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560 NE 95 St (10)MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT 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. - aA - Date - - -_ - - Owner's Name and Address..... ?, /. - .... ... .- .2..... o ... Street , 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 �a State work to be done and purpose of building (by floors) STATE OF FLORIDA, COUNTY OF DADE. ss Disapproved (Signed) Date Building Inspector PLANNING X 4 // / ,7 , and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Estimated Total cost of improvements $ 2- 0 Amount of Permit $ Zone cubage required .Plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him 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. Remarks (Signed) -,49 R oofg 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 dul sworn, upon oath deposes and says that he is the. of the above described const tion, that he has carefully read the for g application, and that he did sign the same, and that all facts therein by him s d are true Permit No / a ate �y- `� d S om to and Subscribed before me. ry Public, State of Florida My Commission Expires 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 Planning Board. A re- inspection fee of 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. OWNER'S NAME W. C. Puhl PRESENT 1 33 N. We 103 LOT 5 ADDRESS d St BLdCK 5 5 Miami LICENSE NO. SUBDIVISION Shores r \'. PH: '11E NO. N JOE LOCATION (ST. OR AVE.) 560'N. E. 95th St. GENERAL CONTRACTOR ADDRESS PHONE E N O. LICENSE NO. BUILDING PERMIT NO. 3293 rf C DATE 2 -27 -56 PERMIT FEE $ 21.00 BUILDER'S BOND NO. 193f DATE 2..27..56 y ZONE REQUIREMENTS 17;M 00 Cu. FT. PLAN CUBE 18973 CU. FT. EST. COST $ 17 DRAWINGS, SPECIFICATIONS. RESTRICTIONS AND CUBE CHECKED BY Read DATE 2 -27 -56 NEW CONSTRUCTION TYPE ,� 'CHS STORIES i ROOF CONSTRUCTION Tile INTERIOR CONSTRUCTION 2 Br. 2 Bath Gar. REPAIRS V' DESCR IPTION Marvel tile nr Carpet Flnpr Plaster Walla, and ea ta ng ALTERATION , DESCRIPTION Ti11 fSi118 ADDITION SUBMITTED TO PLANNING BOARD APPROVED REJECTED REFERRED TO COUNCIL REASONS RE- SUBMITTED TO PLANNING BOARD SUBMITTED TO VILLAGE COUNCIL REMARKS 4 CERTIFICATE OF OCCUPANCY NO. 517 / _ ISSUED /7 -.5 u1/Li BY = � . C. /�, . f,Z . TO BUILDING PERMIT AND INSPECTION RECORD -MIAMI SHORES VILLAGE CONTRACTOR „1 pRJ S . a....t /3'i/.27 PHONE PERMIT NO. .33 /4:3 1 DATE Z - 2 f "- FEE S / 2 Co NEW BLDG. X 1 ALTERATION ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE TEMPORARY SERVICE :S3 t -( $ SEPTIC TANK .33 ..1.k. re.0 ( $ _ Y-' SEWER RANGE CONN. $ SOLAR HEATER MOTORS S GAS FIXTURES $ $ $ INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY ROUGHING - - - GAS ROUGHING SEWER H. W. HEATER CONN, SEPTIC TANK - I SOLAR HEATER RANGE CONN. FIXTURES CONTRACTOR 12 O P 4 C S EL, —c 'Ti> 1,e_ PHONE FEE $ PERMIT NO. - DATE NEW BLDG. I ALTERATION ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE :S3 t -( 2.- Z `. - 4 $ I, an H. W. HEATER CONN. 3`` � •' $ RANGE CONN. $ MOTORS $ FIXTURES $ S INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY TEMP. SERVICE - - - ROUGHING H. W. HEATER CONN, RANGE CONN. FIXTURES & FINAL 1 v J 7 . i/ f Z,4 +.74.y ,�� vJf BUILDING INSPECTIONS` INSPECTIONS DATE BY RE- INSPECT BY I RE- INSPECT I BY FOUNDATION BEAMS & LINTELS FRAMING s lOPON AL CLEAN -UP PLUMBING PERMITS & INSPECTIONS ELECTRICAL PERMITS & INSPECTIONS APPROVAL TO POWER CO. FOR SERVICE DATE S4,11 3 BY r FI :UILDING ❑ :LECTRICAL ❑ 'LUMBING ❑ tiOOFING ❑ . ' ❑ ?weer of ; uilding f �` contractor , T Builder -egal )escription _ address of . uilding Lot � (-. ( MIAMI SHORES VILLAGE. FLORIDA PERMIT / architect f In consideration of the issuance to me ertaining thereto and in strict conformity with epting this permit I assume responsibility for "' 41 1 I Lx.. /,? C5NTRACTOR OR BUILDER Bl. 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 .erefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, rawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any me if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is ranted is the understanding that the contractor or builder named above assumes th,e responsibility for, a thorough knowledge of the ordinances and regulations •ertaining to the work covered hereby whether shown on the plans or drawings or" the stateme3is "tii� specifications and th ,he assumes responsibility for work one by his agents, servants or employees. \ r •'' I Signed. N? 4014 Work to be performed under this Permit Subdi- vision DATE Contractor s License No. Value of Amount of Project $ Permit $ all work done by either, myself, my agent, servant or employee. .te 1 BY 195' 1 INSPECTOR - of this permit I agree to perform the work covered hereunder iry timpliance with all ordinances and regulations the plans, drawings, statements or specifications submitted to the oper authorities of Miami Shores Village. In ac- following described property: Legal description /folio #: for S oC[` 5'f Lot S Block S Subdivision Tax Folio #: requests permission to install: SIGNED. SEALED AND DELIVERED in the presence of: Y/iami SIiores i�ccye 10050 N.E. SECOND AVE. MIAMI SHORES. FLORIDA 33138 -2382 Telephone: (305) 795 -2207 Fax (305) -756 -8972 COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY WHEREAS, g�'f1 -1614_ L -a (owner) 1 [%(Asphalt, concrete, brick pavers [ J Landscaping [ J Other within the public road right of way of 5 XJe. Ism sr: , hereinafter referred to as the Owner of the SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on this i ll day 54■ (_64 $1;a047,..) itt Z �p1Z luEco /4y ft PPR 0 (address) IN CONSIDERATION of the approval of this permit by the Village, the Owner agrees as follows: 1. To maintain and repair, when necessary, the above- mentioned item(s) installed within the dedicated right of way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said items within public right of way including restoration of street by reason of the Owner's failure to do so, such expense shall be paid by the Owner or shall constitute a lien against the above described property until paid. 2. The owner does hereby agree to indemnify and hold Miami Shores Village or dade County harmless from any and all liability, which may rise by virtue of permitting the installation of these items within the public right of way. 3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days notice by the Village to do so. Failure to comply with this notice will result in the Village causing the item(s) to be removed and a lien being placed on the property and/or assessed against the Owner for all costs incurred in the removal and disposal of the item(s). 4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such time as this obligation has been canceled by an affidavit filed in the Public records of Dade County, Florida by the Village Manager of Miami Shores Village (or his fully authorized representative). 4ROPERTY OWNER Name Addres 5/p G 771111 9rr sr. A OA. < cpt, , ft 3310' Home Telephone Business Telephone Dii 373 - "SOD Fax TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'I Detachment Other INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be 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 Job Address: 56 0 Ate 9S 5/Me-T Ml t*t . City Address Apt.' Folio Nu r erl I a 30 b ` O' ' ' Description of Work MAADva _ P i J 4..:s p a.).r rXrv�� - C a we gcr f All S /� :.Subdivision ij d S .c.-<' C, C.D. PB /D 1 Zoning . Linear Feet Current Use of Property h Q (S • 4q�uare Feet 5A ± Units Floors \ '` PrIposed Use of Property � "Value ot✓Work I ttb Bldg Value Tenant Information Tax Assessed/Appraised Value Flood Zone Base Floor Elev. • Lot Block PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Master Permit No. Subsidiary Permit No. State PERMIT APPLICATION 0 6 y Zip ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. Address Telephone Fax Qualifier Name Page 2 IMPORTANT NOTICES 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. 1. 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 twei ve 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. STATE •R,c, COJTY OF MIAMI -DADE STATE OF FLORIDA, COUNTY OF MIAMI-DADE Print Name Print Name Sworn t. a s subscribed before me this / ( day of , Sworn to and subscribed before me this day of A tOe o Fiori • Signature of Notary Public - State of Florida M. �� 1 ' CF F 0 1 Personally known OR, Produced Identification 1/' Personally known OR, Produced Identification Type of Identification Produced 4, L Doo'6, Sa. // ')1 J - .,QType of Identification Produced: SEAL: ature of Owner Signature of Contractor / Qualifier SEAL: PERMIT APPLICATION ELECTRICAL TYPE Minimum Fee QTY. 'TYPE Dryer QTY. TYPE Outlet, Appliance QTY. TYPE Service Repair QTY. A/C Central 1 -3 Ton Fan Dryer Vents, Number of Outlet, Wall Ventilation, Cost Service, Temporary Air Handler, Tons A/C Central 4 -7 Ton Piping, Flammable Liquid Fire Pump Outlet, Switch Fire Sprinkler System Signs A/C Central 8-15 Ton Bath Fan - Vented, # Fixture - Fluorescent - Pressure Vessel 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 Violatiwus 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 TYPI: 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 Solar Water Heater Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Cap - Fixture Bath Fan - Vented, # Fireplaces, Number of - Pressure Vessel Pump and Abandon 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 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 Zoning `� ,/J � to/ � O � Electrical Mechanical Plumbing Fire Public Works Structural Building Official f f'U /re 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 FEES 6 O $ ( sq.ft. = x/1000 x0.60) (¢.005 / sq.ft.) (¢.01 /sq.ft.) REVIEWED AND PREPARED BY: ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ PERMIT APPLICATION ,to ISSUING OFFICIAL 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