • •
• • •.• • • • • •••
Master Pgrmil No.
S Pernilit•N?.: n'
• •••• •
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
ENGINEER
Name
License No.
Address
Telephone
Fax
1 . NC
PERMIT APPLICATION
State
'( ›tsCAN . •
Ra 4%1
Linear Feet
Units Floors
1 )- o3
Zip
Bldg Value
Page 2
IMPORTANT NOTICES
• • •
1. DO NOT BEGIN ANY WORK WIT1 OtT tIAVI13G RECTIVED Yb1JR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant
the right to begin construction. HOURS OF CONSTRUCTKN areiiftfited 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 PRAP$R•i'It S HAZ.LJ .K1rP'ISF1 E •FROM DIRT AND DEBRIS.
4. SWALES MUST BE PROTECTED Fjt 3M BUNC 11444E13 14 W UIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is
required for work in or near the street/sig ra& • • • • • • • •
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 ffLO COZT OF . IAI -DADS
Signat l `
F 'P •vr. `C 's
Sytgm a pcl, s ubscribed
Signatur
SEA
• •• •• • • •
• • • • • • • • • •
• • • ••• • • •
• • • • • • • • • • • •
••.. • ..••••• •
Type of Identification Produced:
•
ST ���-� • n _ I •
: i: • • ontracto Q
e
I: lifter
Print Name
Syvom t o agd subscri
, •I 1
V• ,
I
O
■ (%3
•
re me this / 7
day of
/
I a OX , FiLairel
tbt, C ..rat Ut yg �r�
Signature
SE
UNT
PERMIT APPLICATION
MIAMI -DADE
Personally known OR, Produced Identification Personally known OR, Produced Identification
Type of Identification Produced:
MIAMI SHORES VILLAGE
BUILDING DEPARTM
305- 795 -2204'
Building Inspection Re.,,est O)
Date L ' Time
Type lnsp'n � nG PY I O C.c1
Permit No. N2 t - Lon - fJ)
Name }CA.
Address - l `i V 9 L S T
Company
Phone #
For Inspector: /5 s . Name & Date
Approved
Correction
Re- Insp'n Fee
/ ,Miami Shores Village
-'0850 NE 2nd Avenue
hone: 305 - 795 -2204
Thzo rinted: 3/26/2003
Applicant: SHERYL CUCCHIELLA
Owner: CUCCHIELLA SHERYL
(, JOB ADDRESS: 948 NE 92 ST
Contractor ICOA CONSTRUCTION
Local Phone: 786 - 326 -4041
Parcel # 1132060060100
Permit Status: APPROVED Permit Expiration: 9/22/2003
Work: T DRIVEWAY
? e 4 e w e s v < . . . A Y , v A V . n < . v u v r < . . w e e z * < a < V A < - z < . < •.. '4 r ! < •r e i i v . •. i . v i •. v 'eV < c
SHERYL CUCCHIELLA
948 NE 92ND ST
MIAMI SHORES FL 33138 -2911
Pay to the
order of
WACHO
- Wachovia Bank, National Association
1:0530002 :77L98 98 0 4 0 4 511'000/06
Building Permit
Permit Number: BP2003 -485
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 12 & W1/2 LOT 13 LOT SIZE 75.000 X
Fees: Description Amount
FEE2003 -1777 Builder's Bond $300.00
FEE2003 -1778 CCF $1.20
FEF2003 -1779 Building Permit Application Fee $60.00
Total Fees: $361.20
Total Fees: $361.20
Total Receipts: $0.00
M 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.
Construction Value:
66- 21/530
106
$
a Foolutaa Dollars suc.m Dollars t B:
c: ""
equipment or device described in the application herefor in strict compliance with all
th any plans, drawings, statements or specifications that may have been submitted to
lot done in compliance with such ordinances or if the plans are changed without
x or builder named above assumes the responsibility for a thorough knowledge of the
s or in the statements or specifications and that he assumes responsibility for work done
BY:
BY:
$1,800.00
compliance with all ordinances and regulations pertaining thereto and in strict conformity
1 Village. In accepting this permit I assume responisibility for all work done by either
•
:�l�ti .i r'�' a•� fi
:
mew t Mat Found Ikon Pipt3 M/D.7aund Haas a Disc
atiraJWYnns :: • BRCr 1/�t�IIIBCJiot8a789
EMD
tct
-dm �
- CENT[1tt11L P/IJFF10FERTYW�, o%l- IU 2I[i
MAN Lt . WM- IACIREAMETER, Pta.PO1 1 POLE
. FAA COONFA. It∎fi Q 11.1•11111•510163 1.1•1.1•11111•510163 L11•510I
a _
1. WOOOFF osmium --
•
IOISJiJIVLJM[1 1 J oao V C.
E).ev.
Lomb=
(-w) 14o
Elnvattwn based on
cam •
NGV Daher?.
Index 4
•
f
L I Un ESS OTH RWISB M1. IRE F LUbW1NO NOTES APPLt4
t ` 1),Flonorf a®7 mewed Dan ire M substrata eoresuWV 21 Raring% 11 shown w bard an Pia data. 3) The Iona
▪ sahowfl r eeaW r. not absbectsd Ioof Easements or other recordedetncumbranca, not Osman on tM plal and :no aim*. if
!ti say eeay not bestow] on lllpaa wen. 4) Underground portIona of Faoolntre Foundations or other Improneeeats wets not
2`.IoCiLad. • d) Fie natons are head d m ah
National Geodetic burs 19 Fe ce Mao are w to u C.cI $n r
. of the toe... 7) Will) !:C7M To the face of (tt• WalL 8 ld•]' ithel * N_DIde aiiino TD Ml AZJIID Wins sMD P puce
•
d
J
•
• • •
•• •
•
•••••
o -21
eras.
a 10
entesza
•• •• .
• • •
• •
• •
• • •
•
• •
• • •
•• ••
•
•• •
• • •
• ••
NARK H.XRAJNtK
RegistereQLnnd Sun yor Na 337
Slate of Fiends
FLOOD ZONE
OATS:
1 - 97
SCALE:
Ij 4TMAJE
•
• �
• •
• •
• •
••• •
• •
aertit'ieCeo: Sn■
'St. Miami* * Shores
• •• •Ee11ey,••NA
�., Ati
••.Znc.• GreeRPoint
apcce, ds'd /o,
• •• • iitY appear.
12:111 O SSC,1174:C.Y : (Fur n1 hat a'i CUant)
LEGAL DESCRIPTION: LOT lZ and the West ;j o
OP AMENDED PLAT OP GOLDEN GATE PARK
ACCORDING TO THE PLAT THEREOF AS fi €COROEI7 IN PL
OP THE PUBLIC RECOTi09 O F DADS
, I HE71E3lY CiaTIFY That the sunray rpanwlad
hereon mettle ln. mrimum I d nical r•quwameel•
pool by the 3747E OF FLOAIOA eaaro of tend
Sawvwon autumns .fa Section 472.077 Ronda
Btatvlea.
The• are n. •■vow assasu I, e:uovmnta
app•ul an III• put ar m gta ass eme5IIa 0I•t
than a Shown bottom
Ji 1 !
COUNTY. FIOR
BLANC(
_I.
4100 Aurora st
Carat Gables I
Suit R
(305) 865 - 1200
0Ori
1 ^ 21
Ik R Zj
t .c. Ire,
STATE OF FLORIDA)
COUNTY OF DADE)
attached survey, performed by
s
rther, Affiant sayeth naught.
cn and print)
et`3' L .
SWORN TO AND SUBSCRIBED before me this
Affiant is personally known to me, produced
? ' ? ia,nt � l:LQt 4✓ •. l!E�dcc
property owner)
• • ••• •
• • • • •
• •••••••
•
•
• • • •
• • •
• • . ••
/7 day of
•
• • •
••• ••• ••
(name of surveyor's company)
ess sign - d print
• •
•.•
• ••
• •
•
• • •
• • • •
• •
AFFIDAVIT
•• • •• • •• .••• ••
• •••••••
• - ••• • ••. • • • • ••. • • •
• • • . • •• • • • •
• •
•• • • • • • ••• ••
G •
•
The undersigned Affiant, , does hereby attest that the
performed on , 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 rezulations. The Affiant further understands that the
existence of any such structures may affect final inspections as applicable to this or other permits..
as identification.
t 0,:acur''
ELECTRICAL
TYPE
Minimum Fee
(1"1'1".
'1'1'1'1?
Dryer
QTY.
Ti' "t;
Outlet, Appl nee ; • • :
W
'1') 1i•:
Service Repair
1)"1'1.
A/C Central 1 -3 Ton
Fan
Outlet,Wa11 - • • • . •
•
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
PLUMBING
TYPE
A/C Condensate
QTY"
TYPE
Drains, Roof
QTY
TYPE
Miscellaneous Fixture
Q
. I . 1 . P1.:
Soakage Pit
Q"I'1"
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
•
• • • •
• • • ••• •
• • • • • • •
•
• ..•
•
• • ;, PERMIT APPLICATION
• • • • • ••
• • ..
INSTRUCTIONS: Please indicate the type of work being perfogfed and quatr it s in space provided below.
MECHANICAL
TYPE
QTY. TYPE:
Q "I'1 TYI'I':
QTY. "I'YPI'.
Refrigeration, Tons
QT1
Minimum Fee
A/C Central, Tons
A/C Wall/Win. Tons
Air Handler, Tons
Barbecue
Bath Fan - Vented, #
Condensate Drain
Cooling Tower
Dryer Vents, Number of
Ductwork, Cost of
Fire Sprinkler System
Fireplaces, Number of
Generator
Heating Strips, each
Paint Booth
Piping, Flammable Liquid
Process/Pressure Piping
Pressure Vessel
Vent Hood, Cost
Ventilation, Cost
Periodic Inspections
RECEIVED AND REVIEWED BY: DATE:
SECTION
BY
D TE
5 vZ�
Zoning
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
Page 4
OFFICE USE ONLY
❑ OWNER - BUILDER FORM
(Attach)
•
❑ FIRE DEPARTMENT • • •
APPROVAL (Commercial / • • •
multi - family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
•
• •
• •
. ••
• •
• ••
•
••
• • • •
• • •• • • •
• • • • • •
• • • • • • • • •
•
• •
•
• •
CHECKLIST
d PROOF OF OWNERSHIP
(Attach)
•• • • • ••
• • • • • • • •
I'3 1ST fiti.M
(eptie / €e■er)
❑ IMPACT FEE
(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
30o
$
( x .6 x/1000
0)
(0.005 /sq.ft.)
(0.01 /sq.ft.)
ISSUING OFFICIAL
REVIEWED AND PREPARED BY:
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ 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