290 NE 95 St (12)AIL
State work to be done and purpose of building (by floors)
STATE OF FLORIDA,
COUNTY OF DADE. 9 ss.
MIAMI SHORES VILLA 3E
BUILDING INSPECTION DEPARTMENT
APPLICATION FO IJILDING PERMIT RERCO •
Application is hereby made for the approval of the detailed statement of the 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.
April 18, 1 97!• 19
Owner's Name and Addres 1 O�d L Gordon No 2 Street.?�E 5th St.
Registered Architect and /or Engineer
Name and address of licensed contractor IDEAL R.00. ING &; She et taJ. .Torks, Tno
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done 2 90 NE 95th St Miami Shores,
eafi.nr.... resid.enc.
felt tin capped, three ( 15;, felts
and travel.\
and for no other purpose.
New Building Remodeling- __x.C.],' -QQ.! t Repairs No. of Stories 1
To be constructed of Kind of foundation Roof Covering _ 0/3 - '''.r. a ve 1
Estimated Total cost of improvements $ 3 6 5 0.00 Amount of Permit $ 9.00 ( 32 SO.)
Zone cubage required -Plan Cubage
Distance to next nearest building Size of Building Lot
Maximum live load to be borne by each floor
hereby su.,..:i all U... pl „us and specifications for said building. All notices with reference to the building and its construction may
be sent to Ideal Roofing Cz Sheet Metal 1 Inc., 261 NE 73rd St., Miami, 1?
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatio• ,. . , foyer
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, P- na. Sul )leme
and has complied with the provisions thereof, and will require similar compliance from all .-tractors or sub -con cto : employe.. by him
in the work to be performed under this permit; and will post or cause to be posted nspecti n on the site of _ x such ply lie notice
or notices as are required by the Act. The undersigned agrees to employ only s subcontr. • . s, on . erfo • • under this
permit, as are licensed by Miami Shores Village. /
Remarks (Sign . _ . _
.
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 /?S ') f Date - _ L Read, Sworn to and Subscribed before me.
Disapproved date
Q
(Signed) 1 ?r `
Building spector Commission Expires
Notary Public, State of Florida
PLA ING BOARD DATE
Chairman Member
Member Member
Member - Member
Council Approved Date Disapproved Date
NO..; .A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the I'l:uc,i,, :iu.ird.
A re- i'.,t,(•ction fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
m tcrials :,,,d /or workmanship.
`" Owners Name and Address 1�Csc�4 `�• ."4O1ilI\ •`'1-1`\*-1c1Z‘1.
c. „.Aame and address of licensed contractor
Location and legal description of lot to be built on:
L / / y
Lot'S °4 t Block .
Street and Number where work is to be done ,z(
I SHORES VILLAGE
INSPECTION DEPARTMENT
Remarks (Signed)
STATE OF FLORIDA
COUNTY OF DADE.
} SS.
ifOR BUILDING PERMIT
lent of the plans and specifications herewith submitted for the building or other structure herein
h the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the
tnd regulations of the Building Division of Miami Shores Village shall be complied with. whether
nust be kept at building during progress of the work.
\R- 0 h/47e
Subdivision 74/
f✓
Date
19
No. t 'e- 0: t Street q
Registered Architect andtor Engineer
.471 /3 /ADO i2
M ate work to be done and purpose of building Iby floors). state exterior colors (submit samples)
1 M ty
and for no other purpose
New Building Remodeling Addition Repairs No. of Stories
'lb be constructed of r Kind of foundation Roo Covering
timated Total cost of improvements S sJ �,--6?0 Amount of Permit S
Zone cubage required Plan Cubage
Distance to next nearest building
Maximtm live load to be borne by each floor
I hereby submit all plans and specifications for said building. All notices with reference to the building and its construction may be sent to
Size of Building Lot
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatons as an employer of Labor under the Florida Workmen'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 in the work to be performed under this permit: and ill 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 $grees to employ only s ch subcontractors. on work to be performed
under this permit, as are licensed by Miami Shores Village.
Before me. the undersigned authority. a notary public. duly authorized to administer oaths and take acknowledgments, personally appeared
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. 3D (O " / 5J Date //1 f /ffQ Read. Sworn to and Subscribed before me.
Disapproved Date
t IV r } \tv Notary Public. State of Florida
(Signed) A
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved Date
NOTE: A charge of 525.00 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 525.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials andtor workmanship.
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the 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.
Owner's Name and Address
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot Block
Street and Number where work is to be done
State work to be done and purpose of building (by
STATE OF FLORIDA,
COUNTY OF DADE. j
ss.
Disapproved r Date ,! ,
(Signed) �._r..
Building Inspector /
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
c Date
(I .
floors)
Subdivision
Remarks
New Building Remodeling Addition Repairs
(Signed)
No. ..$t. Street VI;
�G�- l�lrf.��• t�
and for no other purpose.
No of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ /1i� " 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 5968, Compiled General Laws of Florida, Pennanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him
in 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.
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 L_ Q __ • .• Date Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Chairman Member
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 Panning 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.
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date ` � �1 Job Address b k`� Tax Folio
Legal Description Historically Designated: Yes No
Owner /Lessee / Tenant ti■xALLI
Owner's Address e kA .• • °\ , Phone �1
Contracting Co. ( I /s-1 G k_ Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION ,•c■ aNk
Square Ft. Estimated Cost (value)' 1S\Sb - (SO
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 AFFID • VIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
laws regulating co tion and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
Signature 8f owner and/ r ondo President Date Signature of Contractor or Owner - Builder Date
Notary as to Contractor or Owner - Builder Date
My Commission Expires: My Commission Expires:
Notary as to Owner and/or Condo President Date
FEES: PERMIT 1 10- RADON
APPROVED:
Zoning Building 1 ! j Electrical
Mechanical Plumbing Engineering
Master Pennit # ` Z Z I ,
C.C.F. • 600 NOTARY BOND
TOTAL DUE 47`S 6c)
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building ft
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
MIAMI SHORES VILLAGE, FLORIDA
❑
❑ DATE 13 195-40--
❑ PERMIT N° 4774 Contractor's ..
License No
Work to be performed under this Permit
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 fpttrrr condition upon which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough ktltowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings cr in the statements or spec, jica s '+and that he assumes responsibility for work
�
done by his agents, servants or employees. / / +� ,
Signed. : > - . - ' . -- . • ''''s.... BYE
INSPECTOR ''.r,
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with ali` 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.
ti
CONTRACTOR OR BUILDER
4..
Bl.
F 4
BY
Subdi-
vision
Value of
Project $
Amount of
Permit $
AUTHORITY e
DATE: j �o -- a aooa
OWNER'S r:
ADDRESS: o qo AL E. 9,5 1"` airee -
********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE: a Rb d .E. q..5 U.
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME:
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted.
Walls 054
Fascia 0
Drip Cap/Drip Edge 05,
Soffit
Roof —
Flower Bins 1079
Shutters
sa
MIAMI SHORES VILLAGE
Paint Color Approv and Agreement
APPROVED:
Building Official
Awnings
Chimney —'
Doors and door jams
Garage Doors
Railings
Fences
Decorative Metal * /079
All brick (simulated or regular) 0
Stucco Banding /0 7 9
Any other stucco features --
Accessory Buildings — 1/B 976 ✓ tk-e'
Other c,)a1 a2ou d iF'� clot- 97(, � , -4
��64�e61J�� Vt
II ar v"4v l . 7 a if'lda --
ice is �ccurate
OWNER'S AFFIDAVIT: I certify that all the foregoing information
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 ed. Furthermore , the paint colors will be as per the attached
Date
3/E
1/A
PHONE:
1079
054
Signa ure of 0 n r Date Signature of Contractor Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
4/23/01
MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
DATE: /0/ /D
OWNER'S NAME: S4e. hen (cn7a, �- Lim ad PHONE:. s 96/^ 9/.79
ADDRESS: ago AI, E 9. ' 4 , i z vni 1,ares / fl 33,38
******************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE: 0240 4.). E. 5 43- SlYe , 1;4 SGi�,�
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME: PHONE: , ,
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted.
Walls 053
Fascia 053
Drip Cap/Drip Edge o.-3
Soffit 0,513
Roof
lower Bins 1015
hutters `—
Awnings
Chimney
Doors and door jams
Garage Doors —
Railings
Fences l ®`l q
Decorative Metal 1D
All brick (simulated or regular) )0'19
Stucco Banding —
Any other stucco features
Accessory'Buildings --
Other C91.ttd Wad vieaJ egen .
dloofr- 411
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 •
samtales.
Signature of Owner Date Signature of Contractor Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED:
Building Official Date
WHEN PAINTING IS FINISHED
CALL FOR FINAL INSPECTION
7,
•
•
z
tri
En
4/23/01
j �. r ci�l�� S'
1.9/0
1V11A1V11 MrlUKl+,SyILLAGE
Paint Color Approval and Agreement
DATE: /0
OWNER'S NAME:
ADDRESS: a0 L't! < ,
Walls /t 71
Fascia fay I
Doors and door jams
Garage Doors —
Railings
Fences
, n (,inn 7-0-6$ 119: / e d PHONE: 7S 74.1,
**********************.**,********* * * ** * * * * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE: cQ N� � % J. -
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME: PHONE:
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted.
Drip Cap/Drip Edge
Soffit /07?
Roof
Flower Bins ? (4
Shutters --
Awnings —
Chimney
Decorative Metal /07?
All brick (simulated or regular) 05
Stucco Banding
Any other stucco features
Accessory'Buildings —
Other 3 .o -d
2/D
1/A 1079
u % 14 04-
053
/may. ' .
6o04. �
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
sam les.
422z_
o
Signature of Owner Date D Signature of Contractor Date
************************************* * * * * * * * * * * * * * * * * * * *. * *. * * * * * * **
APPROVED:
a/6'
Building Official Date
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
4/23/01
0
r .
- 0
�z.
3
-cn t y # :L1 42
H
2
c
w
x
cn
ACM M/r 0 �10027
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 10/8/2002
Applicant: LISETTE
Owner: GONZALEZ t\5)
JOB ADDRESS: 290 NE 95
Contractor
Local Phone:
Parcel # 1132060133700
STEPHEN O Y GONZALES
LISETTE M D
290 N.E. 95TH ST.
MIAMI, FL 33138
I t:the order of
Bankof merica.
Building Permit
Permit Number: BP2002 -1713
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 5 & E1/2 LOT 6 BLK 28 LOT SIZE SITE
Description
Building Permit Application Fee
CCF
Total Fees:
Fees:
FEE2002 -5632
FEE2002 -5633
Amount
$60.00
$0.60
$60.60
Total Fees: $60.60
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration: 4/6/2003
Work: EXTERIOR PAINTING AS EPR AGREEMENT
If there is no permit package accessible on the job -site for ins
�O fee is $50.00, which must be paid in ad
Date
vAAS
Memo
1 :063 LOO 2771: 0035 L6349565 3 L50
1\
sA
a rs
GONZALEZ
LISETTE
ST
Contractor's Address:
Construction Value:
3150
63- 27/63 FL
988
8
NP
BY:
BY:
$500.00
Page 1 of 1
verify, there will be no inspections. Re- inspection
ection.
all the equipment or device described in the application herefor in strict compliance with all
, ce with any plans, drawings, statements or specifications that may have been submitted to
1c is not done in compliance with such ordinances or if the plans are changed without
tractor or builder named above assumes the responsibility for a thorough knowledge of the
wings or in the statements or specifications and that he assumes responsibility for work done
in compliance with all ordinances and regulations pertaining thereto and in strict conformity
•es Village. In accepting this permit I assume responisibility for all work done by either
PROPERTY OWNER
Name S+ males
Addres> O N . &. 615+k- SJ -e_ r,
Hl'Ami SkoreS FL £13'&
Home Telephone
11.5 757 ‘..ia
Business Telephone
Fax
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'l Attachment
Other
Add'l Detachment
Other
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Step 1.
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
Job Address:
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.
d escription of Work f a t n T , h `el[.. 2ri a r" n'r lam) a r» P_
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
a �.E . q5 5-freek
Address Apt.
Folio Number
Lot Block
Subdivision PB PG
Current Use of Property
Proposed Use of Property
Tenant Information
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
Master Permit No.
Subsidiary Permit N
City
II V
PERMIT APPLICATION
, grr Slams F L 33138
State Zip
Zoning Linear Feet
Square Feet Units Floors
value of Work5 Bldg Value
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
Page 2
I\IPORTANT 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, 1g 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.
ATE OF FL, OXZII A, COUNTY OF MIAMI -DADE
Sign atur of Owner
SEAL:
Print Name
Swom t and subscribed before me this '2- ( day of
Signature of Notary Public - Sta of orida CASAMDRA HARRISON ature of Notary Public - State of Florida
plIbI1C. del, of Raw
No 7. lux
Personally known OR, Produced Identification
Type of Identification Produced:
Signature of Contractor / Qualifier
Print Name
Sworn to and subscribed before me this
PERMIT APPLICATION
STATE OF FLORIDA, COUNTY OF MIAMI -DADE
Personally known OR, Produced Identification
day of
Type of Identification Produced:
ELECT RICAL
TYPE.
Minimum Fee
QTY.
TYPI';
Dryer
QTY.
"rYPI:
Outlet, Appliance
QTY.
'I )PE
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. I'YPF
Generator
QTY. TA PE
Refrigeration, Tons
QTY.
A/C Central, Tons
QTY.
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 and Abandon
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
Gas - Appliance
PLUMBING
TYPE
A/C Condensate
QTY.
TYPE
Drains, Roof
QTY.
TYI'I:;
Miscellaneous Fixture
QTY.
Tvi'P,
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 TE
Zoning
00 `Jt
/!7
3d /6
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
i rt l
L• Z—
Page 4
L OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi - family)
CONCURRENCY
(New Construction)
O 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
f
D
$
(sq.ft. = x/1000
(¢.005 /sq.ft.)
(¢.01 /sq.ft.)
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ (� U j /94o
ISSUING OFFICIAL
REVIEl.nD AND PREPARED BY: DATE:
t1
CONDITION OFAPPRO'AL
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com