PAINTMiami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 12 /3/2002
Applicant: 1ERNESTO
Owner: bON Al EZ(
JOB ADDRESS: 129
Contractor
Local Phone:
Parcel # 1132050100130
ermit Status: APPROVED Permit Expiration: 6/1/2003
f ork: EXTERIOR PAINTING AS PER AGREEMENT
Signed:
Signed:
aKi\
NE 94
Building Permit
Permit Number: BP2002 -2078
n.
- Gursokrsz / t,k-A4-4 _I
\
ST
Contractor's Address:
Page 1 of 1
Legal Description: MIAMI SHORES BAY VIEW PB 40 -16 LOT 15 LOT SIZE 75.000 X 129 OR 19581 -0946
Fees:
FEE2002 -6856
FEE2002 -6857
FEE2002 -6858
Description
Building Permit Application Fee
CCF
Notary Fee
Total Fees:
Amount
$60.00
$0.60
$5.00
$65.60
Total Fees: $65.60
Total Receipts: $0.00
Construction Value: $1,000.00
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.
This Permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all
ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to
and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without
authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the
ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done
by his agents, servan . o employees.
(INSPECTOR) BY:
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity
with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either
myself, my agent, servants or pmploves.
REG C01 120502 1138 1 1C 001 003195 CHARGE
365.60
MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
DATE: //-2 -' 2-
OWNER'S NAME: 5 // PHONE: 75 / - £dtv/
ADDRESS: /3 9aL 4e 6197 0
* * * * * * * * * * * * * * * * * * * * * ** ********* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE: 42 9, rn 7 / -6"
CONTRACTOR & LICENSE (if applicable) !/104, .
COMPANY NAME: PHONE:
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted.
Walls ip( /) (our 4(1
Fascia kg Ai-
Drip Cap/Drip Edge AM f'
Soffit 4P, / (/ ; - -'
Roof /2l 4
Flower Bins _s
Shutters n/ /-)- C
Awnings n /-- ti4
Chimney 4 5'W 6 0 £3
Doors and door jams Ucah ea io r .. //C 1d1ws /
Garage Doors /2//e)
Railings g 4/ 4-
Fences 4/4"
Decorative Metal )1 f 4-
qt All brick (simulated or regular) 4 w®cr& re c�.��
Stucco Banding 4 /4 oL ecc co l �.
Any other stucco features /2/4 ' 5,6, evviA
Accessory/Buildings //li i %; uca ki4 ?
Other
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.
WAO iWziiki /1/2-6/x- 4/
Signature of Owner Date Signature of Contractor Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED: WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
//A ))4-
Building Offici.l ate
4/23/01
"e. " 11 1N 8s.,,N,
.
• FLORIDA 85'NEA
The Sunshine State
- --
HAROLD C MARSHALL
.936 PANNSSIAANUE 18
MIAM 9■0000
S09981)124
C. 1 (.•4 •
Ma24 4 (84 u
E
0-1994
-2001
1994 '
ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPE
Dryer
Q'I'V.
TYPE
Outlet, Appl
QT1'.
TYPE
Service Repair
YrY.
A/C Central 1 -3 Ton
A/C Central, Tons
Fan
Cooling Tower
Outlet, Wall
Heating Strips, each
Service, Temporary
Vent Hood, Cost
A/C Central 4 -7 Ton
A/C Wall/Win. Tons
Fire Pump
Dryer Vents, Number of
Outlet, Switch
Paint Booth
Signs
Ventilation, Cost
A/C Central 8 -15 Ton
Air Handler, Tons
Fixture - Fluorescent
Ductwork, Cost of
Oven
Piping, Flammable Liquid
Space Heater (kw)
Periodic Inspections
A/C Central 16 -20 Ton
Barbecue
Fixture Light
Fire Sprinkler System
Parking Lot Lights
Process/Pressure Piping
Spas/Hot Tubs
Pump, Domestic
A/C Central 20+ Ton
Bath Fan - Vented, #
Flood Lights
Fireplaces, Number of
Plugmold/Strip
Pressure Vessel
Subfeeds, No. of Amps
Pump, Fire Stand
A/C Window
Temporary Toilet
FPL - Load Central
Catch Basin
Posts
Gas - Propane
Swim Pool, Commercial
Pump, Re- circulate
Air Conditioners
Temporary Water Closet
Garbage Disposal
Clothes Washer
Range/Range 'Fop
Gas Piping
Swim Pool, Residential
Pump, Replace - Pool
Chiller
Urinal
Generators, etc.
Dental Chair
Receptacles
Grease Trap
Switchboards
Pump, Sprinkler
Clear Violations
Utility - Sewer
Heat Recovery
Discharge Well
Refrigerator, Comm. (p/PH)
Ice Maker
Temp Serv., Construction
Pump, Sump
Compactor
Utility - Water
Low -volt, Burglar
Dishwasher
Refrigerator, Domestic
Indirect Wastes
Temp for Test - 30 days
Relay Repair
Deep Freezer
Vacuum Pump
Low -volt, Fire
Disposal
Renew - Temp Service
Interceptor
Roof Inlet
Demolition
Water Closet
Low -volt, Intercom/Teleph.
Domestic Well
Repair Circuits
Laundry Tray
Septic Connection
Dishwasher
Water Heater
Low -volt, Television
Drainfield, 4" Tile/Res.
Service, Number of Amps
Lavatory
Septic Tank
MECHANICAL
TYPE QTY. TYPE QTY. TYPE QTY. TYPE: QTY.
Minimum Fee
QTY. TYPE. QT1'.
Condensate Drain
Generator
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
Pump, Domestic
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
Pump, Fire Stand
PLUMBING
TYPE QTY. TYPE
QTY. TYPE:
QTY. TYPE. QT1'.
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
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:
SECTION
BY
D TE
Zoning
�'�
f2 L
f7 r) 7/
Electrical
dJ
Mechanical
Plumbing
Fire
Public Works
Structural
i
Building Official
.a zaimmifigw
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)
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
Notary
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
$ 6O'
$ r a ( sq.ft. = x/1000
x ¢.60)
$ (¢.005 /sq.ft.)
ISSUING OFFICIAL
REVIEWED AND PREPARED BY: DATE:
(¢.01 /sq.ft.)
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File) I I
TOTAL
PERMIT APPLICATION
s Is. e
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756-772 • http : / /www.miamishoresvillage.com
I '
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 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 rpproval 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.
x i STATE OF FLORIDA, COU Y OF IAMI -DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE
4/6;-(le .//.4 (// le------
gnat a of Owner Signature of Contractor / Qualifier
/`oaf /)/ / /d/SA
Print N ame /1_ Print Name
°�
to and subscribed before me t s? day of
ature of No • Public - Stat
9002 'S t ° . wanoN sai.
SEAL: 80005 LOO 1.10!ss!wwo0 AW
lavas Pi e!a6uv
Sworn to and subscribed before me this
Signature of Notary Public - State of Florida
SEAL:
PERMIT APPLICATION
day of
Personally known OR, Produced Identification �� Pefsonally known OR, Produced Identification
2 .1k_612 tf -3U�• �, ° Type of Identification Produced: Type of Identification Produced:
PROPERTY OWNER
/
Name / ' L7L r ,/, r`' /�� f qt r,/I<, //
Address
12,,y1- h.e , st
Home Telephone 3 lJ 2 S % 5-de),
Business Telephone 3D S 7 c 4 / 64
Fax
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
;
Repair
Alteration Interior
I
Demolish
Relocation of Structure
Shell Only
Foundation Only
I
Add'l Attachment
Other
I
Add'I Detachment
Other
I
Master Permit No.
Subsidiary Permit No.
PERMIT APPLICATION
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Step 1.
Step 2.
Tenant Information
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 submit-
ted along with this permit application.
Submit the completed application with all necessary documents to the Building, Planning and Zoning D Ipartment for processing. During the
processing of your application, you may be asked to submit additional information.
APPLICATION
Address Apt. City State Zip
Folio Number description of Work �i�i; -P,{' V/e
I 'r
o b Address: / / )2 __c
Lot Block
Subdivision PB PG Zoning
Current Use of Property Square Feet Units I Floors
Proposed Use of Property a lue of Work /)0/)e Bldg Value I
Tax Assessed/Appraised Value I
Flood Zone Base Floor Elev.
I
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
ENGINEER
Name
License No.
Address
Telephone
Fax
I
I
Linear Feet
CONTRACTOR
Name
License No.
Address
Telephone
Fax
Qualifier Name I
BUILDING ❑
ELECTRICAL ❑
PLUMBING ❑
ROOFING ❑
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Jr F
Lot
MIAMI SHORES VILLAGE. FLORIDA
PERMIT N° 5295
P I", - , 4, t
Signed
Work to be performed under this Permit
t' 6
Value o
•
Subdi-
INSPECTOR
Contractor's a
License No.
vision
Bl I
f .✓' f • ;
$ C �" _
Project
DATE 4 ° 195
7
&Y(
Amount of
Permit $
CONTRACTOR OR BUILDER BY AUTHORITY
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans
drawings, statements or specifications that may have been submitted to and approved by the proper muriicipal authorities. This Permit may be revoked at any
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A furtk er - condition upon which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knout edge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specificat' • ns a • that he assumes responsibility for work
done by his agents, servants or employees. O ,
1
In consideration of the issuance to me of this permit I agree to perform the work covered rettnder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac-
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
6
Type Insp'n
Permit No.
Na
Address
Company
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date Time
a
Phone #
For Inspector: 1 I p
Correction
Re- Insp'n Fee
❑