PAINT PERMITCONTRACTOR
Name q � i3 77 °�/, �A L� te /
! !
"C G s
Address
/ ,v 9I-'74-
Name
C �(
Business Telephone
Fax
License No. ply/ /
Repair
Address , 7 ‘ i
iQ
1/7( Pkaff ;
/2e
'
3
Telephone •
Fax
Qualifier Name
Foundation Only
PROPERTY OWNER
Name q � i3 77 °�/, �A L� te /
! !
"C G s
Address
/ ,v 9I-'74-
Home Telephone C cSJ lit — 6 9
lit
Business Telephone
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'l Detachment
Other
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• ••• • • •
•
••
• • •
• ••
•
• • •
••• ... ..
' Job Address: `22
Address
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
•
• •
• •
• •
•
•
•
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INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Step 1. Compl&t& tit aataahed p.rmit T g l icati on which must be signed by the property owner and qualifier. Both signatures must be notarized. Please
print oftyp� ro.•alm:fo: a mose accurate processing of your application. If roofing work will be done, a roofing application must be submit-
ted alQiwp thietelmtt akl c& ion •
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
Apt
Folio Number
Lot Block
Subdivision PB PG
Current Use of Property
Proposed Use of Property
Tenant Information
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
Master Permit No.
Subsidiary Permit No.
M,pM / n
City
Description of Work
Zoning
Square Feet
alue of Work Z./ V CO
Zip
c e0 !2 5Z-
State
Linear Feet
PERMIT APPLICATION
33/36P
Units Floors
Bldg Value
ENGINEER
Name
License No.
Address
Telephone
Fax
Page 2
IMPORTANT NOTICES
DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT•4tZD PEAMIT einD.'Applyinna r %W it 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 SANITARMCONIOTION•ree From 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 M1Yi t r aE tJSrD CQ2 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 $2,500 or intend to obtain financing, you may wish to consult with
your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at:
22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in
accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and
Choosing a Contractor.
S ATE OF FLORIDA, COUNTY OF MIAMI-DADE
i gnature of Owner
/zi4-ey ,1t ,t' o o ete
Print Name
wom to and subscribed before me this 6 day of
Signature of No Public
SEAL:
Personally known
r I�
�1��
t commission f »,Z11
-"4. �� Bon d ed Thru 006
Atlantic
V OR, Produced Identi
• .•
• •
• •
•
• •
• • • • • . .
• 4'EkT AP PLICATION
STATE OF FLORIDA, CO
Signature of Contract6r / Qualifier
e_
SEAL:
OF MIAMI -DADE
Print Name
Swoj and subscribed before me this C n day o
Si_ :tune o o.ry ' blic State cf Florida
M Becker
4etteit My Commission DD150048
'°► V dr Expires November 15, 2008
aa
Personally known ✓ OR, Produced Identification
Type of Identification Produced: Type of Identification Produced:
ELECTRICAL
TYPE
Minimum Fee .. • •
OT 1.
•
T P•..
• Dry$. • • •
QTY.
TYPE
Outlet, Appliance
QTY.
TYPE
Service Repair
QTV.
A/C Central 1 -3 Ton
Fan
Dryer Vents, Number of
Outlet, Wall
Ventilation, Cost
Service, Temporary
Air Handler, Tons
A/C Central 4 -7 Ton
Piping, Flammable Liquid
Fire Pump
Outlet, Switch
Fire Sprinkler System
Signs
A/C Central 8 -15 Ton
Bath Fan - Vented, #
Fixture - Fluorescent
Pressure Vessel
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
Solar Water Heater
Air Handler, Tons
Ductwork, Cost of
Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
Process/Pressure Piping
Cap - Fixture
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
Pump and Abandon
PLUMBING
TYPE
A/C Condensate
QTY.
TYPE
Drains, Roof
Q
TYPE
Miscellaneous Fixture
Q
"I'YPI?
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
Page 3
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PERMIT APPLICATION
INSTRUCTIONS: Please in Itcate'tre type of work being performed and quantity(ies) in the space provided below.
..- ... ..• •
RECEIVED AND REVIEWED BY: DATE:
SECTION
BY
UI'E
I7.1d
Zoning
'1
Electrical
0 �
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
�
C ✓j — aZ
Page 4
OFFICE USE ONLY
CHECKLIST
❑ 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
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
O OTHER
(Specify & Attach)
PERMIT FEES
0
(X .ft. x/1000
(¢.005 /sq.ft.)
(¢.01 /sq.ft.)
•
• •
• •
•.. •
• •
• • • •
•
:: • PERI APPLICATION
• •
.•
•
• .
••• • . ••. .. •
❑ CONDO ASS OCIATION
(Attach)
•• ••• •• • • • ••
• • • • • • • • •
q BPR PPRbw (pataeants)
•• ••• • • • • • ••
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ b
ISSUING OFFICIAL
REVIEWED AND PREPARED BY: DATE:
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2"° AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com
MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
DATE: Z,C
OWNER'S NAME: / a4( Uk/�`r✓ PHONE:
ADDRESS: izzi
********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE:
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME: PHONE:
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted.
Walls
Fascia
Drip Cap/Drip Edge
Soffit
Roof
Flower Bins
Shutters
Awnings
Chimney
Doors and door jams
Garage Doors
Building Officii
u
Railings
Fences
Decorative Metal
All brick (simulated or regular)
Stucco Banding
Any other stucco features
Accessory Buildings
Other
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
samples.
Signature of Owner Date Signature of Contractor Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED: WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
4/23/01
MIAMI SHORES VILLAGE
:•.•: j•girittilior Approval and Agreement
• •
. • • •••
••..•••
DATE : _ __ Z. .
OWNER;$ N'4 E * -- d OgUor�n�l f j 'PHONE: 3 7� 6 6, 5a_ 9
2 ADDREM: ••• • • MA'S NO 9 S S.+
* * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * * **
ADDRFS $. j $�'E . • />:23" ��. �
CONTR t h'bt &'ZiCENSE (if a • • licable) , 3
COMPANY NAME:
4,.. > ,t- ad, A f � r ' - �- . PHONE ..30 .' 7 -
* * * * * * * ** * * * ** *. * * * * * * * * * * * * * * * * * * * * * * **
* * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted.
Walls l5 5 r DvA shv 1
' Fascia
Drip Cap/Drip Edge W
Soffit to Gee,
Roof IMAIA-&
Flower Bins A
Shutters Ut-) k■A-e-
Awnings NA
Chimney 1
Doors and door jams (*liJ-
Garage Doors i k.
Railings Wes,
Fences k/iA
Decorative Metal ofri.it WkA' be.
All brick (simulated or regular) N fA
Stucco Banding 3 (dezV'
Any other stucco features
Accessory`Buildings ),,, ? ��
Other C.� 14 2 ' 5 7' r �L
� _
OWNER'S AFFIDAVIT: I certify that all t i f o r eg oin g i nformation 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 pe,r the attached
samples. 12....G-62-
/ 6
/�..�/
APPROVED:
Building Offici
Quiet Light • 60YY 65/082
Caisson Green • 45YY 24/158
Oxford Blue • 1OBB 40/090
0
0
cn
P E-4 1:j -
cn
•
z
cil
En
ignature of Owner Date Signatur of Contrac or Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
4/23/01
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed:1 /2/2003
Applicant: — ANTHeNY / Y�
Owner: — WRtPOOO t
JOB ADDRESS: •25 ��5
.) Contractor COMPLETE HOME PAINTING
o Local Phone: 305 - 895 -1368
Parcel # 1132060143990
Permit Status: Approved Permit Expiration: 7/1/2003
Work: EXTERIOR PAINTING AS PER AGREEMENT
This Permit is granted to the contractor or builder named above to construct the
ordinances pertaining thereto and with the understanding that the work will be pert
and approved by the proper municipal authorities. This Permit may be revoked a
authorization. A further condition upon which this permit is granted is the under
ordinances and regulations pertaining to tom,}. rk covered hereby whether shoes
by his agents, sery ; is or employe
Signed' — ! — (INSPECTOR)
In consideration of the issuance to me of this permit, I agree to perform the vi
with the plans, drawings, statements or specifications submitted to the proper ;
myself, my agent, servants or employes.
Sinnerl•"/ ' 7Ytl' - r- -
Building Permit
Permit Number: BP2002 -2233
(Contract
.. wp m stivr6)C1
Contractor's Address: 1476 NE 130 STREET
Legal Description: MIAMI SHORES SEC 3 PB 10 -37 LOTS 25 & 26 BLK 84 LOT SIZE 100 X 131 OR
Fees: Description Amount
FEE2003 -16 Building Permit Application Fee $60.00
FEE2003 -17 CCF $1.80
FEE2003 -18 Notary Fee $5.00
Total Fees: $66.80
Total Fees: $66.80
Total Receipts: $0.00
Construction Value: $2,450.00
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.
9135 2 .11glllgOhb E 8 N't 1: t hIEfOL 92 :I
Page 1 of 1
-.+'. t►.e nnnlinatinn herefor_in_sVict compliance with all
1.91.66 ld 'iW H11,1ON
8Z[L Hl� IVIJNVNIl '1S H1 I WyIW H NON
VA ')INVS l d i f1IN NOlDNIH
JO t1DOr1O
81110.1.,Wd
SZECE 1J '3IAVO
'3AV 411 :M'S OS 12
A 12-1W
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein
described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the
State of Florida. all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with. whether
herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work.
Owner's Name and Address
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on: �/J O�
Lot 4CC7� r Q Block Subdivision (1/ / ,� Lw /1 - /'/ J9W e
/ z- - -- Al, 6 gf S '.c
b floors), state exterior colors (submit samples)
Pa 2 /#
Street and Number where work is to be done
State work to be one and purpose of building (b
Permit No.
Disapproved
(Signed)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
PPLICATION FOR BUILDING PERMIT
rreze
C(
c
Remarks (Signed)
c7'9iJ 7/
Date
Date
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatons as
Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied
compliance from all contractors or sub-contractors employed by him in the work to be performed under this permit•
on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to emp
under this permit, as are licensed by Miami Shores Village.
Read. Sworn to and Subscribed before me.
Date ( ° ( 19 FT
No. /2-2,5 Street / Ff Sr
New Building Remodeling V Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ ° ° 7 Amount of Permit $ 2.5"e
Zone cubage required Plan Cubage
Distance to next nearest building Size of Building Lot
Maximum live load to be borne by each floor
I hereby submit all plans and specifications for said building. All notices with reference to the building and its construction may be sent to
pl
t the
�d wi.
STATE OF FLORIDA
COUNTY OF DADE. } ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
er of Labor under the Florida Workmen's
ovisions thereof, and will require similar
post or cause to be posted for inspection
ch subcontractors. on work to be performed
to me well known.
and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true.
Notary Public. State of Florida
and for no other purpose.
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved Date
NOTE: A charge of $25.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board.
A re- inspection fee of $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.
Date G / Z
Type Insp'n EY � g "
Permit No. � Pte° /� � Z2‘.
Name ado
Address ll Nom_ 5 AF - S 'Il a iL
Compan 6� pt p.,
Phone #
Inspection Date
Approved
Correction ❑
Re- Insp'n Fee ❑
tt / /
MIAMI SHORES VILLAGE ��Q$
BUILDING DEPARTMENT
305- 795 -2204
Builuing Inspection Request
• 00 at (d