77 NE 95 St (8)CONTRACTOR
XrCI Name s 0 ci eg7 e
License No. C6: 063 410
Address Z?s Z S' 2_0
1 1411/ r t4/;
Telephones 'fZ -e. p Fax 11: &95 6 q96 q
7
Qualifier Nan �� C" E .��
PROPERTY OWNER
/t
Name /i � /' l . 9 / / d -' ! � ( 7 1 1
Address
s-Y. A.) 7s' 3-21-
Home Telephone ? v ` 7_1_ _ iF /)7
Business Telephone — b°
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'1 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 thhpro�7erty oweerion. q .alifier •Both signatures must be notarized. Please
print or type to allow for a more accurate processing of your application, Ii.'roofiog work mill be doge, a roofing application must be submit-
ted 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.
Job Address: 7
Address Apt. /
Folio Number Description of Wor
Lot Block
Subdivision PB PG Zoning Linear Feet
Current Use of Property S are Feet (Poo sF Units Floors
Proposed Use of Property alue of Work �SQQ °= Bldg Value
Tenant Information Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
1
License No.
Address
Telephone
Fax
• • ••• • • • •••
• • • • •• • • •
• • • • • • • • • • •
• • "' • • • • ' • PERMIT APPLICA
Master Ph •'• "":�� ��
Sut tdia ' Pejmit N .: ••
• • ••• • •
i
City State
biL
Zip
ENGINEER
Name
License No.
Address
Telephone
Fax
Page 2
1.
STATE OF ORIDA, C
iSdAstr
f�},r
' a
.•.
Print Name
Swom to and subscribed before me this of day.of
Si
SEAL:
... • • • ... •
... •
C.
• •
•
• ••• • •
• • • • •
• • • ••• •
•
•
IMPORTANT NOTICES
DO NOT BEGIN ANY WORK VATfIOtIT HAVIw€ REOEIVED: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 MINT 13flivlirt {rAJIQ1rD IN A CL' 1N, NEAT AND SANITARY CONDITION free from construction debris.
3. STREETS AND NEIGHBORING PROPERTI!BB 911A LL:BI Krrt FLEE FROM DIRT AND DEBRIS.
4. SWALES MUST BE PROTECTED I:ROM BBINSi DAMAGED ICY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is
required for work in or near the street/sidewaIIC ' • •
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.
cure of N
ry Public - State o
aF 49'1'04 GEORGINA L. PILOTO
b MY COMMISSION # CC 982701
EXPIRES: Nov 19.200
1.800-3- • AIRY FL Notary Service & Bonding, Inc.
Personally known OR, Produced Identification
Type of Identification Produced:
•
•
ignature of Contractor / • .r lifier
Print Name
SEAL:
6fra
PERMIT APPLICATION
STATE OF ORIDA,.1`! % MIAMI -DADE
Sworn to and subscribed before me this o day of ,
Si • tore off . ry Public - State of Flo
l ' u ee f , GEORGINA L. PILOTO
Tf MY COMMISSION # CC 982701
OFf��Q EXPIRES: Nov 19.
/ 1. 00,4NOTAR FI. Notary Sean & Bondfng, Inc
Personally known OR, Produced Identification
Type of Identification Produced:
ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPE,
Dryer
QT1'.
TYPE
Oatiet, Appliance • • •.. a
(1'x'1'.
•
TI PE
Service Repair
QT\'.
A/C Central 1 -3 Ton
Dryer Vents, Number of
Fan
Ventilation, Cost
Outlet, Wall
Ductwork, Cost of
Service, Temporary
Periodic Inspections
A/C Central 4 -7 Ton
Fire Sprinkler System
Fire Pump
Outlet, Switch
Fireplaces, Number of
Signs
A/C Central 8 -15 Ton
Fixture - Fluorescent
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
N IECHANICAL
TYPE
Minimum Fee
QTY. 'rl'PE
Condensate Drain
Q'rv. 1'VI'E QTY.
Generator
TYI'I'. QT Y.
Refrigeration, Tons
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
Air Handler, Tons
Ductwork, Cost of
- Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
- Process/Pressure Piping
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
PLUMBING
.I'VPE
A/C Condensate
QTY.
TI'PE
Drains, Roof
()Tv.
TYPI,.
Miscellaneous Fixture
Q.Lv.
TYPE
Soakage Pit
QTv.
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
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• • • • • • • •
• • • • • •
• "' PERMIT APPLICATION
•
.••
• . •
• • •
INSTRUCTIONS: Please indicate the type of work being perform&d add ublity(ieS, iit jlte space provided below.
RECEIVED AND REVIEWED BY: DATE:
SECTION
BY
D E
Zoning
�
?/ i
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
Page 4
OFFICE USE ONLY
❑ 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
Notary
• • • •
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• • • ••• •
••• • •
• • • • • •
•
• • • • • •
•
•
•
•
•
❑ IMPACT FEE
(New Construction)
❑ PROOF OF OWNERSHIP
••• •• (Attach) ••
• . • • • • • •
•• • • • • ••• •
;)13:RI4 APPROVAL
••• • • • • • •
(Septic / Sewer)
•-e
❑ OTHER
(Specify & Attach)
(s .60) x/1000
x
(¢.005 / sq.ft.)
$ (¢.01 /sq.ft.)
PERMIT APPLICATION
CIIECKLIST
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
PERMIT FEES
TOTAL $
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
S•2 009a J
h St.
33138
Lure
mcy
se Curvature
)ound Curvature
U.E. = Utility Easement
IR = Iron Rod
P.R.M. = Permanent Reference Monument
P.C.P. = Permanent Control Point
P.O.B. = Point Of Beginning
P.O.C. = Point Of Commencement
C
D.E.
LS
CA
R
AL
v
• • ••
• • •• .. • •
v .•• '• i • • •••' ••�(�... • ,.../.7..A5,1 � :. • ••. • •':�\V •
. /x,04•. 9.B
LP./e) • • •
•. • • • • • •.. 1 •
•
iption:
feet of Lot 21 and all of Lot 22
ing to the plat thereof, recorded
zty, Florida.
conforms to the minimum technical standards for land surveyors adopted by the
to Board of Land Surveyors on September.1, 1981. This survey depicts all matters contained
s Title Insurance Fund Commitment 242867 dated December 18, 1996. The improvements do not
ith easements, rights -of -way or set back requirements of record, all of which are depicted
rtified To; Investor Title Service, Attorneys Title Insurance Fund, inc., Jeffrey C. Hilton
ice Mortgage, its successors and /or assigns.
PLAT OF MIAMI SHORES, SECTION
t Page 70 of the Public Records
SHED BY CLIENT - NO FURTHER SEARCH OF PUBLIC RECORDS WERE MADE BY THIS OFFICE.
- IEREON ARE PER NATIONAL GEODETIC VERTICAL DATUM OF 1929.
?MED AS TO DETERMINE UNDERGROUND ENCROACHMENTS, IF ANY, IE FOUNDATIONS, SPRINKLER SYSTEMS, ETC... .
\RE FIELD MEASURED AND CORRESPOND WITH RECORD INFORMATION EXCEPT WHERE NOTED.
= Calculated
= Drainage Easement
= Surveyor and Mappers ID
= Central Angle
= Radius /Radial
= ARC Length
P
R/W
CHAT.
EASE
= Centerline
= Plot
= Right -Of-Way
= Chatahoochee
= Properly Line
= Easement
L = Legal Description
/ :100,st f
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO. 5P 3
STATE OF FLORIDA:
COUNTY OF MIAMI -DADE:
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real
property, and In accordance with Chapter 713, Florida Statutes, the following information
Is provided in this Notice of Commencement.
1. Legal description of property and street/address:
2. Description of improvement:
3. Owner(s) name and address: _le
Interest in spropertr
Y • ` -`. � , t 1 Y y � o r s t.M {A - r er...
\-�� V 4i•.il W�.IY iIJ.I J. J:: Ff . -. ...�rc.w.
4. Contractor's name and address:
Amount of bond $
6. Lender's name and address:
Notary Public
Print Notary's Name
My commission expires:
123.01 -52 PAGE4 002
TAX FOLIO NO. 1/ 3 a4m, 0/ 36 7 c90
rr tSZ . /AA Gk
/54,14
5. Surety: (Payment bond required by owner from co t y� DA, COUNTY OF DADE
Name and address:
1 PIMP
Print Owner's Name
I
Sworn to and subscribed before me this5 day of /
_
In Section 713.13(1)(b), Florida t
Name and address: 11
f L PY16Y that
original `° ` el in thin office on
Expires November 15, 2008
tidr ') )D rideIZ
t
,AD2
WITNE6t my rinntl u, d Official Seal.
CFN 2003R0294528
OR Bk 21220 Ps 1240► (1as)
RECORDED 05/06/2003 10 :24:16
HARVEY RUVINr CLERK OF COURT
MIAMI -DADE COUNTY, FLORIDA
LAST PAGE
dry o+ rno
day of
7. Persons within the state of Florida designated by ey s u; ^^ ' "'h notl �e or • e ratlgcume
11111111100111111111111111111111111111111111
L
03 05
provided by Section 719.13(1)(a)7., Florida Statutes, 1 Q roGgIvrpt a1i/k_ 46/Os"'
L 1 3 3-7
t l
8. In addition to himself, Owners designates the following person(s) to receive a copy of the Uenor's Notice as provided
j 471
9. Expiration date of thls Notice of Commencement: (the expiration date is 1 year from the date of recording unless a
d t dat -- pecifled)
ed as
Prepared by 1 .4 {o1 `
2091 r - . 5 s
Address N /
AA 1 ) R a ,ras i t- L
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 4/8/2003
1 Applicant: JEFFREY
Owner: HILTON
JOB ADDRESS: 77 NE 95
Contractor
Local Phone:
Parcel # 1132060130720
Building Permit
Permit Number: BP2003 -548
HILTON
JEFFREY
ST
Contractor's Address:
Page 1 of 1
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 E3OFT LOT 21 & LOT 22 BLK 5 LOT SIZE
Fees: Description Amount
FEE2003 -2048 Building Fee $85.00
FEE2003 -2049 Builder's Bond $300.00
FEE2003 -2050 CCF $3.00
Total Fees: $388.00
Total Fees: $388.00
Total Receipts: $0.00
Permit Status: Approved
Work: DRIVEWAY
Signed
Signed: 154 Q,(' 9 cyLie,
Permit Expiration: 10/5/2003 Construction Value: $4,500.00
If there is no permit . package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection
fee is $50.00, which must be paid in advance before calling for another inspection.
This Permit is granted to the contractor or builder named above to construct the bu
Ordinances pertaining thereto and with the understanding that the work will be perfon7
and approved by the proper municipal authorities. This Permit may be revoked at an
authorization. A further condition upon which this permit is granted is the understandi
ordinances and regulations pertaining to the work covered hereby whether shown on •
by his agents, servants or employees.
(INSPECTOR)
In consideration of the issuance to me of thi ermit, I agree to perform the work c<
with the plans, drawings, statements or specifications submitted to the proper author
myself, my agent, servants or employes.
(Contractor or B
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901. 3iinS ''OA18 OHVMOH9 '3 008
NOI1IH .,) AaI`laaar •un
-- STATE OF FLORIDA)
COUNTY OF DADE)
The undersigned Affiant,
attached survey, performed by
Further, Affiant sayeth naught.
Witn sign and p ' �1
-t-&74-41/1- bli rt `6; /e
i4cmi bw¢ •
• • • •••
• •••• • • •
.
.... • •
•
••• • • • • • •
• • • • • • •
• • ... . . •
•
AFFIDA}IT • • • • • • • • • • •
. • • •
• •
•
•• • • • • • •.. ••
•
g cldoes hereby attest that the
(pro erty owner)
SC)/L" / /fie 06:71111 y� f
(name of surveyor's company)
performed on / Z 2-2 - (o , is an accurate representation of the existing conditions and
(date of survey)
locations of all structures on the property as of this date.
The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the
property without first providing a survey less than six (6) months old. The Affiant, as property owner, further
agrees to remove or obtain permits for any structures which now may exist on the property which are not
permitted or which may violate zoning or building code regulations. The Affiant further understands that the
existence of any such structures may affect final inspections as applicable to this or other permits..
SWORN TO AND SUBSCRIBED before me this a day of
v
Affiant is V personally known to me, produced as identification.
+g1 . P4 te t , GEOP.GINA L. PILOT()
MY COMiel4SSION # CC 982701
�OF BOQ EXP1R 'S: Nov 19, 2004
1-8003NOTARY R Nagy Service & Bonding, Inc.
Address
Approved
Correction
Re- Insp'n Fee
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
o
-00Z13
Type Insp'n _ ' _I
Permit No. / 10 Q3 — 5 t
Name C ■ ei
Y 7 C . 21 S"
Company
Phone #
For Inspectorr2 / Z /V33N & Date
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date / J / a 3 Time
Type Insp'n - -IL1x/1'°�4AS
Permit No. 200_3
S
Name � /. !/
Address C C C I s
Approved
Correction
Re- Insp'n Fee
Company .J - "-
Phone #
For Inspector: 7 / Z / 03 j3 Name & Date
A