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474 NE 94 St (2)CONTRACTOR Name �" \ Name fe 12 � V wevs License 5 _ O `o ff / Address 'ls) N. E . /� s , /0.0t-tiA , Ft.. 33/6/ Telephone O.q 3 774 Fax 3 /.5o7 J Qualifier Name � 0 , 4 1 4 , 4 ,..... 41> PROPERTY OWNER Name �" \ r 5,�\ t �►1 C. o f 1 ' , , Address Home Telephone Business Telephone Fax 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: '47 ¥ N. • ?5 Si; M1/4'111 5tt0Iis Address Apt. City Folio Number 3e OA 1 Y o L \'1 V Lot G lock cL/ Subdivisions PB P Current Use of Property Proposed Use of Property Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other ARCHITECT Name License No. Address Telephone Fax 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. �S Yx7 117_ RMIT Cu' g.r' / .114asterermit.No. Subsidiary Permit No. 4-1,- 0-' ° t— Description of Work Zoning Linear Feet Units Floors 4 3C.O. " Square Feet Value of Work Tax Assessed/A Flo- ' Telephone Fax MANAGEM tction terior rior ructure State Bldg Value PERMIT APPLICATION 33/3k Zip I Value Base Floor Elev. ENT (✓ ) Enclosure Repair Demolish Shell Only Add'l Attachment Add'l Detachment 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) apptoval is 'required foc applications involving sewers. • 1. AFFIDAVIT - Please read carefully. Application is hereby made to obtain a permitto 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. STATE • FLQRIDA, COUNTY OF MIAMI -DADE Signal!" of Owner r , 4 10 ® Print Name Swo. to .nd subscribed before me this Si Personally known Type of Identification Produced: . PERMIT APPLICATION STATE OF ORIDA, C ri ►1 F MIAMI -DADE Si_ .. "ure tra .r Qualifier p0N /041 Print Name Sworn to and subscribed before me this / r day of 1 ?c e"fie( b oo i S' atu a of N tar Public - State of Florida c p c (� t - < s ? CIZTARY PUBLIC - STATE OF FLORIDA SEAL: MICAMAEL GRGEN6PAN COMI a1CM t■CD620405 , Ef0►[PWS 4►J31400! , 90NDED THRU ASA 1 888 NOTARY OR Produced Identification .// Personally known OR, Produced Identification ) 02- • 7) 6 g yi' Z 1 V —0 Ape of Identification Produced: ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. TYPE. Outlet, Appliance QTY. TYPE Service Repair TY. A/C Central 1 -3 Ton Fan Cooling Tower Outlet, Wall Service, Temporary A/C Central 4 -7 Ton Fire Pump Dryer Vents, Number of Outlet, Switch Signs A/C Central 8 -15 Ton Fixture - Fluorescent Ductwork, Cost of Oven Space Heater (kw) A/C Central 16-20 Ton • Fixture Light Fire Sprinkler System Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Fireplaces, Number of 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 Dishwasher Refrigeratqr, Comm. (p/PH) Indirect Wastes Temp Serv., Construction Relay Repair Compactor Vacuum Pump Water Closet Low -volt, Burglar 1 Refrigerator, Domestic Interceptor Temp for Test - 30 days Roof Inlet Deep Freezer Low -volt, Fire Renew - Temp Service Water Heater Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater New Dishwasher Low -volt, Television Service, Number of Amps Water Re -pipe MECHANICAL TYPE Minimum Fee QTY. QTY. TYPE Condensate Drain QTY. 'I'YI'E Generator QTY. TYPE Refrigeration, Tons QTY. A/C Central, Tons Drinking Fountain Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Filter Replace Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Fountain Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue • Gas - Appliance Fire Sprinkler System - Process/Pressure Piping Supply, AC Well Bath Fan - Vented, # Gas - Natural Fireplaces, Number of - Pressure Vessel Temporary Toilet PLUMBING TYPE A/C Condensate QTY. 'TYPE Drains, Roof QTY. TYPE: Miscellaneous Fixture QTY. TYPE Soakage Pit TY. 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 Pump, Sum 1 Utility - Sewer Utility - Water Discharge Well Ice Maker Dishwasher Indirect Wastes Relay Repair Vacuum Pump Water Closet Disposal Interceptor Roof Inlet 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. II RECEIVED AND REVIEWED BY: DATE: • Page 4 OFFICE USE ONLY I IIELYI ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) ❑ PROOF OF OWNERSHIP (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 ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) $ /f®e 612 .? $ �� o $ $ SECTION Zonin Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE 4 (sq.ft. = x/1000 x0.60) (¢.005 /sq.ft.) (¢.01 /sq.ft.) REVIEWED AND PREPARED BY: PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2"° AVE., MIAMI SHORES, FL o (305) 795 -2207 FAX (305) 756 -8972 c http : / /www.miamishoresvillage.com SECURITY MASTERS, INC. PHONE; 305-893-7766 1150 N.E. 125 STREET NORTH MIAMI, FL 33161 www.securitymasters.com MIAMI SHORES 9990 N.E. 2nd Avenue Miami Shores, FL. 33138 Javier Ortiz MEMO loop 54 7 Lug 1:0660 10 3 ? 71: 11'40 5 3l.54. 2 10(1• . •- - - _ _ COMMERCIAL BANK OF FLORIDA NORTH MIAMI OFFICE NORTH MIAMI, FLORIDA 33161 12/26/2001 5471 63-1037/660 4 PAY TO THE ORDER OF MIAMI SHORES $ **65.60 Sixty-Five an d 60/100******************************************************************************************* DOLLARS