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275 NE 94 St (14)Village of Miami Shores 10050 NE 2nd Avenue Miami Shores, FL 33138 Phone: 305 - 795 -2204 J Printed: 2/26 /2002 Applicant: DONNA NEUWEILER Owner: NEUWEILER DONNA Contractor VISCOUNT PAINTING & DECORATi diress: 640 GRAND CONCOURSE 1 Local Phone: 305 - 751 -7164 Cellular: Parcel # 1132060133830 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 22 & W1/2 LOT 23 BLK 28 LOT SIZE Job Address: 275 NE 94 ST Fees: Description Amount M FEE2002 -1141 Building Permit Application Fe*60.00 FEE2002 -1142 Notary Fee $5.00 FEE2002 -1143 CCF $0.60 Total Fees: $65.60 Permit Status: Approved Permit Expiration: 8/25/2002 Work: EXTERIOR PAINTING OF BACK ROOF If there is no permit package accessible on the job -site for inspectors to verify. than:-..8M Look for blue background on the front of t check, and the intageSafem logo 011 back. If not present; do not cash 2003 This Permit is granted to the cont ordinances pertaining thereto and wi and approved by the proper municip, authorization. A further condition up, ordinances and regulations pertainini by his agents. servants or employee; Signed: In consideration of the issuance to t . 1i with the plans, drawings, statements myself. my agent. servants or employ S.igned •r. • q t -OF AC11 WI 063100277 Building Permit Permit Number: BP2002 -396 Construction Value: $500.00 fee is $50.00, which must b- ' VISCOUNT PAINTING AND DECORATING DATE PAY I 67.444‘ 7.44 5A1/.. ( I ( � L � 10 1141 Onf) IA Of _ Bank of America Page 1 of 1 Total Fees: $65.60 Total Receipts: $0.00 2 -2 (..o 11' 200311' ':06 L00 2??': 00 3 60 2 2 600 9 7 11' 63- 27/631 FL 988 /00_DOLLARS x, .111 MIAMI Nnuttu3 v Paint Color Approval and Agreement DATE: 2. 21• OWNER'S NAME:—Cr..-1 Y\GUwci \or PHONE: I 00 ADDRESS: Z'I S 414r# s-r ADDRESS OF SITE: 2 '/.( , 9''i sr— CONTRACTOR & LIg ENSE (if a elt cable) qitgsao al COMPANY NAME: \ Stow PHONE( 'Kr- 7 164 ***************************:***** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All Elements on the site must be listed and indicate the color to be painted. Walls Ik Fascia � 0� Drip Cap/Dr' dge_ Soffit r.1 J< Roof 'c 3 ks - D i 8 Flower Bins t Ot_ Shutters Awnings Chimney Doors and door ja s �. Garage Doors 0 A. Railings k Fences t(# Decorative Metal ,.r r All brick (simulated or reg lar) Stucco Banding t A- Any other stucco features A-- 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. 1 authorize the above -named contractor, if applicable, to do the work stated. Furthermore , the paint • ors will %e as pe the attached samples. O . 1 Z • 21 • b L Signature of Owner � Da *�� * *� Signature 0 *� o�n� *��o� * * * * D�a�e . * * * * ** * * * * * * * * * * * ** * * * * * ** APPROVED: WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION Building Official Date 4/23/01 /0 601,1/Eg 103 G�� o 7465046 AJ 4 P��(T' .good 5 . 416 on1-r mkfAi keror 110 e.9 0K 047) nir: VIE E '- (- P) 5-r ;eeED ,W,K e o Ex o s— Co /t,(e A "iP i r4,4 a - 171,e - 5 war w� R ('acev i[1 P�S< P)0(4 416. w E 1 $o 1AJE GvTi0t AL-04 A�G b✓i iW SP /f tkra aS i 5mv:4 Co zoK vA1( T s • Plai‘a( PeaSv4E 0--6 d od dcE7 S 7 inic \tote ; M18 77115 1 40E - _ o T Ro ntr 49tt5R Fittaa 7 vJ,i; No S PEG Spe-c1Ces ), oair A/c 05(61-e ,o,(4 F (o/J' ( ©t 49use S Pbc5 PRo \i Dcp . V. ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. 'I'VI'E 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 'I'YI'E 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 Wall/VVin. 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. Print Name Swo• nd subscribed before me tldz day of , li' PU 0r1C:AL : .:I 1I c 6� ANGELA �,� r�o69'i nd P 0 iGct_A :J GtC •` l ^ '- 7 LII II. txcli:S I Personally Personally laiown Type of Identifi4t '9 uce ' d 7 1,3_0 Type of Identification Produced: SATE •F FLO Si Signature of Notary i� bIef Flori c� - - SEAL: ature of Contractor / Qualifier PERMIT APPLICATION , Ct UNT • F MIAMI -DADE 7 Print Name �� wo• nd subscribed before me this ,l).— day of 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 /► Name I!> CD 1 I t tJL'1 DATE / Zoning / � oL` -Z e Electrical L S o �O 7 Business Telephon Relocation of Structure Mechanical Foundation Only Add'1 Attachment Plumbing Other Add'l Detachment Fire Public Works Structural Building Official li 2 PROPERTY OWNER New Construction /► Name I!> CD 1 I t tJL'1 NameThk, e. u► w s- 1 \ a i Alteration Exterior Address 7-.74.0. 9 �- 5. Home Telephone (.34?) L S o �O 7 Business Telephon Relocation of Structure Fax Foundation Only CONT CTOR New Construction /► Name I!> CD 1 I t tJL'1 Enclosure License No. q, / OO j , / Alteration Exterior Address A , / /t`r k°°45 Repair Telephon( ^^ _ last() Fax Alteration Interior (� Qualifier a le (^` , 06Ar ceOC1N I r le- TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'1 Attachment Other Add'l Detachment Other Page 4 OFFICE USE ONLY' CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) PERMIT FEES $3.00 per page (Scanning Fee) Miami Shores Village Bond Metropolitan Dade County (C.C.F.) Inspector State Educational Fund State DCA (Radon) Code Enforcement Fine Zoning Review $ ( sq.ft. = x/1000 ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) x ¢.60) (¢.005 / sq.ft.) (¢.01 /sq.ft.) PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) 5", TOTAL — $ _j — 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 Step 1. Master Permit No. PERMIT APPLICATION Subsidiary Permit No.3P' a-00 a. • 39 . INSTRUCTIONS - The following steps must be 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. A PPLICATION Job Address: 2'7 CPI" V -4- ST Address Apt. Current Use of Property Proposed Use of Property Tenant Information j/ 3.)-b CQ.©133, Folt • '. umber Lot Subdivision PB PG Block PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection CHITECT Name License No. Telephone Fax 531 City , State Zip ��, -/ Description of Work 15 �T 80 a!,1 cArra-- �• 6i �� Cob Q APPt 1•t APPR0 M 514cer:PAi $Jd Root Zoning Linear Feet Squye Feet Units Floors 14 clue of Wor]�© C') - Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. INEER Name License No. Telephone Fax motilk L.lt•. o0-533 MIAM! NHUKL' v ,Paint Color Approval and Agreement DATE: - 4 - oz OWNER'S NAME: fl, . ii5 AU ��E e PHONE: 70/— • o'� °'° AD 275 '/. 6"- 9t4r6L sT i * * * * * *** * * * * *a� *4. 4.* ** : ******* ** * * * * * * * * * * * * * * * * * * * ** * * * ** * ** ADDRESS OF SITE: 27.E A. E 9 CONTRACTOR & LIC SE (if COMPANY NA ap 'cable) gi5 P _ 4 1viE VI 55 c out,11"M &riI HONE: . ,� ** ******** **************** : * * * * * * * ** * * * * * * * * * * * * ** ** * * ** o:* *** All Elements on the site must be listed and indicate the color to be pa Walls ,-I C - 3 0 l Fascia /a /�nl v✓ -- - . Edge (,r / I v✓�tT-E o Drip Cap/Drip Edg f z Soffit /.hi/gin/ vd L Roof r 5 LW ' u- al,L Flower Bins al 3 � Shutters g c Awnings N is Chimney /-/-'e- 3g Doors- and -door jams - -- - li4J ifr( Garage Doors (d/./Er+l 1nit'r- Railings r./k Fences /VA- - i Decorative Metal �E� w _ g All brick (simulated o regular) /4/0V W Ikt'i'6 1 Stucco Banding rt i i� Any other stucco features Accessory Buildings -- Other APPROVED: 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 , ors will be as / per the attached sad pies, • �- oz Signature of Owner Date Signature of Contractor Date *******************************:***: * ** * * * * * * * * * * * * * * * * * * * * **** * * ** WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION Building Offic Date rP-(2"16 7 I NI W linen white putnam ivory - 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 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. 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 iii 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. Signature of Owner *nt Name S —� to and subscribed before me thi gnatufe of N SEAL: RIDA't UNTY OF MIAMI -DADE `` Personally known OR, Produced Identification A 1 It e of Contractor / ` Q lifier lb' • 3E1 V l 5 Cec..rT Print Name Swo d subscribed before me this day S ST F T� 1/ SEAL: attire of 'otary Public - tate of Florida Personally known PERMIT APPLICATION OUNTY`. MIAMI -DADE 0 w PO, v \• RS :� .I4 Q r, o ; ;v cn OR, Prod cu^eEk?entiftcation • \ l Type of Identification Produced: / DL ! Y [ 6 n l\ d? 7 7- /(7 °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 DAM 5 /6% Zoning i pA Electrical y Mechanical 4 t 33r 3 ( Plumbing Fax Qualifier am Fire Shell Only Public Works Foundation Only Structural ??_ _ Building Official Add'I Detachment /�-en4 Other CONTRACTOR / OWNER Name /WA It ,t/ AEU yif Name V 15 CO J�T�? t N l ( License No. n, R e L Y � i( Address 60> / ( 4 t 33r 3 ( Telephone / t ( �'( � (P Fax Qualifier am S Eov v ,- -- PROPERTY / OWNER Name /WA It ,t/ AEU yif Address 2 ?5----/4 e: W ST frff /1' 5 F7 33(36' Home Telephone /5, L_D 7...CO Business Telephon 7 - 4 a 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'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 Metropolitan Dade County (C.C.F.) $ 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 APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) PERMIT FEES , r (sq.ft. = x/1000 x ¢.60) $ (4.005 / sq.ft.) $ (¢.01 /sq.ft.) ‘,, _ ISSUING OFFICIAL O a REVIEWED AND PREPARED BY: TOTAL 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 INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1: Step 2. APPLICATION Job Address: Folio Number Lot PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Master Permit No. PERMIT APPLICATION Subsidiary Permit No. B 4-6 Complete the attached permit application which must be signed by the progeny 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. 1 - 7 A/ 9V i /Z( 33/ 38 Address Apt. City State Zip Description of Work Block Subdivision PB PG Zoning Linear Feet Current Use of Property Square Feet Units - Floors Proposed Use of Property Value of Work 2. z D . d'o Bldg Value Tenant Information Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. T lephone F Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT CHANGE (✓ ) ENGINEER Name License No Telephone Fax MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request AJ Date 1D-I0 Time Type Insp'n r' I RM Permit No. il" DIJV - - 3c1(0. tsPZ(Q -an/ Name 1"EU WEIl,�� Address Is) NE. 94. Company V al(114 Phone # For Inspector: ID. Ip `i J Name & Date Approved Correction Re- Insp'n Fee ❑ MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 •� Building Inspection Request Date 1a 3 Time Type lnsp'n f I N �� ?C111 Permit No. ? 1 ( ` 3C1(c'. 5P,2(0.-70 Name ll�EU W E . Address 17:5_�. th C .. Company Phone # For Inspector: Approved Correction Re- Insp'n Fee i