445 NE 94 St (9)Date 19--) l?
Legal Description
Owner/Lessee / Tenant
Owner's Address
Contracting Co.
PERMIT APPLICATION FOR MIAMI SHORES VILLA
Job Address ' ti r L ' c J • Tax Folio
k 5 (ii 1,,
Historically Designated: Yes
Master Permit #
Phone C1 j '7-
Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Cc
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BU DING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 0 vi I
Square Ft. Estimated Cost (value) -R 3 0
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 AFFIDAV1T: I certify that all the foregoing information is accurate and at all work will be done in compliance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the above- najne� trac r to do the ork stated.
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMIT IVO - RADON
APPROVED:
Zoning Building
Mechanical Plumbing
C.C.F.
Signature of Contractor Owner- Builder
Notary as to Contractor or Owner - Builder
My Co
41/4 Pa ' 'Ue / OFFICIAL L
NDRA M MONTIEL
O SANDRA
z w * COMMISSION NUMBER
'�.. a CC401261
1 4:` Mr COMMISSION EXP.
OF F\ AUG. 17 10U8
1 6 & NOTARY �'
Electrical
) 9
Date
Date
BOND
TOTAL DUE % �
Engineering
- .
. APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
Job Address 45 t I` LQ S`TGIa,C
Date 5(
al Description c!7 n
/ Lessee / Tenant VVl(cet, ,.( (,) PL tLf
Owner's Address L ( S- (`Q (- ' S
Contracting Co. ®CJO Qi*
Qualifier SS# - - Phone
State9 Competency 9 Ins.Co.
Architect /Engineer 3 W q.Qw Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
WORK DESCRIPTION f
Square Ft. Estimated Cost .tea - DO
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
ZECORDING YOUR NOTICE OF COMMENCEMENT).
1pplication is hereby made to obtain a permit to do work and installation as indicated above, and
)n 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
)ermits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING, and MECHANICAL work.
WNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work
Ill be done in compliance with all applicable laws regulating construction and zoning.
'urthermore, I authorize the above -named contractor to do the work stated.
ignature o Owner and /or Condo President
ate:
cs oEo Owner and or.Co do President
mmission Expires: L/
'KNIT FEE: APPROVED:
Fire
Address
Tax Folio // J /7 & 2 3
Master Permit 9 3 //j
Phone �S r "t' « i I,
Signature of Contractor or Owner- Builder
Date:
Notary as to Contractor or Owner- Builder
My Commission Expires:
* * * * * * *
Other
oning n;:fi* /' Electrical
Me hanical Plumbing Engineering
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date I S/ Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant 1 (LL f ` -)J vlv1 5 O 1 1 Master Permit #
Owner's Address 49 !`''+ k l( r J ' Phone e/ ` 34) S -) )
Contracting Co. 0 W Vl Q . V 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 xft o\i«'tt h (t h
Signature of owner and/or Condo President
Notary as to Owner and/or Condo President
My Commission Expires:
Date S
Square Ft. Estimated Cost (value) ) 8 OD — 2_060
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.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work wiyl be done in compli ce with all applicable laws regulating
construction and zoning. Furthermore, I authorize the above -named contractor to do the work s ed.
Date Not ry as to Contractor o
My Commission Expires
FEES: PERMIT 5 V RADON C.C.F. / • 2-0 NOTARY 5
or Owner- 13uil g.- S-5-9-'31- 0_04,6j-
-op
Own e' : ija3� r H
YS J VILLAR
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC714103
MY COMMISSION EXP. MAR. 1
BOND
TOTAL DUE 5
1
OD
ate
APPROVED:
Zoning Building Electrical
Mechanical Plumbing Structural Engineer
DATE:
OWNER'S NAME:
ADDRESS:
************************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * **
ADDRESS OF SITE:
CONTRACTOR & LICENSE (if applicable) ,57 .3 - 2/( o,,»t,' ('
COMPANY NAME: cSTFutS G i77 u PHONE: 305 SS6 °s �®
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
All Elements on the site must be listed and indicate the color to be painted.
Walls
Fascia
Drip Cap/Drip Edge
Soff
MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
. 'M ,q L PHONE c ks
4, ra �o/`/NSo,J
ower Bins
Shutters
Awnings
Chimney
Doors and door jams
Garage Doors
Railings
Fences
Decorative Metal
All brick (simulated or regular)
Stucco Banding
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 the work stated. Furthermore , the paint colors will be as per the attached
samples.
Signature of Owner Date Si • nat of Contractor Date
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
APPROVED: WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
Cc� 7(2 /°
Building Official Date
0/
4/23/01
Page 2
IAIPORTANT 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 U F tl RIDA, ®UNTY OF MIAMI -DADE
r
Si: t ture of O e
Print Name
Sworn to and subscribed before me this
Notary ' rlic - Stale o
o �iciAl to A Y SEAL
:tY P- ANGELA Ra BECKER
0 C, CO; VIISVON OUuBER
u 4 • Q CC766697
Wit b a✓ O Y Cd=L1SVON ExPCRES
Personally kn tvi tC VProb_e
SEAL:
V'
cation L
PERMIT APPLICATION
STATE OF FLORIDAi Y OF I -DADE
4 .- nat of Con Qualifier
Print Name
Swr to aid subscribed before me this day o
„ACP. r
j. ►i r
o tiP
a t aYPe., ovnc�iALnOTARvs14i
� 2 •, � ..
ANGELA N 6EC t
f Q coxre �o� r ut: Ea
?a? O CC78 36g7 I�
G F `C� DIY NO
�7ss o; pf F. S
Personally known OR, Pi`htluced ' Ide;ictE_ait1
SEAL:
L 1, Q fI ))L, CAS 710'-8 y 6 0 - 0
Type of Identification Produced: J_�.//�� S' � ( S �'- 33t� -. Type of Identification Produced
PROPERTY OWNER
Name0 /Pi e/40 /40 G ailbksor
Address
'M P-E. 2°V — sr
Home Telephone c _ ?5 ., _ !Z s‘
Business Telephone
Fax
CONTRACTOR
6 Eof § goof- 6 4004- 7 -1 "- 14
Name 57
Enclosure
cA S
License No. 30 — /aQ s5 � !�
/ /
Address
Sz
c yo
( ^' i0 � r A' A l
� FL•33c
Telephone Fax
S's. 6 _saes. 30S'- e‘,43 -1 .a?
Qualifier Name
w1/9.4-);
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'I Attachment
Other
Add'! Detachment
Other
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Step 1.
PERMIT APPLICATION
Master Permit No.
Subsidiary Permit No.
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:
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other A41
Address Apt.
Folio Number ) j 3'046, NV DS (7 Description of Work et‘") 149/%
/A i@ � W//
Lot �o 0 o- ) Block S -----
Subdivision B )C) PG3/ Zoning
Current Use of Property .c571 Square Feet Units Floors
Proposed Use of Property -. A r/ Value of Work ! Q
Tenant Information
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
City
Tax Assessed/Appraised Value
State Zip
\) + P
Linear Feet
Bldg Value
Flood Zone Base Floor Elev.
ENGINEER
Name
License No.
Address
Telephone
Fax
6
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 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. TV'PE
Generator
QTY. TYPI:
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.
TYPI?
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
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
WE
`j.��/l77
Zoningf��%�!
Electrical
dd
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
�
9 J 6/
Page 4
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi - family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(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
$ In
$ d c (sq.ft. = x/1000
x 0.60)
$
S, 00
REVIEWED AND PREPARED BY:
(0.005 /sq.ft.)
(0.01 /sq.ft.)
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ h_
ISSUING OFFICIAL
CONDITION OF APPROVAL
10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com
DATE:
Revised July 2001