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PAINT135 NE 94 ST FINAL PAINT / I ✓ (Ct Passed D 0 ✓ Inspector Comments Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until .1. inspection Number : - INSP- 3243 Inspection Date: 12/19/2005 Inspector: Grande, Claudio Project: <NONE> Contractor: Building Department Comments Friday, December 16, 2005 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 c Owner: BLACK - GORDON, FLORENCE Job Address: 135 94 Street NE Miami Shores Village, FL 33138- :, PermitNumbe BP2005 -1419 Block: Permit Type: Imported Permit Inspection Type: Final Work Classification: Paint Phone Number Parcel Number 1132060132881 Lot: Page 2 of 2 BUILDING PERMIT APPLICATION FBC 2001 Owner's Address °T / 5 A! ' E " 9 5 7 City ) / i9/» / /WM 5 State ?L ` Tenant/Lessee Name Job Address (where the work is being done) 1,35 x/ E • 5 T 5/ • City Miami Shores Villa:e County Miami -Dade Is Building Historically Designated YES NO X Contractor's Company Name &c. '/7'�i Contractor's Address City State Qualifier $ Value of Work For this Permit 0 • OD Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (30 r ►; c Qr� 6. 'Il�,� Phone # State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # Square Footage Of Work: Permit No. Rs —14-1q Ma ker Permit No. Permit Type (circle): Electrical Plumbing Mechanical Roofing Owner's Name (Fee Simple Titleholder) /Q /Hee `jAn 53 5 Phone # (3O5) Z/ S - / 3 Zip 33/30 Phone # zip 33/3 Zip Type of Work: ❑Addition ['Alteration ['New ❑ Repair/Replace ❑ Demolition Describe Work: Submittal Fee $ Notary $S - 00 Scanning $ #); * * * * * * * * * * * * * * * * * * * * * * *** * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Permit Fee $ CQO Training/Education Fee $ Q . 20 Radon $ Zoning Bond $ Code Enforcement $ Structural Plan Review. $ Total Fee Now Due $ (=i• -� (Continued on opposite side) CCF $ fo CD CO /CC Technology Fee $ (t5D Bonding Company's Name (if applicable) M... 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 permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC 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. "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 reinspection fee will be charged. Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this 2E The foregoing instrument was acknowledged before me this da chc 05/13/03 20 by. -t IY7Ce L. 414 day of My Commission Expires: , 20 , by who is personally known to me or who has produced who is personally known to me or who has produced (D - As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Print: My Commission Expires: ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** **************************************** * * * * * * * * * * * * * * * * » * * * * * * * * * * * ** ** ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: / /o D / I � Plans Examiner Engineer Zoning u` Miami Shores v illace Paint Color Approval and A reerent Date O 2 e,0 5 —) 2/5-153, Owner's Name (gee %� .470 S Phone # (3 / Owner's Address # Ats 5 City r,:4,74 1 h / e S State ( Zip .lob Address (where the work is being done) l 5 )V - 7 57 City Miami Shores Village County Miami -Dade Zip 33/3 is Building Historically Designated YES NO X Contractor's Company Name (if applicable) All elements on the site must be listed and indicate the color to be painted 5ai �J,5 5H 1 /14,g Wails / 6/ //if 7,4)/1 _ -- Fascia l� G� � 2 19 (Se v/T .54 - dI �0�(4 Drip Cap /drip Edge Soffit Roof (4-17'1T 2 Flower bins Shutters Awnings Chimney g ara c Doors and door jams Garage doors S. (V. ( //2 1 9 / 5e. Li /7 5f /E /2a / f/ Railings Fences Decorative metal All brick (simulated or regular) Stucco banding Any other stucco features Accessory Buildings Signature APP_,ICATION APPROVEP BY: Owner or Agent 0 1 /4 -.. Phone # Other **************************.*************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with aii applicable laws regulating construction and zoning. Datt SW 6112 Biscuit 17 SW 6115 Totally Tan ( 7.11C 6/1 WO? Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 10 /7/2005 Applicant: FLORENCE Owner: BLACK - GORDON JOB ADDRESS: 135 NE Contractor Local Phone: Parcel # 1132060132881 Signed: (INSPECTOR) Building Permit Permit Number: BP2005 -1419 BLACK - GORDON FLORENCE 94 ST Fees: FEE2005 -13320 FEE2005 -13321 FEE2005 -13322 FEE2005 -13323 FEE2005 -13324 Description Building Painting Fee CCF Notary Fee Training and Education Fee Technology Fee Total Fees: Amount $60.00 $0.60 $5.00 $0.20 $1.50 $67.30 Total Fees: $67.30 Total Receipts: $0.00 Permit Status: APPROVED Permit Expiration: 3/29/2006 Construction Value: $600.00 Work: PAINT 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 employes. Signed: (Contractor or Builder) Contractor's Address: Page 1 of 1 Legal Description: 1 53 41 & 6 53 42 MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 19 & E3OFT LOT 18 BLK BY: CCT 1 1 PAID �i 1 — / p PERMIT AP FOR MIAMI SHORES VILLA Date l9 . ^ ( 8 - ,e Job Address / � J" �- t S I r Tax Folio Legal Description Historically Designated: Owner/Lessee / Tenant ,Y1 1 ci t tr gA ! V l Q o Owner's Address / S / v' E 9 Ili n S , WORK DESCRIPTION PV--€ - C - 2 c „ & Yes aj► Square Ft. Estimated Cost (value) 2 D- Co 3.q 7JlD Master Permit # Phone Contracting Co. 1 � Address Qualifier rY1 1 cv SS# - - F° s'N'hone 3 C9 l 'f 7 C State # Municipal # Competency #(9 e9 / ?Ict � -{ Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN 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 law g construction Signature of o er and/or efk-ral Notary as to Owner and/or Condo President Date My Conission Expires:_ - CGYngy • FEES: PERMIT g 61 • APPROVED: Zoning Mechanical ing. Furthermore, I authorize the above -named contractor to do the work stated. do President RADON Building C.C.F. Signature of Contractor or Owner- Builder Date Notary as to Contractor or Owner-Builder, My Commission EWpiresfa, tIcSyAWV ViAL 3A C.3 vomilet. €��«SY f ;? �;''.;tssIo auc uaR - � Cc4 ©V 31 1/'F ca 1`i7, ( . L 1, NOTARY Electrical TOTAL DUE 4 7 Date !7� Plumbing Engineering MIAMI SHORES VILLAGE Paint Color Approval and Agreement DATE: OWNER'S NAME: 4141 41 &/e/.'.ve% 6 v i PHONE :C 7S7-SoW ADDRESS: /&s Alc 90 d. crif4,7: it r 3si- • ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ADDRESS OF SITE: S.fene 1 �V$ CONTRACTOR & LICENSE (if applicable) //4 COMPANY NAME: PHONE: ******* * * * * * * * * * * * * * * * * * * * * * * * * * * * * -•- y 4, * * * * * ** All Elements on the site must a listed and indicate the color to Walls % V- PEC -Al Fascia a.)h,t� Drip Cap/Drip Edge ,,),4, Soffit whit-s Roof ',Wit Flower Bins /1 P c- Shutters ,tit'? Awnings AJ /il. Chimney Doors and doof jams c3/,c/ Garage Doors /) )9- Railings A!/,�. Fences LP. Decorative Metal All brick (simulated or regular) 4)1,://e W / Stucco Banding hi/ A VOA,/ A Any other stucco features �/» . Accessory Buildings A/ M. ° ��� Other 01)4, �`� v OWNER'S AFFIDAVIT: I certify that all the foregoing informatior, and that all work will be done in compliance with all applicable lawn construction and zoning. I authorize the above -named contractor, if do the work stated. Furthermore , the paint colors will be as per the sa ?''es. Signature of Owne S Date Signature of Contracts, ******************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** WHEN PAINTING I� CALL FOR FINAL APPROVED: ae / Building Official Date SECTION BY DATE Zonin • ,�;' Address / 3S 4V d % 5AWA Electrical IIIIII J� Mechanical Plumbing Fire Public Works Structural Building Official _. Shell Only Foundation Only PROPERTY OWNER, We New Construction Name /� /02'/IeG " 69 Cda J Enclosure Address / 3S 4V d % d "er x �- i Home Telephone 7. C Repair Business Telephone g? 3 _ azs Alteration Interior Fax 00. Flys _09.20 Demolish 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 KLIST CI OWNER - BUILDER FORM (Attach) ® FIRE DEPARTMENT APPROVAL (Commercial / multi- family) • CONCURRENCY (New Construction) • OTHER (Specify & Attach) PI? $3.00 per page (Scanning Fee) Miami Shores Village Bond Inspector State Educational Fund $ State DCA (Radon) Code Enforcement Fine Zoning Review $ Metropolitan Dade County (C.C.F.) $ • 0 (sq.ft. = x/1000 x0.60) CI PROOF OF OWNERSHIP (Attach) HRS / DERM APPROVAL (Septic / Sewer) Ul IMPACT FEE (New Construction) CI OTHER (Specify & Attach) (¢.005 / sq.ft.) (¢.01 /sq.ft.) PERMIT APPLICATION C/ CONDO ASSOCIATION APPROVAL (Attach) ® BPR APPROVAL (Restaurants) CI CONTRACTOR REGISTRATION (On File) TOTAL $ O •S_. 6 D r ISSUING OFFICIAL 0 0 REVIEWED AND PREPARED BY: DATE: CONDITION OFAPPRAL. Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL o (305) 795 -2207 0 FAX (305) 756 -8972 0 http:/ /www.miamishoresvillage.com e take rao obtain ,a .ermitf`ro i Shores Vtllagc: W Step I. 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 submitted 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. V AP P E I' C' ' 'A T I' O N Job Address: / S /Lie W Address Apt Folio Number, I 3 ° 0 1 3 2-8?-s Lot 14 7 (? Block Subdivision ins Se- F ) 0 PG D V Current Use of Property Proposed Use of Property ' 1 PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other. Chg. Contractor Renewal Revision Extension Supplement Reinspection PERMIT CHANGE (✓ ) ARCHITECT Name License No. Address Telephone Fax /27/4w) Sh/e.r • • City Master Permit No. Subsidiary Permit No. 2 1 7 State Description of Work ke-th: PERMIT APPLICATION 33/.49 Zip Zoning Linear Feet Square Feet Units iXalue of Work 1 ZSO Bldg Value Floors Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. Address Telephone Fax Qualifier Name ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. TYPE Outlet, Appliance QTY. TYPE Service Repair QTY. A/C Central 1 -3 Ton Heating Strips, each Fan Outlet, Wall Service, Temporary Paint Booth A/C Central 4 -7 Ton Fire Pump Outlet, Switch Piping, Flammable Liquid Signs A/C Central 8 -15 Ton Fixture - Fluorescent Process/Pressure Piping Oven Space Heater (kw) A/C Central 16-20 Ton Pressure Vessel 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 QTY. TYPE Generator QTY. TYPE Refrigeration, Tons QTY. A/C Central, Tons QTY. Cooling Tower Heating Strips, each Vent Hood, Cost A/C WalWVin. 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 and Abandon Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Gas - Appliance PLUMBING 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 ` OF FLORIDA, CO,J' OF MI Print Name ,,--�� Sworn to and subscribed before me thisG (J day SEAL: • . - D ADE .. 6<_) Signature of Owner 7 �D/e/7ee afeA - • si, Are 411 0 i $' J P A/ gnature o i Notary Pu. is - Sta of F7onda gn rY �` v� OFFICIAL NOTARY " sS 1 L li OST c/., ANGELA Nl BECKER 2 ' 1 Cl COh:'..'.1 rO7 Mu".aan i ( �. ¢° CC7866 �` ✓ 9 '1 - .''ON E]tMRSS '' fr pr 10‘i, i5,P.002 Personally known ._ -- - - OR, Produced identification Type of Identification Produced: / ok .b/ G-, Signature of Contractor / Qualifier Print Name Sworn to and subscribed before me this day of Signature of Notary Public - State of Horida SEAL: PERMIT APPLICATION STATE OF FLORIDA, COUNTY OF MIAMI -DADE Personally known OR, Produced Identification ) - 0 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: PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date le- Job Address AJE34 - 1 ‘ 5- Tax Folio /J `7CV 6 r Y 181° ✓ Legal Description 4 6 V o L 6 G %' c/ „La 74D / Lessee / Tenant \CikkV'C - eirtA - < r Master Permit 4 ilf Phone /& / 7 Contracting Co. vtX Own-ev' Address Qualifier SS# - - Phone State # Municipal # Competency # Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one):( BUILDING) ELECTRICAL L'� PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION - PCZ \A-t `r'�- - o - r �h a ' S( Q. V` Is'slV . L-00 \I' 5 Square Ft. Estimated Cost(valuejlf d 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 ize the above - name•, • oe ;4,E4 VL � tated. o ' qt =PIM t c fttft, State *I Owner's Address ( ,QE �� 5 Signat Date' APPROVED: • • • Print type or stamp name of Notary Public ° j p ar. n ur l eg •a ` /�/ Ld: re of owner and /o fotar l as to Owner and/ y Commission Expires: Signature of Contractor or Owner - Builder Date: Notary as to Contractor or Owner - Builder My Commission Expires: [❑ DID take an oath, or DID NOT take an oath. ** * * * * * * * * * * * * * * * ** FEES: PERMIT RADON C.C.F. - -- 4 - 22 NOTARY /212 TOTAL DUE 40%9 te Fire Other Zoning Buildin > 11 2 Q Z Electrical Mechanical Plumbing Engineering 135 NE 94 ST FINAL PAINT D Inspector Comments . Passed Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled until re- inspection fee is paid. 'Inspection Number: INSP -3243 Inspection Date: 12/19/2005 Inspector: Grande, Claudio Owner: BLACK - GORDON, FLORENCE Job Address: 135 94 Street NE Miami Shores Village, FL 33138- Project: <NONE> Contractor: Building Deaartment Comments Friday, December 16, 2005 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 e L- Biock: Permit Number: BP2005 -1419 Permit Type: Imported Permit Inspection Type: Final Work Classification: Paint Phone Number Parcel Number 1132060132881 Lot: Page 2 of 2 Tenant/Lessee Name Contractor's Company Name Contractor's Address Architect/Engineer's Name (if applicable) Submittal Fee $ Notary $S - 00 Scanning $ Total Fee Now Due $ - 30 (Continued on opposite side) Miami Shores Village BUILDING PERMIT APPLICATION FBC 2001 City State Qualifier Type of Work: ['Addition ['Alteration Describe Work: 19 Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (30fp)3 M: EI J'r16.8972 Permit Type (circle): Electrical Owner's Name (Fee Simple Titleholder) c � 1 /i-f ee _j9 n70 5 Owner's Address 415 A/ - E " / ' 7 5 City 5`( /,9/» I S I7 0 / te 5 State ?Z Job Address (where the work is being done) City Miami Shores Village Is Building Historically Designated YES $ Value of Work For this Permit 00 • I3SX/•E• 5'zi5i. County Miami -Dade NO X State Certificate or Registration No. Certificate of Competency No. ['New Phone # Phone # Phone # Square Footage Of Work: * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Permit No. -a — 14 q Master Permit No. Plumbing Mechanical Roofing Phone # ( 3 6 S) 2i 5 " / 5 3, Zip 33/_33 Zip ,33/38 Zip 111 Repair/Replace ❑ Demolition Permit Fee $ ( ( ft/ CCF $ (D• fogy CO /CC Training/Education Fee $ Q . 2.0 Technology Fee $ 1 "c Radon $ Zoning Bond $ Code Enforcement $ Structural Plan Review. $ 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 permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC 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. "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 reinspection fee will be charged. Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this 7� The foregoing instrument was acknowledged before me this day.nt foc �� 20G'_ by YY7Ge day of , 20 , by who is personally known to me or who has produced who is personally known to me or who has produced lD - As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: APPLICATION APPROVED BY: chc 05/13/03 Signature NOTARY PUBLIC: Sign: Sign: Print: Print: My Commission Expires: My Commission Expires: 0S Plans Examiner Engineer Zoning Date 0 Miami Shores Village Paint Color Approval and Agreement ze o5 'B 4 (1' n7 L V 57 City � e jv/te S State 7 Zip �1G9 //'I ` Owner's Name Owner's Address Job Address (where the work is being done) 13 1 57 City Miami Shores Village Is Building Historically Designated YES NO X County Miami -Dade Zip Contractor's Company Name (if applicable) ************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ******************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All elements on the site must be listed and indicate the color to be painted Walls -- rtrirt 4 ill 7A1') 5 t,I/ ' /I ✓5 5 1/1.4 a/r`1/oA -s Fascia Vi // /3 (gecd/T &, d , eri,u/ i4' Drip Cap /drip Edge Soffit Roof (.42/J7 f e. Flower bins Shutters Awnings Chimney Doors and door _jams ' //° Garage doors S•uf. 6 Ira 8/•)&011 SALE /2al;∎ a/ �, Railings Fences Decorative metal All brick (simulated or regular) Stucco handing Any other stucco features 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 regulating construction and zoning. S i enature APP —I CATION APPROVED BY: Owner or Agent Phone # ( 307 ) 2/5 -) 53, ,3 3/ 3 33/3 B Phone # SW 6112 Biscuit SW 6115 Totally Tan Date 09 /ge / Date /�' /; 17 cnc 6/1g/07 } Y Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Permit Number: BP2005 -1419 Printed: 10 /7/2005 Applicant: FLORENCE Owner: BLACK - GORDON JOB ADDRESS: 135 NE 94 Contractor Local Phone: Parcel # 1132060132881 Building Permit BLACK - GORDON FLORENCE ST Contractor's Address: Legal Description: 1 53 41 & 6 53 42 MIAMI SHORES SEC 1 AMD PB 10 - 70 LOT 19 & E3OFT LOT 18 BLK Fees: FEE2005 -13320 FEE2005 -13321 FEE2005 -13322 FEE2005 -13323 FEE2005 -13324 Description Building Painting Fee CCF Notary Fee Training and Education Fee Technology Fee Total Fees: Amount $60.00 $0.60 $5.00 $0.20 $1.50 $67.30 Total Fees: $67.30 Total Receipts: $0.00 Permit Status: APPROVED Permit Expiration: 3/29/2006 Construction Value: $600.00 Work: PAINT Signed: (INSPECTOR) Signed: (Contractor or Builder) BY: Page 1 of 1 t -r 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 employes. JJ PERMIT AP FOR MIAMI SHORES VILLA Date C ( ( K Job Address / S / T S r Tax Folio Legal Description Historically Designated: Yes Owner/Lessee / Tenant j'Y1 i t Aii, v v ) e,; 01© Owner's Address / Q. Ai E ` 44 S , Contracting Co. (/ g L 09 v, PC (� r. @, Address �' 2 S C �, I C , Qualifier (l 1 cic,, a S \ SS# G 1 - (3_ ?' e,NPhone State # Municipal # Competency #0 ey 1 WSti L{ Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION ft—€ °. C e� rQ Square Ft. Estimated Cost (value) 1 2- Co Signature of o Notary as to Owner and/or Condo President Date My Commission Expires: FEES: PERMIT V I APPROVED: Zoning do President Building Mechanical Plumbing Signature of Contractor or Owner- Builder Master Petrnit # es/ eirr: Phone Electrical Engineering 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 law. - gula g construction . . ing. Furthermore, I authorize the above -named contractor to do the work stated. ) Notary as to Contractor or Owner- Builder My Commission Expires: - (-8 RADON C.C.F. 1 i NOTARY TOTAL DUE Date ieq Date ©s DATE: OWNER'S NAME: 4/41 6cao;ve/ PHONE: 7,5 ADDRESS: /3s R/c 9s' d. m.,l $fcror,,r'c . 3s/ - 13. ***** * * * ** * * * * * * * * * * * * * ** * * * * * * * * * ** ADDRESS OF SITE: „Q ,1 A v i z . CONTRACTOR & LICENSE (if applicable) /1//4. COMPANY NAME: PHONE: *************************** * * * * * * * * * * * * * * * * * * * * * * * * * * *ak * * * ** All Elements on the site must ,1af r Walls V P C'A Fascia 6, -)h , •t2 Drip Cap/Drip Edge tJi , te Soffit A)hr,'e Roof Ohife Flower Bins . in/ , - \ Shutters . A.//h Awnings A01. Chimney Doors and doof jams Garage Doors A/) )- Railings A09. Fences ,v1/9. Decorative Metal All brick (simulated or regular) t),; /e Stucco Banding Any other stucco features .s/ //d Accessory Buildings Ai// Other MIAMI SHORES VILLAGE Paiirt Color Approval and Agreement Signature of Owne * * * * * * * * * * * * * * ** APPROVED: Building Official '7 70/ Date e listed and indicate the color tc Put! c ro e ° ki o L y ry � OWNER'S AFFIDAVIT: I certify that all the foregoing informatioi . and that all work will be done in compliance with all applicable law - construction and zoning. I authorize the above -named contractor, if do the work stated. Furthermore , the paint colors will be as per the Date Signature of Contracts. **** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** WHEN PAINTING L CALL FOR FINAL 4/23/01 ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. 'TYPE Outlet, Appliance QTY. TYI'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 Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service , Demolition Low -volt, Intercom/Teleph. Repair Circuits Wa .e4tu... Dishwasher Low -volt, Television - Service, Number of Amps Water Heater New MECHANICAL TYPE Minimum Fee QTY. TYPE Condensate Drain QTY. TYPE Generator QTY. TYPE 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. '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 ischarge We]] Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump D -s csa: - " ...-4 l'I ?.et Water Closet Domestic V V ue__ ..�L..+��..ry ._ray ( Roof Septic Wa .e4tu... '.2. ain e L, 4" Ti—e%'. .avatory - Septic Tank Water Heater New Drains, Area Mete: se (Gas) Sewer Connection Water ire -pis'e Drains, L +Icor Minim= Yee Shower Water Service Drag- s,'French Niece= lane^us lvc, ,:ipment - Sink Weil, 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. STAY OF FLORIDA, CO OF MI = BADE tlr �i4-t) • Signature of Owner �/oieti7ee nztU.:: o:' No:ary ?.:� is - Stz.e of -:c i C',;730;: : 6 .v .;7',.‘.;.::_ 1 , SEAL: PERMIT APPLICATION STATE OF FLORIDA, COUNTY OF MIAMI -DADE Signature of Contractor / Qualifier Print Name Print Name Sworn to and subscribed before me this 7 day , Sworn to and subscribed before me this day of S: t re of Zo *zry ?ubiic - Sate of Florida SEAL: Personally known OR, Produced Identification L/ Personally known OR, Produced identification Type of Identification Produced: F � 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: SECTION BY DATE Zonin: M4W` AWA Electrical Mechanical Business Telephone 11,3_ mss,/ Alteration Interior Plumbing Demolish Fire Shell Only Public Works Foundation Only Structural Other Building Official Add'I Detachment Other PROPERTY OWNER,. New Construction Name / /O/G'/IeC' 60 doc) Enclosure Address / Ogled /01112 51 /er, :.7/.8 Home Telephone 7.Y Safi Repair Business Telephone 11,3_ mss,/ Alteration Interior Fax /2,�i-, ?7 _093 Demolish TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'I Detachment Other 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 Inspector State Educational Fund $ State DCA (Radon) Code Enforcement Fine Zoning Review ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) PERMIT FEES Metropolitan Dade County (C.C.F.) $ 0 (sq.ft. = x/1000 x t.60) (¢.005 /sq.ft.) (¢.01 /sq.ft.) REVIEWED AND PREPARED BY: PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) 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 Step 1. V Job Address: 'Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other / 55 AJ€ 9y'' SEP m/ ; Sh.es. Address Apt. City Lot j e l 1 3/1 t Block o I Subdivision pc Se ./ [1 IQ I 0 PGI D Current Use of Property JP Proposed Use of Property Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone PERMIT APPLICATION Master Permit No. Subsidiary Permit No. 2 i l 1 INSTRUCTIONS - The following steps must he taken to obtain a permit from the Miami Shores Village: 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 Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. APPLICATION �C- State Folio Number' f 3R O b 0 13 2 -8$ Description of Work Zip Zoning Square Feet Units Floors p4alue of Work /I /SO Linear Feet Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT CHANGE (✓ ) ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. Address Telephone Fax Qualifier Name