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CONTRACTOR hi ,400 License No. 0 / /3/ Address / X76`�QC 7 9/ // /"e' ✓3- - ,e5/ Telephoi(3� rj3'7— 3/3/ Fax Qualifie Name PROPERTY OWNER Name 15gili>"e_ /aa Address Z 93 /tie- J - /1 /a '1/, f 334 Home Telephone Business Telephone / 1 f7 - 3f 6/ Fax (3 V. ) --- /U 2Z_ z TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'1 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. 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: /273 ARCHITECT Name License No. Address Telephone Fax Complete the attached permit application•wticle m+istbe. fined by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a'gaoit'a4c atg piw6eessipg of your application. If roofing work will be done, a roofing application must be submit- ted along with this permij git1Cattpn• • • • • • • • • • • • Address PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other • • • • • • • • ••• • • • • • • • • • • • • • ••••••• •••• • • • • • • • Master Permit No. • • • • • • • • • • • ••• • • • • • • • Subsidiary Permit No. • • ••• •••• • • • • • 9r Sf Folio Number Description of Work CDC1ev C14/1 Lot Block Aevde / Subdivision PB PG LVr e a Feet Current Use of Property Units Floors Proposed Use of Property Bldg Value Tenant Information Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection , Apt. City Zoning Square Feet Value of Work ENGINEER Name License No. Address Telephone Fax State 33/4e PERMIT APPLICATION Zip eL / t Page 2 IMPORTANT NOTICES DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VAilDAT D §ERM 1 (ARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:315 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, NEN MR §ANI R •COND1T1O N free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT APED flE$RNS. • • • • • • • • • • • • • • • 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VBHIC+.£S,•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. STATE O RIDA, C F MIAMI -DADS Signatur of Owner /4 /ice JT(zi-e Print Name Sworn to nd subscribed before me this .3 day of 155 e4.4- 4 — Signature of Notary ' is - State of Florida • • • • • •. • • SEAL: SEAL: Personally known OR, Produced Identification • • • • • • • ••• • • • •:.: : PERMIT APPLICATION STATE OF FLORIDA, COUNTY OF MIAMI -DADE Signature of Conyt`actor / Qualifie 1 /37• 4 v.Gcw Print Name Sworn to and subscribed before me this day of Signature of Notary Public - State of Florida Personally known OR, Produced Identification Type of Identification Produced: Type of Identification Produced: l • iil -MLA. I JA- i ►...F V i ► ♦ 1.. LLL7►V J..L Paint Color Approval and Agreement • • 41 • • 00 0 • • • •• 00 • • • • • • • • *Off 0 • • DATE //3 d_3 ...41.41 • 414141 OWNER'S NAME: ADDRESS: /2-9/ . e46 Q6': ***************** t*********'* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ADDRESS OF SITE: /293 it/.0 96 CONTRACTOR 8t LICEPS '(i ;cable) COMPANY NAME: ' • • :. 1, tfi e‹—PHONECso T) / tg?" ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * *** All Elements on the site must be listed and indicate the color to be painted. Walls Fascia tfc_ — 6P-2- Drip Cap/Drip Edge ,1c Soffit /v //I Roof ti //J Flower Bins Shutters Awnings Chimney Doors and door jams /2/c -- /?- - 7 Garage Doors // /• Railings .w Fences /P//,` Decorative Metal. �.6k- lzY All brick (simulated or regular) hie-- 9 Stucco Banding /U Any other stucco features "g 1-- Accessory'Buildings ` Other APPROVED: Building 1ficial y/ PHONE: .3rx!J 2/B 3/B HC -93 HC -82 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 Signatu of Contra -< r Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION 4/23/01 ELECTRICAL TYPE QTY. " VVP.:. QTY. TYPE QTY. 'I'YI'F: ()I 1. Minimum Fee Q rY. Dryer _ • • • - - • Outlet, Appliance Miscellaneous Repairs Service Repair Solar Water Heater A/C Central 1 -3 Ton Bidet • • • fan Outlet, Wall Service, Temporary A/C Central 4 -7 Ton Fountain Fire Pump Pump and Abandon Outlet, Switch Sprinkler System Signs Cap - Water 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 Drainfield, 4" Tile/Res. Demolition Low -volt, Intercom/Teleph. Repair Circuits Drains, Area Dishwasher Low -volt, Television Service, Number of Amps Drains, Floor MECHANICAL TYPE QTY TYPE QTY TVI'I: QTY. " Q . I . V . Minimum Fee QTY. Condensate Drain QTY. Generator Q rY. Refrigeration, Tons Drinking Fountain A/C Central, Tons Miscellaneous Repairs Cooling Tower Solar Water Heater Heating Strips, each Bidet Vent Hood, Cost A/C WaWWin. Tons Dryer Vents, Number of Paint Booth Fountain Ventilation, Cost Pump and Abandon Air Handler, Tons Sprinkler System Ductwork, Cost of Cap - Water Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Pump, Fire Stand Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Pump, Re- circulate PLUMBING TYPE A/C Condensate QTY. TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. 'rvI'E. Soakage Pit Q rY. 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 • • • • • • • .• . • • • • • • • • . • • • • • • •.. • •.• . • .. • • • • • • • • • PERMIT APPLICATION INSTRUCTIONS: Please indk 4e tht; 40 of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: SECTION BY D T Zoning (o r� J 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) ❑ IMPACT FEE (New Construction) $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 $ 1d CO $ a tg:0 • • • • • .•• • .•• • • •• ❑ PROOF OF OWNERSHIP (Attach) •• ••• • • • •• ❑ HRS / DERM APPROVAL (Septic / Sewer) • • • • • ❑ OTHER (Specify & Attach) (s .60) x/1000 x (0.005 /sq.ft.) (0.01 /sq.ft.) • • • • • ••. • • • • • • • • •••••.. •. • • • .• • • : PERMIT APPLICATION CHECKLIST ❑ CONDO ASSOCIATION APPROVAL (Attach) • • • • • • . • • • • • • • •• ] :B R.4 (Restaurants) • • • • • •• ❑ CONTRACTOR REGISTRATION (On File) PERNIIT FEES TOTAL $ 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 Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 4/9/2003 Contractor Local Phone: Applicant: ALICE Owner: SADUSKY JOB ADDRESS: 1293 Parcel # 1132060143870 NE 95 Fees: FEE2003 -2066 FEE2003 -2067 FEE2003 -2069 Description Building Permit Application Fee Notary Fee CCF Total Fees: Amount $60.00 $5.00 $0.60 $65.60 Total Fees: $65.60 Total Receipts: $0.00 Permit Status: Approved Permit Expiration: 10/5/2003 Construction Value: $2,485.00 Work: EXTERIOR PAINTING AS PER AGREEMENT 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 an This Permit is granted to the contractor or builder named above to construct the build ordinances pertaining thereto and with the understanding that the work will be performe and approved by the proper municipal authorities. This Permit may be revoked at any t authorization. A further condition upon which this permit is granted is the understandini ordinances and regulations pertaining to the work covered hereby whether shown on th by his agents, servants or employees. Signed: (INSPECTOR) In consideration of the issuance to me of this permit, I agree to perform the work cov with the plans, drawings, statements or specifications submitted to the proper authoritii myself, my agent, servants or employes. Signed: Building Permit Permit Number: BP2003-556 Legal Description: MIAMI SHORES SEC 3 PB 10 -37 W75FT OF LOTS 4 & 5 & W75FT OF S1/2 OF LOT (Contractor or Bui SADUSKY ALICE ST Contractor's Address: Page 1 of 1 .a .�1a!- ti�.YiCu...n 3 COMPLETE HOME PAINTING BY MICHAEL N.E. MICHAEL I ST,. W A S K E W Y C Z 1476 95 -1368 10050 N. E. C 2nd C' AVENUE ORDEROP ist1 Witt $4 HOBjSj, EL 33138 MEMO QUO r ual Washi Washinggtton Mutual Bank, North Miami/125th Street 900 NE. 125th Street North Mialty„Fl 33161 ndal Center 1728 1 24 h0 Sorvioe 1: 267013 L3LI: El L4a35L1311' 37 DAT 63 -8413 -2670 $ 3733 DOLLARS ,--m - Ztr1B Permit No. Disapproved (Signed) ,V) 1 3SVB Name and address of licensed contractor Location en Je�l descr on of lot to be built on: Lot 75" % 3 Block eL Street and Number where work is to be done z1IM Building Inspector MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT e for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the 3 of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with. whether y of approved plans and specifications must be kept at building during progress of the work. ta, 1 l Owner's Name and Addddr ess r ( �) 1 Registered Architect anchor Engineer ■ Subdivision , 9 pe /1 .10 14 ,'T gem \I Azfr State work to be done and purpose of building (by floors), state exterior colors (submit samples) All — la or u b I pc i C c} slrlv *(s c o' -- (iopi b( u-e_ �+�� New Build' g Remodeling Addition Repairs To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements S e °f• In 14 1 ) (9 V© ? Amount of Permit $ 37- S O 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 The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatons as an employer of Labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida. Permanent Supplement, and has complied with the provisions thereof. and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned Agrees to employ only s} h subcontractors. on work to be performed under this permit. as are licensed by Miami Shores Village. Remarks (Signed) STATE OF FLORIDA COUNTY OF DADE. P Before me, the undersigned authority. a notary public. duly authorized to administer oaths and take acknowledgments. personally appeared 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 for going application, and that he did sign the same. and that all facts therein by him stated are true. Date I'v Date 52 7 — Zi Date nI aD, \qi 9 No /49,1 Street f g s s-r and for no other purpose. No. of Stories_,f Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires PLANNING BOARD DATE Chairman _ Member Member Member Member Member Council Approved' Date Disapproved Date NOTE: A charge of S25.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board A re- inspect,- _ �nspectlo.- • _ . necessary by improper notice for inspection or faulty materials and or workmanship.