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1234 NE 94 St (4)CONTRACTOR c / / e r/ 1, Name /S t� �ieo 0 i License No. 0 / v / 1/ Home Telephon 3p J Address / V7,6 ,ti /�P Sr- / m »// r` ' Business Telepho e Telephone 3os 87s / j FFFaxx f j .� 4j pap / n Qualifier Name et1p `/"— /` PROPERTY OWNER Mg h t to1/7/0, Address New Construction 0 i Enclosure Home Telephon 3p J U 7 - /AM U Business Telepho e Repair Fax Alteration Interior 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 A PPLICATION INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. Step 2. N ob Address: Folio Number Lot Subdivision Current Use of Property Proposed Use of Property Tenant Information PERMIT TYPE ( ✓ Building Electrical Mechanical Plumbing LPGX Roofing Fence Other ARCHITECT Name License No. Address Telephone Fax 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 alow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted along with this p application. Submit the comt application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of yo application, you may be asked to submit additional information. /23y ,u 94/ - • Address Apt. 03, C ,9 6/ 0 Oc 0,0 Description of lock PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection Master Permit No. ubsidiary Permit No. City State PERMIT APPLICATION 3 3/a e f Zip ork � � �' p ) / to PB PG Zoning Square Feet 0"\ of Work Z Tax Assessed/Appraised Value Flood Zone Base Floor Elev. Linear Feet 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 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 PROTEC:I'hD 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. 1. 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 $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1°` Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. ST 1E OF FL IDA, COUNTY F MI I -DADE Signature of Owner 5 - coke rr -tj k MICHAEL IWASKEWYCZ ors meracOMMlSSI0N100# dos EXPIRES:'April 10, 2002 B ed Thni N' :: Public Underwriters I r Print Name Sworn Air Signature of Nota ' Public - State of Florida SEAL: Personally known OR, Produced Identification Type of Identification Produced: STATE OF FLORI A, C U7 O� MIAMI-DADE Signature of Contractor / Qualifier v ` pi, - 6 e,/ -2 cv.1rYT .ycz Print Name Swt . d subscribed before me this day of OF / rgnature . Notary Pui 'c - State of orida SEAL: Personally known "PERMIT APPLICATION o'r'Ft ' 93 P ANGELA u�QER r gptl,: c - ti { � Jy ¢ CC786697 pt3 c' y CO i.'r. t 3' RPI'rd Idghfification — - Type of Identification Produced: DATE: 1 Z ZDO / OWNER'S NAM : _S76h GOA PHONE(30r) 7.J - / //6 ADDRESS: xxxxxxxxxxx MI MI SHORES VILLAGE` Paint Color Approval and Agreement xxxx xxxx�e ADDRESS OF SITE: /Z3 y /1/. 9 S7 ' CONTRACT* & LICENSE (if applicable) O /y /. / COMPANY NAME: C»,f/ e /1/4', 'a ► 1 PHONE: e rc�cx cxxxxx�e$c3c xxxxxxxxxxx�exxxxxx x�c All Elements c n the site must be listed and indicate the color to be painted. Walls Fascia Drip Cap/Drip Edge /// Soffit GvAl Roof Flower Bins f" /i Shutters 0 Awnings a.) C° Chimney c Doors and door jams w %% Garage Doors lvkt Railings A24 Fences v 4 Decorative Metal N/ All brick (simulated or regular) N /.t" Stucco Banc ling. Any An other s features / Accessory I uildings Other 81 -DO El Essex Green 43 OWNER': AFFIDAVIT: I certify that all the foregoing information is accurate and that all! work will be done in compliance with all applicable laws regulating constructicn and zoning. I authorize the above -named contractor, if applicable, to do the wor stated. Furthermore , the paint colors will be as per the attached samples. Signature • f Owner Date Signature of Contra • r Date * * * * * * ** APPRO\ ED: WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION *** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Building • ffic'al Date 4/23/01 INSTRUCTIONS: P1eae indicate the type of work being performed and quantity(ies) in the space provided below. ELECTRICAL TYPE Minimum Fee TY. TYPE Dryer QTY. TYPE Outlet, Appliance QTY. TYI'E Service Repair QTY. A/C Central 1 -3 Ton Heating Strips, each Fan Vent Hood, Cost Outlet, Wall A/C Wall/Win. Tons Service, Temporary Dryer Vents, Number of A/C Central 4 -7 Ton Paint Booth Fire Pump Ventilation, Cost Outlet, Switch Air Handler, Tons Signs Ductwork, Cost of A/C Central 8 -15 Ton Piping, Flammable Liquid Fixture - Fluorescent Periodic Inspections Oven Barbecue Space Heater (kw) Fire Sprinkler System A/C Central 16-20 Ton Process/Pressure Piping Fixture Light Sprinkler System Parking Lot Lights Bath Fan - Vented, # Spas/Hot Tubs Fireplaces, Number of A/C Central 20+ Ton Pressure Vessel 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 Pump, Sum? Relay Repair Roof Inlet Heat Recovery Utility - Sewer Utility - Water Vacuum Pump Water Closet Refrigerator, Comm. (p/PH) Discharge Well Temp Serv., Construction Ice Maker Indirect Wastes Compactor Disposal Low -volt, Burglar Interceptor Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Lavatory Demolition Low -volt, Intercom/Teleph. Repair Circuits Meter Set (Gas) Dishwasher Low -volt, Television Service, Number of Amps Minimum Fee Drains, French MECHANICAL TYPE QTY. Minimum Fee 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 Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Sprinkler System Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Supply, AC Well 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 Pump, Sum? Relay Repair Roof Inlet Utility - Sewer Utility - Water Vacuum Pump Water Closet Discharge Well Ice Maker Indirect Wastes Dishwasher Disposal Interceptor Domestic Well j Laundry Tray Septic Connection Waver Neater Drainfield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area I Meter Set (Gas) Sewer Connection Shower Water Re -pipe Water Service Drains, Floor I Minimum Fee Drains, French Miscellaneous Equipment Sink Well, Supply Page 3 RECEIVED AND REVIBWED BY: PERMIT APPLICATION DATE: 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 4 O ISSUING OFFICIAL $ ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) o $ S..O 6 REVIEWED AND PREPARED BY: SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY / (sq.ft. = x/1000 x ¢.60) (¢.005 /sq.ft.) (¢.01 /sq.ft.) "'PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) PERMIT FEES TOTAL $ 4, o 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