280 NE 95 St (8)BUILDING
PERMIT APPLICATION
FBC 2001
Owner's Name (Fee Simple i i e der)
Tenant/Lessee Name
Job Address (where the work is being done)
City Miami Shores Village
Is Building Historically Designated YES
Architect/Engineer's Name (if applicable)
$ Value of Work For this Permit
Type of Work:
Describe Work:
Submittal Fee $
Notary $
Scanning S Radon $
Code Enforcement $
Total Fee Now Due $
(Continued on opposite side)
6 s0c). -0
Permit Fee $
Training/Education Fee $
Miami Shores Village
Building Department
10050 N.E/ln& venue, Miami Shores, Florida 33138
TeI , (305 )'t $ 2 Q4 Fax: (305) 756.8972
Permit Type (circle): Building Mechanical Roofing
-t �t !4J c (d( Phone # a:6 -- p — cs k t Cpl J
Owner's Address t td (, 4l ) (: t S S 'K"-- 4t- /\ r
City / 1 / 1-r State F ( ' Zip 3 ( t '
Electrical Plumbing
Phone #
113S /Ut`_ 100 sl
County Miami -Dade Zip 3 3 (
C� „
Contractor's Company Name /% f. Pho 7 6 - 2 -, O Y
Contractor's Address • ....4 tardfil
City 1/1 i State I 1- ( Zip '3 3 (c -
Qualifier
State Certificate or Registration No. Certificate of Competency No.
l co
Zoning
Structural Plan Revio4v. $
Permit No. J P ° � — ( Lf 3
Master Permit No.
o
Phone #
Square Footage Of Work:
Addition ❑Alteration ❑New ❑ Repair/Replace ❑ Demolition
* * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
CCF $
Technology Fee $
Bond $
CO /CC
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate pennit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: 1 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.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a rein pection fee will be charged.
ature
,wne or gent
i
Si
The forgoing instrument was acknowledged before me this
da
Gai
wl . c ; sonally known tom or ho has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY ' 0
Sign: -,—
Pr %�e /I� � r g
My ommission E
* * * * * * * * * * * * * * * * ** *�* *+
********************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
Chc 05/13/03
"op 2u■puop Doom+
� pep uog
D OL8£Z£QC uorssr •
•,
* * **
u p
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of ,20,by
NOTARY PUBLIC:
Sign:
Print:
8002 9Z /fey :sairdxg ; +e. y ck _
0 * - • ********************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
My Commission Expires:
c.�
*************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
t\ \dam
Plans Examiner
Engineer
Zoning
Miami Shores Village
Paint Color Approval and Agreement
Date
C Phone 30 5 — q 3-- (o0
Owner's Name �' ld�.� 't" ' �" �' ' �'• 1
Owner's Address s" 11C N �i 3�(
Cit (/`(� h't State '1� L Zip 33)d zf 1
l(3S if•-) C (c)
g t
Job Address (where the work is being done) ��
City Miami Shores Village County Mi Dade Zip h
Is Building Historically Designated YES NO . V
Contractor's Company Name (if applicable) C D Co).., Cy 9PNi °J_S Phone #
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All elements on the site must be listed and indicate the color to be painted
Walls CO Ep os
Fascia /1.1n .7
Drip Cap /drip Edge
Soffit
Roof
Flower bins
Shutters
Awnings
Chimney
Doors and door jams
Garage doors
Railings
Fences
Decorative metal
All brick (simulated or regular)
Stucco banding ( 4JI.t Ire.
Any other stucco features
N(x1
Accessory Buildings
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 re: ting construction d
Signature
APPLICATION APPROVED BY:
Date
Date
chc 6/18/03
sE
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: BP2005 -143
Printed: 2/7/2005
Applicant: THOMAS WENSJOE
Owner: WENSJOE THOMAS
JOB ADDRESS: 1135 ST NE 100
Contractor
Local Phone: 786- 487 -9844
Parcel # PARC2003 -17
Fees: Description Amount
FEE2005 -1295 Building Painting Fee $60.00
FEE2005 -1296 CCF $1.80
FEE2005 -1297 Training and Education Fee $0.60
FEE2005 -1298 Technology Fee $1.50
FEE2005 -1299 Notary Fee $5.00
Total Fees: $68.90
Total Fees: $68.90
Total Receipts: $68.90
Permit Status: APPROVED Permit Expiration: 7/30/2005 Construction Value: $2,500.00
Work: PAINT HOUSE EXTERIOR
Signed:
Legal Description:
(INSPECTOR)
Building Permit
Contractor's Address:
Page 1 of 1
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 1 assume responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
Remarks_----_______
— ____ --
STATE OF FLORIDA,
COUNTY OF DADE. ss.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of 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.
Date Jan. 13, 19 49
Owner's Name and Address Mrs. M ill er No 2 80 Street N• r:. 95th St.
Registered Architect and /or Engineer
Name and address of licensed contractor kittl.e__.JQ12bQr _.__9Z_0,__1i_. 11 al ____ th__ Ave_.
Location and legal description of lot to be built on:
Lot Block Subdivision_
Street and Number where work is to be done _
State work to be done and purpose of building (by floors Misnellaneiau8 ___repair_a.___painting -
and for no other purpose.
New Building Remodeling Addition Repairs Y No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $____ 43.63 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
m 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.
(Signed) IT .LL JOBBERS
`711 -,_
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. 7
Disapproved Date
(Signed)
/
I
„I/
Building Inspector
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
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.
Chairman
Member
�/ PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date " 1" (p '" ( 6 Job Address &k0 N 9 5`f Tax Folio
Legal Description T Historically Designated: Yes No _
Owner/Lessee / Tenant NI G_ o r C e J U (r 51 Master Permit #
Owner's Address c(-) N F 5 Phone 34 S 7• '7 7 328
Contracting Co. :J e I Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): DIN ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION e e ct A cc p oL t n T d v S e r i c kr
Square Ft. 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 penmts 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.
Notary as to Own
My Commission
d/' syr -�,�� fir•; tr R Da te
ikOfKRY PUBLIC Sy ATE OF FL:.IZIDA
COR MLES;ON NO. CC7Mt03
r�Y COM,'iI33:ON EXP. MAR. 12002 ,
- boo
Date
Signature of Contractor or Owner - Builder Date
Notary as to Contractor or Owner - Builder Date
My Commission Expires:
FEES: PERMIT RADON C.C.F. NOTARY BOND
APPROVED: TOTAL DUE
Wing Building Zo ' Buil ' N ,0 Electrical
Mechanical Plumbing Structural Engineer
Applicant
Contact Name:
Buyer
e-Q7-e;j0 /7yla i ,
APPLICATION FOR CERTIFICATE OF RE- OCCUPANCY
to re- occupy the single family residence known as : (address)
aeo E 95 9tteet , Miami Shores, Florida.
Legal Description:
Lot: 7 e V 68 Block c2d PB & PG: /O '7
I hereby certify that I understand that the zoning of the property is for single- family residential use
and that it is unlawful for more than one family to reside therein. I also understand that any
Certificate of Re- Occupancy that may be issued by Mani Shores Village, certifies only that the
referenced property is being used for single- family purposes and that such Certificate does not
constitute any representation, warranty or certification as to the condition of the dwelling or other
structures on such property.
Print Name l.� P /1" -e cz
************* w*************************** * * * * * * * * * * * * * * * * * * * * * * * *_ * **
hereby apply for a certificate
Date
For purposes of conducting the inspection required by Section 902 of the Muni Shores Land
Development and Zoning Code, please contact:
ac, Z-c. %a_ Telephone: 75 9'517
Seller Realtor — ompany Name ii ��a
R/7
Application Fee (550) paid: Cash Check No./5 7
Inspected b( Q �o Approved 17 Denied Date ()-- 4, 0
Comments:
PAGE _ OF
CER I'ir ICATE OF RE- OCCUPANCY
On behalf of Miami Shores Village, Florida, the undersigned certifies that the propeny
described in the above application has bee inspected for purposes of re- occupancy pursuant to
Sections 901 and 902 of the Miami Shores Land Development and Zoning Code and that such
property may be re- occupied by the above applicant for single - family residential purposes.
By
THIS CER1LHCATE VERIFIES THAT THE REFERENCED
PROPERTY HAS BEEN INSPECTED BY MIAMI SHORES
VILLAGE AND HAS BEEN DETERMINED TO PRESENTLY
COMPLY WITH THE SCHEDULE OF REGULATIONS OF THE
MIAMI SHORES LAND AND DEVELOPMENT CODE
PERTAINING SOT ,Y TO THE REQUIREMENT THAT EACH
ONE- FAMILY DWELLING IS USFD AND INTENDED TO BE
USED FOR A ONE - FAMILY DWELLING PURPOSE ONLY;
HOWEVER, THIS CER'T11 DOES NOT CONSTITUTE ANY •
REPRESENTATION OR WARRANTY AS TO THE CONDITION
OF THE DWELLING OR OTHER STRUCTURES ON THE
PREMISES DESCRIBED HEREIN, OR ANY ASPECT OF SUCH
CONDITION, AND iNTERESfl) PERSONS ARE ADVISED AND
ENCOURAGED TO MAKE THEIR OWN INSPECTION OF THE
PREMISES IN ORDER TO DETER INE THE CONDITION,
THEREOF.
PAGE2OF2
MIAMI SHORES VILLAGE, FLORIDA
Date of Certification: ^ b .' 0 l
PAY TO THE
ORDER OF
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: BP2002 -1777
Printed: 10 /17/2002 Page 1 of 1
Applicant: DANIEL DOWER
Owner: DOWER DANIEL
JOB ADDRESS: 280 NE 95 ST
Contractor
Local Phone:
Parcel # 1132060133710 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 7 & E1/2 LOT 8 & W1/2 LOT 6 BLK 28 LOT
Daniel P. Dower
280 NE 95th Street
Miami Shores, FL 33138
Fees:
FEE2002 -5846
FEE2002 -5847
FEE2002 -5848
Permit Status: APPROVED Permit Expiration: 4/15/2003 Construction Value: $400.00
Work: EXTERIOR HOUSE PAINTING
NQ 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.
MEMO
First Union National Bank
Miami Beach. Florida 33139
1:06 70064 3 21:10900 134083 L011' 0 S 18
Description Amount
Building Permit Application Fee $60.00
CCF $0.60
Notary Fee $5.00
Total Fees: $65.60
DATE
40/k,
Building Permit
Contractor's Address:
518
6 5
0 DOLLARS
le e or device described in the application herefor in strict compliance with all
✓ith any plans, drawings, statements or specifications that may have been submitted to
not done in compliance with such ordinances or if the plans are changed without
tor or builder named above assumes the responsibility for a thorough knowledge of the
3s or in the statements or specifications and that he assumes responsibility for work done
compliance with all ordinances and regulations pertaining thereto and in strict conformity
G Village. In accepting this permit I assume responisibility for all work done by either
BY:
BY:
Total Fees: $65.60
Total Receipts: $0.00
ivlraivir Strc3KES VILLAGE
Paint Color Approval and Agreement
DATE: /0 11 6�
OWNER'S NAME: PHONE:
ADDRESS: . .FG 9
* * * * * * * * * * * * * * * * * * * * * * ** ********* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE:
CONTRACTOR & LICENSEf applicable)
COMPANY NAME:
PHONE: .-- • • _ °-
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site be listed and indicate the color to be painted..
Walls
Fascia f
Drip Cap/Drip Edge
Soffit r
Roof
Flower Bins
Shutters
Awnings
Chimney WW/
Doors and door jams 64
Garage Doors
Railings
Fences
Decorative Metal
All brick (simulated or regular) /
Stucco Banding f A
Any other stucco features
Accessory'Buildings
Other
m
Beer Al a e C
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
d • � r work stated. Furthermore , the paint colors will be as per the attached
sa
ae
d
Building Of 'ial Date
• . 0
. r.
-1/1"1
WHi"(
Signature of Owner " `Date Signature of Contractor Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED: WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
4/23/01
IV11AMV11 S1 i' S VILLAGE
Paint Color Ap #royal and Agreement
DATE: /6 /6 A
VOWNER'S N I " 1 LZ / J � ONE 7 X9"53
DDRESS: aEi<)
**********************.*********** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
L4 DRESS OF SITE: Sill—HC
CONTRACTOR & LICENSE (if applicable) hl / y �
COMPANY NAME: PHONE^ - •
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All' Elements on the site must be listed and indicate the color to be painted.
Walls
Fascia fI C J
Drip Cap/Drip Edge , , e// /7V
Soffit
Roof
Flower Bins A/4 —
Shutters AiA
Awnings A4
Chimney o
Doors and door jams 13' /AJ
Garage Doors kIk
Railings A/14
Fences A
Decorative Metal /Vial'
All brick (simulated or regular)
Stucco Banding
Any other stucco features
Accessory'Buildings
Other
-Fo�
5e/'ec - ce /iy. to
ail brick
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate eloL
and that all work will be done in compliance with all applicable laws regulating �� `� l �'
construction and zoning. I authorize the above -named contractor, if applicable, to
d • e work stated. Furthermore , the paint colors will be as per the attached
Ad ii -
Si nature of Owner Date Signature of Contractor Date
************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED: WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
sa
Building Official Date
,ate �-- -ego
4/23/01
ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPE
Dryer
QTY.
TYPE
Outlet, Appliance
QTY.
'1'1'1'1{
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
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
N1ECHANICAL
TYPE
Minimum Fee
QTY.
TY'PI'.
Condensate Drain
QTY.
TYPE
Generator
QT Y.
FYPE
Refrigeration, Tons
QT1'.
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
TYP1'.
A/C Condensate
QTV'.
TYPE
Drains, Roof
QT\'.
T1'I'E
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:
SECTION
BY
DA
T
/oh/ A 0L.
Zoning
,�Q�f p
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
4R&C (vp,Q�
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
Notary
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
PERMIT FEES
$
O ( x .6. 1000
(¢.005 / sq.ft.)
(¢.01 /sq.ft.)
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ Sy C2 D
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
PROPERTY OWNER
Name D ` /i? � 1�'p e er/
Address , A t ) 969k
J 1 S 7 ' 3 8
Home Telephone
-- 9 9
Business Telephone
9-.5.9-243 2
Fax
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
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Nliami Shores Village:
Step 1.
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.
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.
I/1ob Address:
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other Pa 4,.1-71*
Address
Folio Number
Lot Block
Apt.
A scription of Work
HMS/ d 33/38
City State Zip
&air Pew
Subdivision PB PG Zoning Linear Feet
Current Use of Property Square Feet Units Floors
Proposed Use of Property ue of Work y 0 0 • Bldg Value
Tenant Information Tax Assessed/Appraised Value
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
Flood Zone
PERMIT APPLICATION
Master Permit No.
Subsidiary Permit No.
Base Floor Elev.
ENGINEER
Name
License No.
Address
Telephone
Fax
CONTRACTOR
Name
License No.
Address
Telephone Fax
Qualifier Name
Page 2
INIPORTANT 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, 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 '��." ORIDA, COUNTY OF MIAMI -DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE
� igna e of Owner
sPoeAlg—
Print Name ,-r.
Sworn to and subscribed before me this day of C
Signature . Notary_Eub�ic:fate
SEAL:
Personally known l/ OR, Produced Identification
Signature of Contractor / Qualifier
Print Name
Sworn to and subscribed before me this day of
Signature of Notary Public - State of Florida
SEAL:
PERMIT APPLICATION
Personally known OR, Produced Identification
Type of Identification Produced: Type of Identification Produced:
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date Time
Type Insp n ! �� ►� L - Pn
For Inspector:
Approved'
Correction
Re- Insp'n Fee
Permit No.
Name
— Address
Company
Phone #
)77y
Name Da e