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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 &#01M1. 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