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PAINTD PERMIT APPLICATION FOR MIAMI SHORES VILLAGE ab Address /) i11g 9 � Owner / Lessee / Tenant /e97 / y 9 j Owner's Address 141 9 Contracting Co. < Z4 0AVeiy4C Qualifier SS# Phone 9/5 ' ® - l/ State # Municipal # Competency # Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION �� f 407 o't ff %F�s Signatfire o Date: 7 / No f ry -`s to My Commission E * * * APPROVED: C Square Ft. Estimated Cost(value) ;04 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 construction 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 nstruction and zoning. , Furthermore, I autI the above -named contractor to do the work sta owtia / and/or Co do President EPHiNE mks ;I. h • 5 o :Condo i 'ate; No. 1,6197545 PEES: PERMIT3/` J RADON C.C.F. ,5 -0 Zoning Buildin Address Fire Mechanical Plumbing Tax Folio / / laWd 1# A/10 My Commission v Master Permit # Phone ),641h /2/ <b. Ins.Co. NOTARY J r " TOTAL DUE If ¥i Other Electrical Engineering )1' ° MIAMI .SHORES VILLAGE Paint Color Approval and Agreement DATE: 1. 1 c 0 3 OWNER'S NAME: /►C 4 Mg. b r4 � 11,04J PHONE: 3 '1(7 fl� ADDRESS: l 2te-) n( - R 5 -11 S-r ********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ADDRESS OF SITE: 120o rJ - �= • q 5 714. CONTRACTOR & LIC NSE (if a licable) (tit 13G 00 21 COMPANY NAME: Y\ 1.14 PHONE: a ..11 . ************,********************* * * * * * * * * * * * * * * * ** * * * * ** * * * * * * ** All Elements on the site must be listed and indicate the color to be painted.. Walls g b>%iauia ithsoe6h (�l Fascia Drip Cap/Drip Edge ,,.1� Soffit v/1,,j -(E Roof (4ld - s Al..gy Coale. -Qo oak-- Flower Bins vi E Shutters r-1/A- Awnings 1 Chimney (q v Doors and door jams v■i'1tt Garage Doors vai-rE , Fences s i A-- Decorative Me al ,� All brick (simulated o r gular) vf�E Stucco Banding A- , Any other stucco fea ures vJ - p, , ,J L0,4 Accessory'Buildings Other \o" ding ding Official 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 ing. I authorize the above -named contractor, if applicable, to do the . • -ta - • . Furthermore , the paint colors will be , s per the attached sam • 1/c - 7- /S:03 r Date Signature of Contract ' r Date ********************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION cn r i. - ti . tn brilliant white - N z. - c to . Exi En 4/23/01 ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY" TVPF: Outlet, Appliance QTV' TN PI': Service Repair Q 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 AJC 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 TYI'F. Minimum Fee QTY. "1'YPF: Condensate Drain on'. TYPE Generator (inc. TY1'E Refrigeration, Tons QTV'. A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost AJC 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 T1'1'F: A/C Condensate QTY. TYPE: Drains, Roof QTl'. TYPE: Miscellaneous Fixture QTY. TYPE Soakage Pit Q'I'V. Bath Tub Drinldng 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 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 nce w'th Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and a C tractor. cco Choosi STATE 0 Signat ORIDA, Print N •t,' e i Print Name Sworn to and subscribed before me this 1 i day of JUN , Sworn and subscribed before me this day of Signature of Notary Public - State of Horida SEAL: Personally knr .wn Type of Identification Produced: UNTY OF MIAMI -DADE DALIA E. MADRID y 'F % : *. ��• .- Y COMMISSION # DD 214511 •.�* -: EXPIRES: May 22, 2007 Banded mm rotary Public unee+wnteis Signature of Notary Public - State of Florida PERMIT APPLICATION S F FL RI A, OWNT • MIAMI -DADE S ign tore of Contractor / Qualifier ," SEAL: Pilot, Angela M Becker My Commission 00150048 or n Expir AA ovember 15, 2006 Personally known ✓ OR, Produced Identification Type of Identification Produced: 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: SECTION BY QJ/ DATE 1 t-0k') Zoning Electrical r Mechanical Telephone 3 f .-. ( 6 Fax ,,�'7 4 Plumbing Qualifier Name ' 8 V/ S Go%JT Demolish Fire Relocation of Structure Public Works Foundation Only Add'I Attachment Building fficial Build Official \ a4 Other CONTRACTOR New Construction Name V 1 4 ? i - r- Enclosure License No. D pC Da / 7 / r Address 6 4 , /ti R ` ' 0 /' . ( v As E � Mt ; - 54c.4 ES 33i 3A7 Telephone 3 f .-. ( 6 Fax ,,�'7 4 Alteration Interior Qualifier Name ' 8 V/ S Go%JT Demolish PROPERTY OWNER l New Construction Nam ' • Name ` A m 5 L 0 , / C/U/�IV Enclosure Address / 0 M E 9 1 - 'Tif . �/Qn4 j S e r F( , 33(3' 1 Home Telephone (3osi 7S �.l ' O 34 Repair Busines s 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 Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi - family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) PERNIIT FEES $3.00 per page (Scanning Fee) Miami Shores Village Bond Inspector State Educational Fund $ State DCA (Radon) $ Code Enforcement Fine Zoning Review Notary ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) Metropolitan Dade County (C.C.F.) $ `' �v $ 5.00 (sq.ft. ) x/1000 x 0.60 (¢.005 /sq.ft.) (¢.01 /sq.ft.) PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) D BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ G. 60 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 I E J UL 2 2 2003 INSTRUCTIONS - The following sieps must be taken to obtain a permit from the Miami Shores Village: Step 1. 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: /- N Address Folio Number Description of Work Lot Block Subdivision PB PG Zoning Linear Feet Current Use of Property Square Feet Units Floors Proposed Use of Property Value of Work Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other ieaf.R.2(:, 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 submit- ted along with this permit application. g 5 s fri s Apt. PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection e7P PE RMIT APPLICA Master Permit No. 2cXJ3 - / rave Subsidiary Permit No. A,44;4 t She RES City 34.0 ereRl 7-c Do Tax Assessed/Appraised Value ENGINEER I Name License No. rot I CDG State 331 3 Zip Bldg Value Flood Zone Base Floor Elev. Telephone F MIAMI SHORES VILLAGFA BUILDING DEPARTMEN Date Phone # Inspection Date 305- 795 -2204 Building Inspection Request Type Insp'n fl o\ Mir* Permit No. ' X Y \ a `Q Name lcrTh mc%c\ . Address c� Cop E qS S • Company . Approved Correction ❑ Re- Insp'n Fee ❑ MIAMI SHORES VILLAGE. BUILDING DEPARTMENT Ik 305- 795 -2204 Building Inspection Request ,/ \\ 7 Date' -1 1 Type Insp'n fi f( Permit No. 9 Name 'LC ThC� r (Thc Address ' Cc) F Company y'1 I S c r k \ Phone # Inspection Date Correction ❑ Re- Insp'n Fee ❑ Approved