1298 NE 95 StDate
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
" I )oo Job Address % g e$ NG 9 c 57
Legal Description
Tax Folio
Historically Designated: Yes No
Owner/Lessee / Tenant e , t Master Permit # 7 v 3
Owner's Address / q 8- /l3 i q S T Phone 3 0 3 7S - W D S 0 3
Contracting Co. - Address
Qualifier SS# -/ Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Ili aw h Fe e L- U N,t, t uvt. Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION t An 0 -c , C L i I r (771 't vt c e.._ — ' ) I/� L/ L/ p;.LC�_ e
l�l�.z t'c In ( �, v ) i
( Lon S c° . vk-.
vcr
Square Ft. Estimated Cost (value) 3' ,5 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 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
construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
Signature o o i and/or Condo President Date Signature of err `Owner - Builder Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
Notary as to Contractor or Owner - Builder Date
My Commission Expires:
F.06— P?Oo —alp e l— L /6 — e es
trq J. a
FEES: PERMIT RADON C.C.F. - / a NOTARY (5 BOND
ea
APPROVED: TOTAL DUE .
Zoning Building 0[1 Electrical
Mechanical Plumbing Structural Engineer
COUSINS SURVEYORS & ASSOCIATES, INC.
5915 SHERIDAN STREET
HOLLYWOOD, FLORIDA 33021
CERTIFICATE OF AUTHORIZATION : LB a 6448
PHONE (954) 964 -7090 FAX (954) 986 -7010
R•25.00'
Zvi WO' 06'27'
A-43. 68'
A PORTION (FIELD)
OF LOT i
BLOCK 85
CERTIFIED TO:
A PORTION
OF LOT 2
BLOCK 85
75. 09'
FIP (1/2')
A PORTION
OF LOT i
BLOCK 86
J
0.0'
82. 12' } Q> \F `� cum ncic HALL
FNAIL OUND WOOD ANCHORS
o OW
o (0.7' N.) P POLES ER
7., b WATER
NETER 0
LESLIE A. NORTHUP AND EDITH DAYLE PECK
COMMONWEALTH LAND TITLE INSURANCE COMPANY
KEITH, MACK, LEWIS, COHEN S LUNPKIN
NAVY FEDERAL CREDIT UNION
117. 88' (PLAT)
117.74' (FIELD)
LAND DESCRIPTION:
NOTES:
i. NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED
SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER.
2 LANDS SHOWN HEREON WERE NOT ABSTRACTED FOR RIGHTS-OF -WAY.
EASEMENTS, OWNERSHIP, 0A OTHER INSTRUMENTS OF RECORD.
3. THIS SURVEY WAS DONE SOLELY FOR BOUNDARY PURPOSES AND DOES
NOT DEPICT THE JURISDICTION OF ANY MUNICIPAL, STATE.
FEDERAL OA OTHER ENTITIES.
,n,. n„ N,nw.l „rnr,v, u1C nnnvi f1Cl Ov TLC ,^1 ICkIT
SKETCH OF SURVEY
ALL OF LOTS i AND 2, BLOCK 85, 'MIAMI
SHORES SECTION NO. 3', ACCORDING TO THE
PLAT THEREOF, AS RECORDED IN PLAT BOOK
10, PAGE 37 OF THE PUBLIC RECORDS OF DAD
COUNTY, FLORIDA, LESS THAT PART LYING
WEST OF THE FOLLOWING DESCRIBED LINE;
FROM A POINT IN THE NORTH LINE OF LOT
1, A DISTANCE OF 75.00 FEET EAST OF THE
NORTHWEST CORNER OF SAID LOT 1. RUN
SOUTHERLY 100.2 FEET TO A POINT IN THE
SOUTH LINE OF LOT 2, LYING 82.12 FEET
EAST OF THE SOUTHWEST CORNER OF SAID
LOT 2.
in
b as FIP (1/2')
41 265 N
C fROJECT NUMBER : 1710 -97 J
1
CLIENT : KEITH, MACK,
LEWIS, COHEN & LUMPKIN
LEGEND:
CBS
CND
CONC
OWN
FB /PG
FR
FIP
FNC
A/C
P.B.
D.C.
R
A
A
N.
T YP.
0 65'FIP(1'
$e
CONCRETE BLOCK STRUCTURE
CHECKED BY
CONCRETE
DRAWN BY
FIELD BOOK AND PAGE
WOOD FENCE / CHAIN LINK FENCE
SET 5/8' IRON ROO AND CAP 644B
FOUND IRON ROD
FOUND IRON PIPE
FOUND NAIL AND CAP
AIR CONDITIONER SLAB
PLAT BOOK
DADE COUNTY RECORDS
OVERHEAD POWER LINES
RADIUS
CENTRAL ANGLE
ARC
TY PICAL
I HEREBY CERTIFY THAT THE ATTACHED 'SKETCH OF SURVEY' OF THE HEREON
DESCRIBED PROPERTY 1S TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE
AND BELIEF AS SURVEYED IN THE FIELD UNDER MY DIRECTION IN MARCH,
1997. 1 FURTHER CERTIFY THAT THIS SURVEY MEETS THE MINIMUM TECHNICAL
STANDARDS FOR SURVEYING IN THE STATE OF FLORIDA ACCORDING TO.CHAPTEV
61G17 OF THE FLORIDA ADMINISTRATIVE CODE, PURSUANT TO SECTION 472.027,
FLORIDA STATUTES. THERE ARE NO ABOVE GROUND ENCROACHMENTS OTHER THAN
Fax ,-4o.
.7._. 1 . 0B 1999 021 12Pr1 P1
** * * ** * *:+:* << FILM /PAPER SAIJE >> TO EXTEND INTO ORIGINAL SIZE, PLEASE USE EXTENSION COPY : * * * * * * * * **
2.1 14
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date
Type Insp'n
1
Permit No. 0r3 -- cc rJ !
Name L.
Address I "LY NE, GS S
Compan p 1 ` , -
Phone #
Inspection Date 7 / I
Approved L[Y 7 / (°5
Correction ❑
Re- Insp'n Fee ❑
1 0 .00
Owner's Name and Address /1'
STATE OF FLORIDA,
COUNTY OF DADE. j ss.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
ing 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.
Registered Architect and /or Engineer a
Name and address of licensed contractor __ ' /�_✓l ' I_
Location and legal description of lot to be b t on:
j , �.""
Lot ( Block ° ' Subdivision _ __ _ _ _ _
Street and Number where work is to be done /_ /
State work to be done and purpose of building (by floors) s i r_______ 4'7
/ .)
s ' / Date 71 i, , 19
No. Street
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ ____ l C ` f ' Amount of Permit $
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 the 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 obligations 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 such subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remark§ / % j . < /,
— - - - - ---- (Signed/ p T ^ F
Notary Public, State of Florida
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared _
- - -- 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.
Permit No Date • Read, Sworn to and Subscribed before me.
Disapproved Date
(Signed)
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member __ Member
Council Approved Date Disapproved Date
NOTE: A charge of $1.00 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 $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
PERMIT APPLICATION FOR MIAMI SH
Date J t1 � / L/ ' g7Job Address / o°I q y / i 4S f L 54- Tax Folio
Legal Description 1 Historically Designated: Y es No
Owner/ Lessee / Tenant 17 a L e Q I e 5 e crr r Master Permit #
Owner's Address / aZ Q S-- Phone 7 S ? p ?( 3
Contracting Co. ul l C f2 Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION l= 7c % cry �.�.� . L l ✓ v_ - -I r n C rr. f-[ 5 ,
Square Ft. Estimated Cost (value) If 5
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.
OWNERS 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 and/or Condo President Date
Signature of Contractor or Owner- Builder Date
t✓ - C.ec `
Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner - Builder Date
My Commission Expires: My Commission Expires:
FEES: PERMIT 4- RADON
C.C.F. , lv 0 NOTARY S BOND
TOTAL DUE �--C 6.r)
APPROVED:
Zoning Building 1/ cri Electrical
Mechanical Plumbing Engineering
CONTRACTOR
game c /' ., WrAtt �G .1�' f f /if, i/ /
�
L ic ense No. O /5t//
�J
Address moG !4/ /.
—
Telepho>e3 ./J f .
�
F
Qualifier Nam ey�A
Alteration Interior
PROPERTY
OPPERTY OWNER
/ 1
l LtM t e_ 1� 1 L. e !S [ 11 C � N OY�I�t V
Address (
s/ V
/R /V 9S s+
Home Telephone 75 _ e O s- D 3
Business Telephon .0 _ 6 10 8,6 a a
Fax . QS 7-5 `O eO 3
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'I Attachment
Other
Add'l Detachment
Other
Step 1.
ob Address: /Z9/ /uf
Lot
Subdivision PB PG
Current Use of Property
Proposed Use of Property
Tenant Information
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
Folio Number
Address
Block
• • • •
• • • •.• •
• • • • • •
• ••...••
•
• •
• •
• • • • • Ma4er Jtrmit No. - —�/
• • • • '
• ' • SuEbsidiary 'Permit No.
�
• • .. • • •
•. .. . • . •
• • •.. •
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Complete the attached permit application wly!tfm4stj a Sityed vth:, peepgrtfowner and qualifier. Both signatures must be notarized. Please
print or type to allow for a more accurate proosssipg pf yoi apaltcaQen. If tiofing work will be done, a roofing application must be submit-
ted 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
Apt.
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
City
Description of Wo i �
Zoning
Square Feet
,. 3/3er
State Zip
/21 Pf.e -to a * ze / 0Gr
Linear Feet
Units Floors
Value of Work Bldg Value
Tax Assessed/Appraised Value Z1
Flood Zone Base Floor Elev.
PERMIT CHANGE (✓ )
ENGINEER
Name
License No.
Address
Telephone
Fax
PERMIT APPLICATION
Q
Page 2
imPoRTA NT NOTICES
1. DO NOT BEGIN ANY WORK WITHOUT HAVING REC"ELVI) LOUR; VALID/MD PGRMIT AND PERMIT CARD. Applying for a permit does not grant
the right to begin construction. HOURS OF CONSTRUCTION are limited te: MDAd'ey 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' EP1 E.1 M tgR':A&D
4. SWALES MUST BE PROTECTED FROM BEING DAMACIEb BY'Ekll'C1:I IESITIllt 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.
0 DA, B OUNTY OF MIAMI -DADE
Signature
9 ►4 L l77 fi t= c )
Print Name �j
Swom subscribed before me this Z-7 day of / L4ite
blic - State of Flori
oss P YP i i Itlll cy
SEAL: �.`p ' L
r e. > 211
S . q ,
.r C
Atlantic 1b�Q�pg
Personally known OR, Produced Identifica
• •..•.. • .•.•
• • • • • • • • • •
• • • .•. • •
•
• • • •
•
... • • • • • • • • • • •
STATE OF FLORID , C U Y OF MIAMI -DADE
Signature of Contractor / Qualifier
Mat e/ 1w
Print Name
worn to and subscribed before me thi y
SEAL:
StatN
PERMIT APPLICATION
M Seeker
ot1001
o vember 15, 2006
Personally known — OR, Produced Identification
Type of Identification Produced: Type of Identification Produced:
ELECTRICAL
TV.1,1.,
Minimum Fee
QTY.
'I'Yl,E
Dryer • • • ;
Q.V. "'
• ; 'Quaet,
"1 11 Ii
AppQance
QTY.
. LV . PI:
Service Repair
Q
A/C Central 1 -3 Ton
Dryer Vents, Number of
Fan • • •
. 1
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 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 QTY.
Minimum Fee
TYPE QTY.
Condensate Drain
TYI'F
Generator
QTY. TYPE QTY.
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
TYI'I.
A/C Condensate
QTY.
TYPE
Drains, Roof
QTY.
TYPI',
Miscellaneous Fixture
QTY.
nil.:
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
• • • •
•
• • • •• • • • •
• • • • • • • • • • • •
•
• • • ••..
••.
•••
PERMIT APPLICATION
INSTRUCTIONS: Please indicate the type of wprlc bpina7erfOrriei quantity(ies) in the space provided below.
RECEIVED AND REVIEWED BY: DATE:
SECTION
BY
DATE /
Zoning
.P/
; //
Electrical
f/ /�'
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
Page 4
OFFICE USE ONLY
C11ECK1.IS'I'
❑ 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
• • • • •
• • • •• • • •
• • • • • • • • • • • •
••• • • • • •• • • •
••• •
•
• • • • • •
•
❑ PRCTOF CIF OWIIERMP •
(Attach)
••
•
•• ❑ BPR APPROVAL (Restaurants)
(Sep'tia/ Sower; • • • • : : • • •
•• • •• • • • • •
• • • • • • • •
❑ I-IRS ( DER1! APMCIVa.L: •
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
PERNI1'1' FEES
/
$
( x .60) 1000
(¢.005 / sq.ft.)
(¢.01 /sq.ft.)
•••
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $
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
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 3/31/2003
Applicant: EDITH DAYLE
Owner: PECK
JOB ADDRESS: 1298 NE 95
Contractor COMPLETE HOME PAINTING Contractor's Address: 1476 NE 130 STREET
Local Phone: 305 - 895 -1368
Parcel # 1132060144030
Building Permit
Permit Number: BP2003 -502
PECK
EDITH DAYLE
ST
Page 1 of 1
Legal Description: MIAMI SHORES SEC 3 PB 10 -37 LOTS 1 & 2 LESS W75FT BLK 85 LOT SIZE 101.500
Fees:
FEE2003 -1869
FEE2003 -1870
FEE2003 -1871
Description
Building Permit Application Fee
Notary Fee
CCF
Total Fees:
Amount
$60.00
$5.00
$1.80
$66.80
Total Fees: $66.80
Total Receipts: $0.00
Permit Status: Approved Permit Expiration: 9/24/2003 Construction Value: $2,400.00
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.
fee is $50.00, which must be paid in advance before calling for another inspection.
This Permit is granted to the contract
ordinances pertaining thereto and with I
and approved by the proper municipal a
authorization. A further condition upon
ordinances and regulations pertaining t(
by his agents, servants or employees.
Signed:
In consideration of the issuance to mt
with the plans, drawings, statements or
myself, my agent, servants or employe:
Signed:!'
'"";. rl SNVTIOU
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MIAMI SHORES VILLAGE
Paint Color,eippnV,akltbtl Agreement
• ••••• • •
• • •••••• ••••
DATE: 3 7 03
OWNER'S NAME: „Oak ee' • : •.• .:: . PHONE: 30:)71Y
ADDRESS: /ZQc" 'Ve T• C •.. ••.
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE: /291." • S . _ •�. • •
CONTRACTOR & LICENSE (if apniliiibler Cc:iv/%ie 1 - � ; ae,/ /3/
COMPANY NAME: C1-77 PHONE: 3v0 , 9j- /0'e"
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted.:
Walls / `/72 t /7ef L
Fascia /lc - /,l7 ''y. /4 f e .
Drip Cap/Drip Edge N/ r
Soffit if! -/‘ 7
Roof - /vim
APPROVED:
Building Offi
7A6 - /3
Date
Flower Bins /t/ /7
Shutters /a i6 7
Awnings API"
Chimney r hf
Doors and door jams coOlor ,f c(
Garage Doors /4'7
Railings #c -/6 7
Fences iv,/
Decorative Metal //c - /6 7
All brick (simulated or regular) ti/f
Stucco Banding fr/
Any other stucco features /vd
Accessory w
Other -- -
1/A
W
1472
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 a of Contraot‘r Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
_07/o
)141
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
4/23/01