135 NE 94 St (20)MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date Time
Time
Type Insp'n
Permit No.
Name
For Inspector:
Correction
Re-Insp'n Fee
Address — /3.5
Company e
Phone # =Cu c) / / '30/1
Li
Name & Date
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37.50'
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REMAINDER OF LOT 18
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LOT 20
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NOT VALID UNLESS EMBOSSED W+TH
SURVEYOR'S SEAL
VIP 1 2
I at
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SCALE:1 " =20'
BOUNDARY SURVEY
FLOOD ZONE:
WNI .
DATE:
7_(3- 01
'ABBREVIATIONS:
SWK= SCEWALK. CBS =CONCRETE 3LOCK STRLCTURE. CLF =CHAN LINK FENCE. PL= PROPERTY UNE. DUE =DRAINAGE UTILITY EASEMENT.
IP =IRON PIPE. F= FOUND. A/C =AIR CONDITIONER PAD. P/C =P oPERN CORNER DM= DRILLED HOLE. W/F= WOCOEN FENCE.
RES= RESCENCE. CL =CLEAR R9= REB.+R UE= UTILITY EASEMENT. CONC= CONCRETE SLAB. R/W =RIGHT OF WAY. DE= DRANAGE EASEMENT
C/i. =CENTER LINE. 0= 0IAMETER IYP= TYPICAL M= MEASURED. R= RECORDED. ENCR = ENCROACHMENT. COMP = COMPUTER ASP`+ =A3P-L Lt
N/D =NAIL & DISC. S= SEL•FFE= FINIS-4 FLOOR ELEVATION. O/S= OFFSET. P/P =POWER POLE. OHP= OVERHEAD POWERLNE. WM= WA:E:P ,■ETErt
s s I E! ?v3 ;iG'.5 t3; ?d Cn
W000 FENCE= • + •
MASONRY WALL ----- - - - - -- CE`!
CONCRETE= : • •. eV _t . .
Locator Incex T
1) Record and measured calls are in substantial agreement. 2) Bearings. if shown are based on Plat data. 3) The lands
shown hereon were not abstracted for Easements or other recorded emcumbrances not shown on the plat and :he same, if
any may not be shown on this sketch. 4) Underground portions of Footings. Foundations or other improverner.ts were not
located. - 5) Elevations are based on National Geodetic Datum. 6) Fence Ties are to the Centerline of the rent :e. 7) Wail
Ties to the face of the Wall. 8 g .R.M fit-- r' - SHOtJ ARc. REPERED TO AN ASSUM D VALUE SAID FS PPG:.
CERTIFIED TO: FLORENCE BLACK— GORDON AND CORDINEL GORDON,135 N.E. 94TH ST., MIAMI
SHORES, FLORIDA 33138., DANA F. CHARLES, P.A., ATTORNEYS' TITLE INSURANCE
FUND, INC., SIB MORTGAGE CORP., ITS SUCCESSORS AND /OR ASSIGNS, ATIMA.
LEGAL DESCRIPTION: LOT 19 AND THF, EAST 30 FT. OF LOT 1 R BLOCK 71
OF AMENDED PLAT OF MIAMI SHORES SECTION NO. 1 SUBDIVISION
ACCORDING TO THE PLAT THEREOF AS RE.CO -DED IN PLAT BOOK 10 AT PAGE 70
OF THE PUBLIC RECORDS OF MIAMI —DADE ;COUNTY. FLORIDA.
I HEREBY CERTIFY That the survey represented
hereon meets the minimum technical requirements
adopted by the STATE OF FLORIDA Boa•d of Land
Surveyors pursuant to Section 472.027 Florida
Statutes
There are no encroachments. overlaps. easements
appearing on the plat or vls+bte easements ether
than as shown hereon
ADIS N. NUNEZ
Reg ;s :erec Land Surveyor No
S :3 :e of Florida
rA
LOCATION SKETCH,
SCALE: INS
37.5'
(305) 865 -1200
N.E 1st AVENUE
128.75'
128.75'
(s,
128.75 '
128.75'
0
15'
w
r.�
(n
cn
4
SINCE 1987
BLANCO SURVEYORS INC.
Engineers • Land.Survevors • Planners LB 4l 0007059
555 NORTH SHORE DRIVE
MIAMI BEACH FL. 33141
Fax (305)865-7810
SUFFIX ::J DATE: 7 -17 -95 BASE: a�
O O 93 C(X`'i� 1N1T'1'Y IuT T�faFp 1 2 0 E S3
SCALE: DWN. BY: JOB No.
1 "= 20' F.: CO
01— //3
lageLLS 1 M76 9
.11VHdSV .[Z
PROPERTY OWNER
New Construction
Name (3 / f ,e r 4 on 4/ ( Cyr / d v
J 1 ,_
Enclosure
Address 3 5 NI � „ Lel ��
rq,aolI si• or-c5 FL-
3313c.
Home Telephone .3 o 5 7 6 S -o I-
Business Telephone
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
Page 4
OFFICE USE ONLY
CHECKLIST
CI OWNER - BUILDER FORM
(Attach)
® FIRE DEPARTMENT
APPROVAL (Commercial /
multi - family)
® CONCURRENCY
(New Construction)
CI OTHER
(Specify & Attach)
PERIM
$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
CI PROOF OF OWNERSHIP
(Attach)
HRS / DERM APPROVAL
(Septic / Sewer)
Li IMPACT FEE
(New Construction)
OTHER
(Specify & Attach)
$ o o 0
4 6 (sq.ft. = x/1000
S
0
BY
SECTION
Zoning
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
DATE
7/x/
2.
x ¢.60)
(¢.005 /sq.ft.)
(¢.01 /sq.ft.)
REVIEWED AND PREPARED BY:
PERMIT APPLICATION
U CONDO ASSOCIATION APPROVAL
(Attach)
BPR APPROVAL (Restaurants)
CI CONTRACTOR REGISTRATION
(On File)
TOTAL $ 6 S , b D
ISSUING OFFICIAL
DATE:
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2"° AVE., MIAMI SHORES, FL e (305) 795 -2207 c FAX (305) 756 -8972 o http : / /www.miamishoresvillage.com
tl\L ' i`Sh es V i 1 1a g &�`
Step 1.
Step 2.
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.
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.
Job Address:
135 Nl
Apt.
Address
Folio Number �! � (�t - b' F
Lot /f e Block 'l
Subdivision jfrid. tPt T P► °°"PB p_ PG -co
Current Use of Property. iji
Proposed Use of Property
Tenant Information
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
tr
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
PERMIT CHANGE (✓ )
ARCHITECT
Name
License No.
Address
Telephone
Fax
Master Permit No.
Subsidiary Permit No. '-4? `1 J
33/g$
Zip
Description of Work &- f F Yl c e.
Joao' if-/)c .5 46'
Zoning Linear Feet 1 v
Floors
1Yict/IJ ;k0 3
City
Square Feet Units
State
PERMIT APPLICATION
Value of Work 1.1.0 0 Bldg Value
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
ENGINEER
Name
License No.
Address
Telephone
Fax
CONTRACTOR .// ft
Name lv
License No.
Address
Telephone Fax
Qualifier Name
ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPE
Dryer
QTY.
'I'1'PE
Outlet, Appliance
QTY.
TYPE
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
MECHANICAL
TYPE
Minimum Fee
QTY.
TYPE
Condensate Drain
Q1'1'.
TYPE
Generator
QTY.
TYPE
Refrigeration, Tons .
QTY.
A/C Central, Tons
Cooling Tower
Heating Strips, each
Vent Hood, Cost
A/C Wal)n. 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
PLUI\IBING
TYPE
A/C Condensate
QTY.
TYPE
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 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, 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.
STA 0 FLORIDA, CO OF
Signature of Owner
, /9e. 6d/�O.ci
Print Name
S to and subscribed before me thi
SEAL:
PERMIT APPLICATION
STATE OF FLORIDA, COUNTY OF MIAMI -DADE
Signature of Contractor / Qualifier
Print Name
Sworn to and subscribed before me this day of
Ai Al- ,
9k s yam..
ignature of !. ry '?tom. T " Signature of Notary Public - State of Florida
• , LidOTARY
cj7-- U6i ANGELA N3 BECAER
Z ") ( fr n ooc;ass:o:: t:u�aan SEAL:
.t. ¢ CC7a6E9
I � OFf O P:OJ. X 5,:002 --
Personally known F /
OR, Produced Identification � Personally known OR, Produced Identification
'Type of Identification ProduceG ( , 3 5 - ) a -1Y-Ya 1- t/ /� Type of Identification Produced:
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:
APPROVED:
V-774; . �; �,
Date �� - l� Job Address �� " Tax Folio � �V 6P
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Lessee / Tenant (6...t\LWCP U
Legal Description AWr�/ /
Owner's Address \ 2 h - ' S
Master Permit #..�3 7 /L%
Contracting Co. OWYN(-(A — Address
Qualifier SS# - Phone
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): ILDI ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING ENCE SIGN
WORK DESCRIPTION A- 1A3 Duy CC '- / 7 f ( C; -,
Phone - 75 ? 2, `
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
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
a e t e above -named contractor to do the work stated.
Signat e o f owner and /or Condo President Signature of Contractor or Owner-Builder
Date:
i
My ommission Expires
y a to Owner a
Date:
** * * * * * * * * * * * * * * sty
FEES : PERMIT I" RADON C.C.F. S NOTARY 5 C ®€/ n TOTAL DUEI 6
Fire Other
Electrical
Zoning
Notary as to Contractor or Owner- Builder
My Commission Expires:
Mechanical Plumbing Engineering
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