431 NE 94 St (8)Date
Type Insp' n
Permit No. r3 o7.-_
Name Co r K.f_ I
Address 43 1 L IS - I --
Company L./ Vl/ VL (
Phone #
Inspection Date
Correction
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Re- Insp'n Fee ❑
61)01
'ELECTRICAL
'TYPE
Minimum Fee
QTY.
TYPE
Dryer
Q1
TYPI'.
Outlet, Appliance
QTY.
TYPE
Service Repair
QTY.
A/C Central 1 -3 Ton
Drinking Fountain
Fan
Outlet, Wall
A/C Wall/Win. Tons
Service, Temporary
Dryer Vents, Number of
A/C Central 4 -7 Ton
Paint Booth
Fire Pump
Ventilation, Cost
Outlet, Switch
Cap - Fixture
Signs
Fountain
A/C Central 8 -15 Ton
Fixture - Fluorescent
Barbecue
Oven
Fire Sprinkler System
Space Heater (kw)
Process/Pressure Piping
A/C Central 16-20 Ton
Supply, AC Well
Fixture Light
Cap - Sewer
Parking Lot Lights
Gas - Natural
Spas/Hot Tubs
A/C Central 20+ Ton
Flood Lights
Plugmold/Strip
- Pump, Re- circulate
Subfeeds, No. of Amps
Temporary Water Closet
A/C Window
Clothes Washer
FPL - Load Central
Gas Piping
Posts
Swim Pool, Commercial
Air Conditioners
Garbage Disposal
- Pum I, S s rinkler
Range/Range Top
Utility - Sewer
Swim Pool, Residential
Discharge Well
Chiller
Ice Maker
Generators, etc.
Receptacles
Switchboards
S
Clear Violations
- Relay Re' air
Heat Recovery
Vacuum Pum s
Refrigerator, Comm. (p/PH)
Dis i osal
Temp Serv., Construction
Interce I for
Compactor
Low -volt, Burglar
Refrigerator, Domestic
Temp for Test - 30 days
- Se • tic Connection
Deep Freezer
Water Heater
Low -volt, Fire
Drainfield, 4" Tile/Res.
Renew - Temp Service
Lavatory
- Se s tic Tank
Demolition
Low -volt, Intercom/Teleph.
Repair Circuits
- Sewer Connection
Water Re- s i s e
Dishwasher
Drains, Floor
Low -volt, Television
Minimum Fee
Service, Number of Amps
Water Service
Nt'E C HANI t�C AL
1 1 ' I �.. .:. :art . -,
Minimum Fee
a s;
. > :- O I Y. 1'1 PG
- u Condensate Drain
QTY.
TYPE
Generator
QTY.
TYPE M
Refrigeration, Tons
A/C Central, Tons
Bath Tub
Cooling Tower
Drinking Fountain
Heating Strips, each
Vent Hood, Cost
A/C Wall/Win. Tons
Bidet
Dryer Vents, Number of
Filter Replace
Paint Booth
Ventilation, Cost
Air Handler, Tons
Cap - Fixture
Ductwork, Cost of
Fountain
Piping, Flammable Liquid
Periodic Inspections
Barbecue
Cap - Water
Fire Sprinkler System
Gas - Appliance
Process/Pressure Piping
Supply, AC Well
Bath Fan - Vented, #
Cap - Sewer
Fireplaces, Number of
Gas - Natural
Pressure Vessel
Temporary Toilet
Pl IBING
1 11
A/C Condensate
QTY.
-
TYPE
Drains, Roof
QTY. TYPE
- Miscellaneous Fixture
QTY.
TYPE
Soakage Pit
Q:=
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 Tra r
- Pum I, S s rinkler
Utility - Sewer
Discharge Well
Ice Maker
Pum •, Stun'
Utility - Water
Dishwasher
S
Indirect Wastes
- Relay Re' air
Vacuum Pum s
Dis i osal
Interce I for
Roof Inlet
Water Closet
Domestic Well
Laundry Tray
- Se • tic Connection
Water Heater
Drainfield, 4" Tile/Res.
Lavatory
- Se s tic Tank
Water Heater New
Drains, Area
Meter Set (Gas)
- Sewer Connection
Water Re- s i s e
Drains, Floor
Minimum Fee
Shower
Water Service
Drains, French
Miscellaneous Equi , ment
- Sink
Well, Su .sly
Page 2
ItMpOR FANiT NOTIG
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.
i iF FID T 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.
\TATEO # " IbA,CIt !/
•
Tor
nt Name
Sworn to and s : ribed before me this ' day of /ny
ft
ra�tate of FNIAMAR PEREZ
COMMISSION ?% CC 997478
• . a EXPIRES: January 29, 2005
ty � Bonded Thru Notary Public Underwriters
St. of Nota
SEAL:
ature
Personally known OR, Produced Identification Personally known OR, Produced Identification
Type of Identification Produced: Type of Identification Produced:
F MIAMI -DADE
PERMIT APPLICATION
STATE OF FLORIDA, COUNTY OF MIAMI -DADE
Signature of Contractor / Qualifier
Print Name
Sworn to and subscribed before me this day of
Signature of Notary Public - State of Florida
SEAL:
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:
$CTION
BY
DATE
s / -2 y/d1
Zoning
0-e 4-
Electrical
Home Telephone gcy.7
Mechanical
Business Telepho
Alteration Interior
Plumbing
Demolish
Fire
Shell Only
Public Works
Foundation Only
Structural
Other
Building Official
;����fM
.�.� .�
Other SLZ,P p&I A -r
//
PROPERTY OWNER
New Construction
Name )t _ Z `'
Enclosure
41 ` N (2...— 7
M 1 prl4
9�--
P- -
Home Telephone gcy.7
S4 . 4 g,Q,
Business Telepho
Alteration Interior
Fax
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'1 Detachment
Other SLZ,P p&I A -r
//
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)
LI OTHER
(Specify & Attach)
$ (¢.005 / sq.ft.)
$ (¢.01 /sq.ft.)
(sq.ft. = x/1000
x ¢.60)
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
PERMIT FEES
TOTAL $ o a V
ISSUING OFFICIAL
VIEWED 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
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Step 1.
Step 2.
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 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.
APPLICATION
Address
Apt.
Folio Number
Lot Block
Subdivision PB PG
Current Use of Property
Proposed Use of Property
Tenant Information
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other SP1
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
einspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
j Va1ue of Work
Subsidiary Permit No.
PERMIT APPLICATION
Master Permit No.
Nil/ 1 / Eu2salS
City State l
escription of Work
Zip
9Q
Zoning Linear Feet
Square Feet Units Floors
O �
e
Bldg Value
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
Coo CE:t013 - L `
ENGINEER
Name
License No.
Address
Telephone
Fax
CONTRACTOR
Name
License No.
Address
Telephone Fax
Qualifier Name
BOARD DECISION:
A PPROVED
DENIED
SIGNATURE & TITLE
DATE: inly 0)1 010N
CERTIFICATE OF APPROPRIATENESS
ADDRESS OF PROPERTY: 431 N.E. 94 Street
NAME(S) OF APPLICANT(S): Jerry & Suzanne Cornell
APPLICATION DATE: (Date Application Received by Village Clerk) Mav 21, 2002
CERTIFICATE OF APPROPRIATENESS REQUEST FOR:
Paint exterior of home using the following colors:
Base Wall Color = Benjamin Moore Clarksville Grey (HC -201)
Trim Highlights = Benjamin Moore Crownsville Grey (HC -106)
Decorative Trim above arched windows = Benjamin Moore Providence Olive (HC -98)
Restore & Stain as many wood casement windows as feasible using the following stain:
Benjamin Moore Medieval Brown Stain
Remove jalousie windows and replace with casements.
APPROVED WITH CONDITIONS
/ 40
/ /.�•;
MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
DATE:
OWNER'S NAME:
ADDRESS: vl
********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE: ZPs As €A �
CONTRACTOR & LICENSE (if applicable) pig
COMPANY NAME: PHONE:
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted
Walls (;(4.,-
Fascia 0 W '! ,.r.� SA,on
Drip Cap/Drip Edge P - -
Soffit
� '1
Roof 11 s
Flower Bins ({(2-6.1
Shutters P
Awnings per `f
Chimney
Doors and door jams
Garage Doors Al f 10
Railings fr
Fences
Decorative Metal
All brick (simulated or regular) ()
Stucco Banding 42
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. I authorize the above -named contractor, if applicable, to
do t , • stated. rthermore , the paint colors will be as per the attached
r
e of Owner
* * * * * * * * * * * * * * * * **
LPHONE:
a
t , K= L5 S co ►c- �---
�24 �
M 4"t` e ,24. ,
C 4)
Date Signature of Contractor Date
************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
.75 3- 4-07
4/23/01