The URL can be used to link to this page

PAINTMIAMI SHORES VILLAGE Paint Color Approval and Agreement DATE: c ' e b 40 ( D R OWNER'S NAME: ADDRESS: ********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ADDRESS OF SITE: l l S W, S� CONTRACTOR & LICENSE (if applicable) COMPANY NAME: PHONE: ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All Elements on the site must be listed and indicate the color to be painted. Walls � Floo l 7eilotw Fascia er GO hi Drip Cap/Drip Edge IDnvev k j 4 Soffit Roof Flower Bins Shutters Awnings Chimney Doors and door jams Garage Doors Railings Fences Decorative Metal 1( `` o i e V ( '` 1' All brick (simulated or regular) Do ' 0611e-) Stucco Banding Any other stucco features Accessory Buildings Other PHONE: 3O5 ( ( D X X SW1381 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 S. files. __■ AAA Sig C ture of Owner Datec -q- Q Signature of Contractor Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED: WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION 2e /5_,.02 -ily/d,2_ Building Official, Date 4/23/01 PROPERTY OWNER New Construction hn Theam, A Address 115 06 9y s'�r. Home Telephone a o 5 „ 7 6 ' - 4010 & Business Telephone D - &,76 &,76 '� 156 Fax TYPE OF MANAGEMENT (1 ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'] Attachment Other Add'] Detachment Other 0100 I Sic R `I1 I'he,followin step must be takenao obtain a p ro mth u -kpia ni iator es tlla 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 be submitted 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. 7A PPI.ISCATION Job Address: Address Folio Number 1 �� V Lot Block Subdivision PERMIT TYPE (,/ ) Building Electrical Mechanical Plumbing LPGX Roofing ]Fence Other PB PG PERMIT CHANGE ( ) Chg. Contractor Renewal Revision Extension Supplement einspection ARCHITECT Name License No. Address Telephone Fax Master Permit No. Subsidiary Permit No. 5j2 0( ,MCP cQ wit Shp'e$ PERMIT APPLICATION 33138 Apt. City State Zip Description of Work ex YID' pa I �5 Zoning Linear Feet Current Use of Property Square Feet Units Floors et) Use of Property Value of Work ' !OO Bldg Value Tenant Information 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 I. 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. STATE OF FLORIDA, COUNTY OF MIAMI -DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE Signat fe of Owner gnature of Ma ry Public SEAL: Personally known 14 47 c_, Print Irne Sw . nd subscribed before me this c-3 day of Print Name tate of Florida ' PU B NOTARY ANGELA MBECKER 14 " r! < � 0 COMMISSION NUMBER V/ J �0P Q CC786697 �lF cis MY COMMISSION EXPIRES OF F\ NOV. 15,2002 o, uce. . erittffba 'o " Signature of Contractor / Qualifier Swom 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: �� / / /7T ) 0 WsO7 I T'pe of Identification Produced: f !4,y to the order o CYNTHIA A. RHEAULT 115 NE 94TH ST. MIAMI SHORES, FL 33138 AA CRED17 UNION DALLAS /FORT WORTH BRANCH HEADQUARTERS - DALLAS /FORT WORTH, TX 88- 9290/3119 Dale CZG -fig "T O� 1:3 L L99 29041: HSO002 18 L 611 °0800 Dollars 800 5** MIAMI SHORES VILLAGE Paint Color Approval and Agreement DATE: /✓ 4 5- O, OWNER'S NAME: /. /i a Y ICi !, HONE: 305-751r ADDRESS: J)5 No 9.y `'T ADDRESS OF SITE: 16 Ng 94/ CONTRACTOR & LICENSE (if applicable) COMPANY NAME: PHONE: ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All Elements on the site must be listed and indicate the color to be painted. Walls m - e r See* Fascia . v1/4D1c1 2, Drip Cap/Drip Edge L,,.) (nA--€) Soffit v1/43hA Roof �h�� 00 V Y\e-ext5 Flower Bins 03Inky , doe c\ Shutters Awnings Chimney Doors and door jams (-c-rvP4 doom 11 16-1-or " "`� rneY � al Garage Doors ()A l\ °P) � lS v,�qt s Railings Fences Decorative Metal IA* L All brick (simulated or regular) vJhA--42/ Stucco Banding Any other stucco features S o.rn me r Scen4 Accessory Buildings VI *Kt 'C3. Other � door o n\ L) APPROVED: Building Official I A L / Date 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 sa •les. ‘).(. CA, ' Sign ure of Owner Date Signature of Contractor Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION 4/23/01 ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. I' I'Pl Outlet, Appliance QTY. 1 TYI'13 Service Repair ' ' Q 1; Y. 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 'eater (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 N�,1ECIIANICAL TYPE QTY. Minimum Fee TYPE Condensate Drain Q 1 } 1 I l } Generator i0 u -. 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. ' , rvPH; Miscellaneous Fixture QTY..f'PE 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 _,il I 11, I 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: 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 ❑ PROOF OF OWNERSHIP (Attach) LI HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) . 66 $ V (sq.ft. = x/I000 x0.60) $ (¢.005 /sq.ft.) $ (¢.01 /sq.ft.) • J ISSUING OFFICIAL REVIEWED AND PREPARED BY: SECTION Zoning Electrical Fire Mechanical Plumbing Public Works Structural Building Official BY 111.5 I 6 z . ATE PERMIT APPLICATION ❑ CONDO A APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ � h 0 DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2r'r° AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date r Job Address q s ' ax Folio a Legal Description Historically Designated: Yes No L.,/ O w n e r / L e s s e e / Tenant f . 6->e me l/ a}- 6 DM 0 Master Permit # 3? 7Y9 Owner's Address /\l E (Z) 115 M L q 1 .5'Tg e eT Phone Contracting Co. 6 Ln) &l E Address Qualifier State # Municipal # Architect/Engineer Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL OOFING PAVING FENCE SIGN WORK DESCRIPTION - -- tom ;, ^ q G2 or Le T a s Square Ft. Estimated Cost (value) i &coo . WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOU FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction4 this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. 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. Furthermore, I 'authorize the above -named contractor to do the work stated. Signature of owner and/or Condo President Date Signature of Contractor or Owner-Builder ^ 11 S 6 L i # , ¥ 3 Notary as to Owner and/or Condo President Date Not My Commission Expires: My FEES: PERMIT a 7 RADON APPROVED: Zoning Mechanical Plumbing d• rssro1XPg wog ea i�L CO (5ISSIO' ammo= Q CC4®12 1 �• rav COMPAISSIO1 F OF FAO AUG, 17 1998 , 5- U v o v NOTARY S, TOTAL DUE L 3. - 2S/ - 7(, 7 � SS# Phone Competency # Ins. Co. Address viOrro Date Date Buil Electrical Engineering PROPERTY OWNER Name 0 _ j f ai 1h u H- �It J Address H5 /JG 9i ST Home Telephone a 05 - 76 - g , _ / _ 1 o Business Telephone 30s _ 6R6 --- a c2.1. la 6 Fax 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 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 be submitted 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 Job Address: Address I3 Folio Number Lot Block Subdivision Zoning Linear Feet Current Use of Property Square Feet Units Floors Proposed Use of Property Value of Work g c0 CO Bldg Value Tenant Information Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PB PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other PG Apt. City L 7 9 / - 0 Description of Work ex PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Master Permit No. Subsidiary Permit No. 3 -G( I P ' PERMIT APPLICATION State Zip D z or pa r'Mi j 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. STATE OF FLORIDA, COUNTY OF MIAMI -DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE / 1 Signat of Owner k Print IVme i — Print Name Si � anddsu scribed before me this �� day of _ _ �..i iI . 'el "Ig nature of , Mary Public I tate of Florida .01,0 p OFFICIAL NOTARY SEAL SEAL: O 'e, ANGELA M BECKER SEAL: •Z -,..' 0 COMMIS/ON NUMBER ' ill' 4 ,: , ? CC786697 CI c), MY COMMISSION EXPIRES OF o.P NOV. 15,2002 Personally known o'uces 'en Signature of Contractor / Qualifier Swom to and subscribed before me this day of Signature of Notary Public - State of Florida PERMIT APPLICATION Personally known OR, Produced Identification Type of Identification Produced:1/,D2- R t13 D. ) 4-6 3 Col °Type of Identification Produced: CYNTHIA A. RHEAULT 115 NE 94TH ST. MIAMI SHORES, FL 33138 Pay to the order of Date AA CREDIT UFQION DALLAS /FORT WORTH BRANCH HEADQUARTERS - DALLAS /FORT WORTH. TX 88- 9290/3119 Ii,rr ': 3 L 199 290 41: P000 2 LB L 600E100 Dollars G }, 800 bad MIAMI SHORES VILLAGE Paint Color Approval and Agreement DATE: /— 45 O � OWNER'S NAME: ADDRESS: /QS NO 93/ sr. ********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ADDRESS OF SITE: //,- Ng 9z CONTRACTOR & LICENSE (if applicable) COMPANY NAME: PHONE: ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All Elements on the site must be listed and indicate the color to be painted. Walls Surrnme r Fascia vo1RA-e, Drip Cap/Drip Edge Lk) A-e) Soffit W \MIV -€ ) Roof Flower Bins Shutters Awnings Chimney Doors and door jams (- crvn4- door") t�.4ori Garage Doors W V\ l ) Railings Fences Decorative Metal All brick (simulated or regular) vJA -\---e_ Stucco Banding [„ a \d) \Ve Any other stucco features 5 o ,,m mer Se_en Accessory Buildings \f 4olvlc, fe k Other � door O nkj) 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 sa .les. ,, , ( apex/ Sign ure of Owner Date Signature of Contractor Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED: Building Official 0 -5 / 42 Date ( }l\ 5 A \°e CNON WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION HONE: 305 - 7Si -6./ 4/23/01 ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. TYPE Outlet, Appliance QTY. TYPE, Service Repair QTY. A/C Central 1 -3 Ton Miscellaneous Fixture Fan Soakage Pit Outlet, Wall Bath Tub Service, Temporary Drinking Fountain A/C Central 4 -7 Ton Miscellaneous Repairs Fire Pump Solar Water Heater Outlet, Switch Bidet Signs Filter Replace A/C Central 8 -15 Ton Pool Piping Fixture - Fluorescent Sprinkler Repair Oven Cap - Fixture Space Heater (kw) Fountain A/C Central 16-20 Ton Pump and Abandon Fixture Light Sprinkler System Parking Lot Lights Cap - Water Spas/Hot Tubs Gas - Appliance A/C Central 20+ Ton Pump, Domestic Flood Lights Supply, AC Well Plugmold/Strip Cap - Sewer Subfeeds, No. of Amps Gas - Natural A/C Window Pump, Fire Stand FPL - Load Central Temporary Toilet Posts Catch Basin Swim Pool, Commercial Gas - Propane Air Conditioners Pump, Re- circulate Garbage Disposal Temporary Water Closet Range/Range Top Clothes Washer Swim Pool, Residential Gas Piping Chiller Pump, Replace - Pool Generators, etc. Urinal Receptacles Dental Chair Switchboards Grease Trap Clear Violations Pump, Sprinkler Heat Recovery Utility - Sewer Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Dishwasher Refrigerator, Domestic IIndirect Wastes Temp for Test - 30 days Relay epair Deep Freezer Vacuum ° , mp Low -volt, Fire Renew - Temp Service Root Inlet Demolition Domestic Well Low -volt, Intercom/Teleph. Laundry Tray Repair Circuits Septic Connection Water Heater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New Drains, Area MECHANICAL TYPE Minimum Fee QTY. TYPE Condensate Drain QTY. TYPE Generator QTY. 'TYPE Refrigeration, Tons QTY. A/C Central, Tons Miscellaneous Fixture Cooling Tower Soakage Pit Heating Strips, each Bath Tub Vent Hood, Cost Drinking Fountain A/C Wall/Win. Tons Miscellaneous Repairs Dryer Vents, Number of Solar Water Heater Paint Booth Bidet Ventilation, Cost Filter Replace Air Handler, Tons Pool Piping Ductwork, Cost of Sprinkler Repair Piping, Flammable Liquid Cap - Fixture Periodic Inspections Fountain Barbecue Pump and Abandon Fire Sprinkler System Sprinkler System Process/Pressure Piping Cap - Water Gas - Appliance Bath Fan - Vented, # Pump, Domestic Fireplaces, Number of Supply, AC Well Pressure Vessel Cap - Sewer Gas - Natural PLUMBING TYPE QTY. TYPE QTY. TYPE QTY. TYPE QTY. A/C Condensate Drains, Roof Miscellaneous Fixture Soakage Pit 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 tee Maker Pump, Sump Utility - Water Dishwasher IIndirect Wastes Relay epair Vacuum ° , mp Disposal IInterceptor Root 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 Water Service Drains, Floor Minimum Fee Shower j 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: Page 4 OFFICE USE ONLY CHECKLIST O 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 ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) (sq.ft. = x/1000 x0.60) $ (¢.005 / sq.ft.) $ (¢.01 /sq.ft.) REVIEWED AND PREPARED BY: SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY PERMIT APPLICATION LI CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) PERMIT FEES TOTAL $ ‘S, , b (� • AIMAM ISSUING OFFICIAL 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 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE ''r'"' Date 02 .. '' S Job Address 1)5 N / 7 Folio . Legal Description Historically Designated: Yes No C� Owner/Lessee / Tenant R. (-, e /L i t l / q- 3 U N 0 Master Permit # _4/24) Owner's Address ((' ` — E 2/ ( 1 5 N - k 57—Se el Phone —1 /— --7 6-1 7 a Contracting Co. O C ) &I E (2 Address Qualifier SS# Phone State # Municipal # Competency # Ins. Co. Architect/Engineer Address " Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING M E ROOFING PAVING FENCE SIGN WORK DESCRIPTION �� _ e GQ-C'3 (e P TO G�Lc,° '_.. Pic) tee- / ))) Square Ft. Estimated Cost (value) $ c k o 0 WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating constructi� in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. 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. Furthermore, I authorize the above -named contractor to do the work stated. Signature of owner and/or Condo President Date Notary as to Owner and/or Condo President Date Not My Commission Expires: My g -c FEES: PERMIT a 7 o RADON APPROVED: Zoning Mechanical Plumbing Signature of Contractor or Owner - Builder �' t1J 0.x Date b(3 - ec `S Li # o '..3° A). ms xpw d8 ?IONTIE>., 34 ��f % COMMISSION NUMBEI 'r� � lr ;.r Q CC401261 -f �• Qp MY COMMISSION ..;: > >. � Op pv AUG. 17.10V I y �) NOTARY 2 t` Date cc) cc0 TOTAL DUE Li 3 Buil. ("P Electrical Engineering iiide(W gluts: t kCOVEVIeW4 quafe leeA • 4- • • :ti