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F.CA IN$UR� TMATED •
, 39, 1.97.2 AND REVISED MAR H 10,
''1977 PUBLISHED BY THE UNITED ATES •
DEPARTMENT OF HOUSING AND MAN DEVELOPMENT DELINEATES THE EREIN
... DESCRIBED LAND TO BE SITUAD • fH
ZONE
THIS IS NI& A FLOOD
HAZARD ZONE.
• LAND SURVEYOR
RECORDED IN PLAT BOOK No.
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SURVEY SO, 79!
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, hereby artily that this sketch of survey of the above described property Is true and correct to the best oT k no+v0ga an eller a s
tty Surveyed sad ptatled'under my direction.' I funhor certify that this survey meets the minimum requirements adopted by the
Soda .roiessionat Land Surveyors and the Florida Land Title Association. There are no encroachments, except as shown.
'a"oA 2/ A/ - G A coor
Notos: 1. If shown, bearings aro to an assumed merldlan(srA'
2. If shown elevations are referred to N.G.V. Datum''
3 THIS IS A LANG. SvgdgY
SCALE I" 22
cUAMVY FAINTS 8 SIW'V11 n.t •
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( /owner's Name and Address / 127 , - ti ( . ,iy. 0 -, re,' d ri 5 2 r1 c---t No. Street
Registered Architect and.or Engineer
fr Name and address of licensed contractor t _,l.! _
Location and legal description of lot to be built on:
Lot -4- L'� /iL Block 7 Subdivision 7
r A ,/ .0 3 /! `9/ _ffi / ,;/ ',
Street and Number where work is to be done
1c t. t.S /1/t Ci S s d
L
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building 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.
State work to be done and purpose of building by floors). state exterior colors (submit samples) C -' P....1
f ce
e„'.7. 1h. re r1 (A-'x• }t.
New Building Remodeling Addition Repairs No. of Stories_. —
To be constructed of Kind of foundation Roof Covering
e . Estimated Total cost of improvements S / e 7r,� Amount of Permit S / °1� 1 t y°f�(�J
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 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 obligatons as an employer of Labor under the Florida Workmen's
Compensation Act. being Section 5966, Compiled General Laws of Florida. Permanent Supplement. and 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 un. - s permit: and will post or cause to be p.- •d fo 'n.pection
on the site of the work such public notice or notices as are required by the Act. The undersigned to employ only such ontrartnrs. on or)4 to .e . rformed
under this permit. as are licensed by Miami Shores Village.
Remarks (Signed)
Permit No.
Disapproved
(Signed)
�3v
�1
M]IAME SHORES ITXILLAG E
BUILDING INSPECTION DEPARTMENT
APPI.IC.A ION FOR BUILDING (PERMIT
Date ) IY
Date
/
Date <' t 19 i
J e rd/1
and for no other purpose
STATE OF FLORIDA
COUNTY OF DADE. } ss.
Before me. the undersigned authority. a notary public. duly authorized to administer oaths and take acknowledgments. personally appeared
to me well known.
and who. being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same. and that all facts therein by him stated are true.
Read. Sworn to and Subscribed before me.
Notary Public. State of Florida
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member _
Member Member
Member Member
Council Approved Date Disapproved Date
NOTE: A charge of $25.00 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 525.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and.or workmanship.
'GLMIT APPLICATION FOR MUNICIPALITIES OF DADS COUNTY
(OWNER TO RETAIN COPY) s L ,�/
Date 00A Job Address 6 1 , 9J - 4 e: 9J -H S c.e/3 Tax Folio // 5 / /. 0� 15Z
Legal Description .- , / // /', Master Permit #
Owner / Lessee / Tenant
Owner's Address
PERMIT FEE: APPROVED:
Signature of Owner and /or Condo President
Date:
Fire
Zoning Building
t
Mechanical Plumbing
Phone J/ S 7 --453
Contracting Co. Address
Qualifier i& /ii/f/E/j SS# - - Phone
State# Competency# Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
WORK DESCRIPTION //JJ
/i�iN7" /,v �- 4CFS l7,C,0,Tii4( A st c-
1.iLt02 - S vetz_0 .! !3 ' CH -A) (Sc, ,47r4CH6r, S47
Square Ft. �, vac, Estimated Cost 37, o o . C C
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 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.
Furthermore, I authorize the above -named contractor to do the work stated.
Signature of Contractor or Owner - Builder
Date:
i� LLB
Notary as to Owner and /or Condo President tar as to Contractor or Owner - Builder
My Commission Expires: Commission Expires:
Other
Electrical
Engineering
{2 9
f
MIAM! SHO
aanrt Color A
DATE: F ) /. Zo v Z..-
OWNER'S NAME: /(E- /A.: /Yl�llvfior. ® .. }'I-I1JNE:3� =
• •
• • •
•• 0 •..
ADDRESS: S55,i1,N, 9S - Sri 0 O•
********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE: 3? 4/. E. d • •• ® ®° 0..
CONTRACTOR & LICENSE (if a�paioatle) / ..� ttt
COMPANY NAME: j p ` ' ! , cc o � PHONE: 3 vs' =332 — 2 �C�
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted.
Walls
Fascia CJ, , Tr CJo a«.z t '
Drip Cap/Drip Edge
Soffit
Roof
Flower Bins
Shutters
Awnings
Chimney
Doors and door jams
Garage Doors
Railings w64,T6
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
sa yples. /1)70(
Signature of Owner ate Signature of Contractor Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED:
Building Official
Date
ES VII, AGE
• .. • .
t ®vali . a A . rngreement
• • • • . . •
• • • . • • • • 0 . • •
0
C
fziow �g, )
WHEN PAINTING IS FINISHED,
CALL (FOR (FINAL INSPECTION
4/23/01
T Y P E
Minimum Fee
QTY.
TYPE
Dryer
QTY.
r 7 77
TYPE
Outlet, Appliance
7 .., r
()Ty.
7il
r ii .
Tyl i
Service Repair
QTY.
A/C Central 1-3 Ton
Heating Strips, each
Fan
Outlet, Wall
Service, Temporary
Paint Booth
A/C Central 4-7 Ton
Fire Pump
Outlet, Switch
Piping, Flammable Liquid
Signs
A/C Central 8-15 Ton
]Fixture- Fluorescent
Process/Pressure Piping
Oven
Space Heater (kw)
A/C Central 16-20 Ton
Pressure Vessel
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
0
MECHANICAL
TYPE
Minimum Fee
QTY.
-
TYPE
Condensate Drain
QTY. TYPE
Generator
1
QTy. Typy,
Refrigeration, Tons
. _
QTY.
AJC Central, Tons
QTY.
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
Pump and Abandon
Bath ]Fan-Vented, #
Fireplaces, Number of
Pressure Vessel
Gas - Appliance
PLUMBING
TYPE
A/C Condensate
QTY.
TYPE
Drains, Roof
QTY.
TYPE
Miscellaneous Fixture
QT1c.
i 1
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
11111M1373
ZralffEEMEIMENEtaillffratMEM veo* 'ZIESIIMIUDEMEMER
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
G?fl
..._VJ-C7
Electrical
Mechanical
~
Plumbing
Fire
Public Works
Structural
Building Official
_
Page 4
OFFICE USE ONLY
CHECKLIST
L] OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi - family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
$3.00 per page (Scalping 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)
PERNII'I' FEES
$ 020 C O
$ l ( ( sq.ft. = x/1000
x ¢.60)
ISSUING OFFICIAL
REVIEWED AND PREPARED BY:
(¢.005 /sq.ft.)
(¢.01 /sq.ft.)
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ (Qf' 6
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
PROPERTY OWNER
New Construction
Name A /774 4 . N. o f
Enclosure
Address ,Ff1-Aj, N , . 9T-its, ,5 9`
/yflrtm, 44 &. 3?
1 3r
Home Telephone 3 o S_ 7S 7 — - 3 /
Repair
Business Telephone J n/ ®P. i
Alteration Interior
Fax V A'
Demolish
TYPE OF MANAGEMENT (f/ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
]Foundation Only
Add'] Attachment
Other
Add'l Detachment
Other
1 NITRUCTIf ® NS - The follow ing must be to ken Ito to a permit:
the n�lt�n S�hore�s �?ill��c:
from
Step 1.
Master Permit No.
Subsidiary Permit No.
PERMIT APPLICATION
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.
■PPvLICr>T
T
Job Address: c FrA/r 9-670 rrnwzr JIl 4l � o
City
Address
Folio Number j/ — .A04 - 0 / V — 2d`.56b
Lot
Block
Apt.
,Description of Work
Subdivision PB _ PG Zoning Linear Feet
Current Use of Property A Square Feet Units Floors
Proposed Use of Property kt's t ( 1' Value of Work A Q n Bldg Value
Tenant Information Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
PERMIIT TYPE ( )
Building
Electrical
Mechanical
Plumbing
L]PGX
Roofing
Fence
Other
PERMIT CHANGE ( )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
ENGIINEER
Name
License No.
Address
Telephone
Fax
Name
CONTRACTOR
License No.
Address
Qualifier Name
N t Air t ,
State
Telephone Fax
Zip
Page 2
INIPORTANT 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 $T'ORM 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.
A 1 1 1 DAVIT - 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.
STAT OF FLO VA, COUNTY OF MIAMI -DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE
Signature of Owne �,�J
—1 7. L , it
Print Name � Print Name
Sworn to and subscribed before me this day of /CB •
SEAL:
ARLENE J. BYRD
Notary Public. State of Florida
My comm. expires June 12, 2005
No. DD030778
OR El J LI 'f l•
Personally
f/
SEAL:
Signature of Contractor / Qualifier
Sworn to and subscribed before me this day of
Signature of Notary Public - State of Florida Signature of Notary Public - State of Florida
PERMIT APPLICATION
Personally known OR, Produced Identification
'Type of Identification Produced: Type of Identification Produced: