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PAINT6 o O 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 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 Blame and address of licensed contractor Registered Architect and/or Engineer rtin/k Location and le al description of lot to be built on: 6 1 �tree and Lot /? Block Subdivision 70 6 4.4 // J nd Number where work is to be done / ✓v 8 7 1 (1 T State work to be done and purpose of building (by floors). state exterior colors (submit samples) As--)4. Era 1-C r oe and for no other purpuri New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation �j Roof Covering e� Estimated Total cost of improvements S °DO Amount of Permit s /` c 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' Compensation Act. being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with 1.he provisions thereof. and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed and 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 a ee to employ only such bcontractors. on work to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) Date 610.7 Permit No. Disapproved Date (Signed) Building Inspector PLANNING BOARD DATE p� Datte �� � 19 0 No./�71_ 4 Street 219 fAf $' STATE OF FLORIDA COUNTY OF DADE. } ss. Before me, the undersigned authority, a notary public. duly authorized to administer oaths and take acknowledgmerts. personally appeared 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. Read, Sworn to and Subscribed before me. Notary Public. State of Florida My Commission Expires to me well known. 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 S25.00 will be charged when such re- inspection is made necessary by improper notice for inspe :tion or faulty materials and or workmanship. Village of Miami Shores 10050 NE 2nd Avenue Miami Shores, FL 33138 Phone: 305 - 795 -2204 Printed: 2/8/2002 Applicant: DOUGLAS Owner: JACOBS Contractor Local Phone: Parcel # 1132050100140 Job Address: 1284 NE 94 ST Fees: FEE2002 -813 FEE2002 -814 FEE2002 -815 This Permit is granted to the contractor or builder named above to ordinances pertaining thereto and with the understanding that the we and approved by the proper municipal authorities. This Permit may t authorization. A further condition upon which this permit is granted it ordinances and regulations pertaining to the work covered hereby wt by his agents, servants or employees. Signed: (INSPE' In consideration of the issuance to me of this permit, I agree to pert with the plans, drawings, statements or specifications submitted to th myself, my agent, servants or employes. Signed: Address: Cellular: JACOBS DOUGLAS Legal Description: MIAMI SHORES BAY VIEW PB 40 - 16 LOT 16 LOT SIZE 75.000 X 129 OR Description Amount Notary Fee $5.00 Building Permit Application Fe$60.00 CCF $0.60 Total Fees: $65.60 Permit Status: Approved Permit Expiration: 8/7/2002 Building Permit Permit Number: BP2002 -274 Construction Value: Work: EXTERIOR PAINTING AS PER AGREEMENT (OWNER BUILDER PERMIT) 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 ins • ectio Bank of America Advantage' (, SUZANNE S. JACOBS 1284 N.E. 94TH ST. MIAMI SHORES, FL 33138 -2947 erzler o Pay to tl BankofAm ACH F1tr 003100277 ri $500.00 Menlo eA 1 �' " 1:0 30000 4 ?I: 00 14 6 4 5O 5 26011° Page 1 of 1 Total Fees: $65.60 Total Receipts: $0.00 Re- inspection 5206 63 -4/630 FL * 2 - 1346 Date $ (p6 I «oo Do/lars, 8 = : ne ty APPROVED: MIAMI SHORES VILLAGE Paint Color Approval and Agreement ATE: J (p 2 00 , 6WNER'S NA E: ' i ce _ A - C - 0 I PHONE :: 30/-5 '7 - SLyg 2 - i,ADDRESS: / 0,y /q CL( ********************************** * * * * * * * * * * * * * * * ** * * * * * * * * * * * * ** "'ADDRESS OF SITE: Sa-' e- CONTRACTOR & LICENSE (if applicable) N COMPANY NAME: e-Th PHONE:' * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * All Elemq is on the site must be listed and indicate the color to be painted. Walls C r CW P Ni■; (� Fascia G 0,A) Pp v c, - a__ Drip Cap/Drip Edge V }1, - ke Soffit Roof Flower Bins Shutters &) /4 Awnings /(J �} Chimney " al Doors and door jams W ) "�e Garage Doors /l//// Railings Fences Decorative Metal All brick (simulated or regular Stucco Banding Any other stucco features Accessory Buildings Other 6(i 3t2 Building Offici pp 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 sa les. /1i . f Owner Date Signature of Contractor Date Signature *******-.*************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION 4/23/01 PROPERTY OWNER Name f 51A 2...am pi-< v 0 y S Address /`"" t l q Lf S'i--- Home Telephone 305 7 5 (4,-- ti / B Z., Business Telephone - 5 – 04.s°3 Fax 306- - 0 '7 TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Demolish Alteration Interior Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'I Detachment Other Step 1. Master Permit No. Subsidiary Permit No. INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami 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 submitted along with this permit application. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoring Department for processing. During the processing of your application, you may be asked to submit additional information. APPLICATION Job Address: 1 ' l ht ( Sh A S" F/. 333E PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Address Apt. City State Zip Folio Number I _3) 015 010 Block Lot Subdivision PB PG Current Use of Property Proposed Use of Property Tenant Information PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax 'Description of Work Zoning Square Feet Units Floors Value of Work 50 Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. Address Telephone Qualifier Name PERMIT APPLICATION hores Village: Linear Feet Fax 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, P' 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 OF FLORIDA, COUNTY OF MIAMI -DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE /1 /.: Sign fir of 1 er Print Name Swo t771 d subscribed before me this U day of , SEAL: ature of No Signature of Contractor / Qualifier Print Name Sworn to and subscribed before me this day of • /L4 L/ I , A _ . 0_ NOTARY SEAS i ' r F tiP ' P°a ANGELA M BECKER 2 p i CouaSsON NUMBER SEAL: N q Q CC786697 y M Y COMMISSION EXP RFS ` OF ego NOV. 15,200 Personally known OR, Produced Identification l! Personally known OR, Produced Identification Type of Identification Produced:PI 1) L a I a 7 t1'q q •I 1 - 0 Type of Identification Produced: Signature of Notary Public - State of Florida PERMIT APPLICATION SECTION BY / Zoning .'217 CC Gic., . Electrical Mechanical Plumbing Fire Public Works Structural Building Official 92 - u -c''Z ,, Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi - family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) PERMIT FEES $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 $ ISSUING OFFICIAL o 0 REVIEWED AND PREPARED BY: ( sq.ft. = x/1000 x0.60) (¢.005 /sq.ft.) (¢.01 /sq.ft.) CONDITION OF APP PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ j 5"... , c DATE: Revised July 2001 10050 N.E. 2`''° AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. TYPE Outlet, Appliance QTY. TVI'E Service Repair QTY. 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 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 Coi pactor 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. '1'VI'E Generator QTY. i'VI'E 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 Supply, AC Well Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Temporary Toilet PLUMBING TYPE A/C Condensate QTY. TAPE Drains, Roof QTY. TYPE. Miscellaneous Fixture QTY. TYPE 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 work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date Job Address/ / Y1 ci y �ff Tax Folio Legal Description � Historically Designated: Yes No Owner/Lessee / TenantY j U 2 41 16. 5,j (-ohs Master ]Permit # Owner's A d d r e s s Phon43 0 ` , - 5 Contracting Co. C _ 26 4; Qualifier , :t: t 1 WORK DESCRIPTION J\ o c 7 ( / (L / E_ State # Municipal # C 7 / Competency # l / ; l Ins. Co.() T Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN 1 a G'o%. r A h, Square Ft. 9" 300 Estimated Cost (value) 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. andior condaP�eideRl�v. on Expires: t — - 1 G?t,7�A COMMi:-3510N 7:70. 10 NIL r 4 U 7 t FEES: PERMIT O RADON C.C.F. Phone ctor or 4 Electrical BOND AL 4 0 7 I:RY i� p t f i'() . 11 N1'f MA 1 TOTAL DUE A/Z. Date APPROVED: Zoning Building �T /}1 " Mechanical Plumbing Structural Engineer a te