67 NE 94 St (2)ROILERTY OWNER
New Construction
Iv.mme/ e i,, .' �4'T
v l ti(.
Acj Tess
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Ac'dress
(7 il WSt- • i /4//)/U
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:D. :me 7e._eg ]r i• ,
Repair
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lam / �O t S '
Alteration Interior
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Demolish
' CHITECT
New Construction
L?eense No.
Acj Tess
7e:27 one
I."213
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'l Attachment
Other
Add'l 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 the property owner and qualifier. 3oth 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 submit-
ted along with this permit application.
Step 2. Submit the com len ted ap licp anon 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
Address Apt. City
Folio Number '' \escription of Work
Lot Block
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
Tax Assessed/Appraised Value
Master Permit No.
Subsidiary Permit No. 3 • L3C)/
State
PERMIT APPLICATION
"Li
Zip
Subdivision PB PG Zoning Linear Feet
Current Use of Property Square Feet Units Floors
Proposed Use of Property >alue of Wog 0 Bldg Value
Tenant Information
Flood Zone Base Floor Elev.
ENGINEER
Name
License No.
Address
Telephone
}Fan
CONT
CTO
Name
ILEce se No.
Address
Telephone IFan
QuaT4ftiaa Name
Page 2
IMPORTANT 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.
v' ra J� a a ar i
a� a y v a •. a
• Signs a of Owner
ea4 2 ....C,) s
int Name
Sworn ._: d subscribed before me thi
ature o o Pttb �t -7•., N "" Signature of Notary . c e o %' � ... `� � gn Public - State of Florida
. U® AoGE, p E, r '+
,, s L�170097
(l C .
Personally known OR, Produced Identification L..." Personally known OR, Produced Identification
Type of Identification Produced: f . i dam-/ L5 5 R,,o® 571° L1 q - i I Type of Identification Produced:
SEAL:
STATE OF FLORIDA, COUNTY OF MIAMI -DADE
Signature of Contractor / Qualifier
Print Name
Sworn to and subscribed before me this day of
SEAL:
PERMIT APPLICATION
ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPE
Dryer
QTY.
TYPE
Outlet, Appliance
Q "1
TYPE.
Service Repair
QTY.
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 To
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 Centr
Posts
Swim Pool, Commercial
Air Conditioners
Garbage Disposal
Range/Range Top
Swim Pcol, Residential
Chiller
Generators, etc.
Receptacles
Switchboards
Clear Violations
Heat Recovery
Refrigerator, Comm. (p/PH)
Temp Se: v., Construction
Compactor
Lcw -volt, Burglar
Refrigerator, Domestic
Temp for Test - 30 days
Deep Freezer
Low -volt, Fire
' enew - Temp Service
Water Closet
ur ^emolition
Low -volt, Intercom/Teleph.
Repair Circuits
Water Heater
Dishwasher
Low -volt, Television
Service, Number of Amps
Water Heater New
MECHANICAL
TYPE QTY.
Minimum Fee
TYPE
Condensate Drain
QTY. TYPE
Generator
QTY. TYPE Q•IT
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
3 arbecue
Fire Sprinkler System
Process/Pressure Piping
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
PLUMBING
TYPE
A/C Condensate
Q'FY.
TYPI:
Drains, Roof
QTY.
TYPE
Miscellaneous Fixture
QTY.
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 '' °'ping
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
Drainlield, 4" Tile/Res.
Lavatory
Septic Tank
Water Heater New
Drains, Area
Meter Set (Gus)
Sewer Connection
Water Re -pipe
Draarrs, Floor
Minimum Fee
Shower
Water Service
Dr .-ins, French
Misceliauteons Equipment
1 Sink
Well, Supply
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
D ' E
Zonin:
`/
a ,
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
- G - 7
..c ��
Page 4
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi - family)
❑ CONCURRENCY
(New Construction)
O OTHER
(Specify & Attach)
$3.00 per page (Scanning Fee)
Miami Shores Village
Bond
Inspector State Educational Fund
State DCA (Radon)
Code Enforcement Fine
Zoning Review
Notary
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
O IMPACT FEE
(New Construction)
O OTHER
(Specify & Attach)
PERMIT FEES
Metropolitan Dade County (C.C.F.) $ 1. SD (sq.ft. = x/1000
x ¢.60)
$ (0.005 /sq.ft.)
$ (¢.01 /sq.ft.)
$ , D0
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ liC Le a �v
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
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Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: BP2002 -1301
Printed: 7/25/2002
Applicant: LEAH • SIMMS
Owner: SIMMS LEAH
JOB ADDRESS: 67 NE 94 ST
Contractor
Local Phone:
Parcel # 1132060130570
Signed: (I SPECTOR)
S
Building Permit
Contractor's Address:
Page 1 of 1
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 20 & 21 BLK 4 LOT SIZE 100.000
Fees: Description Amount
FEE2002 -4114 Building Fee $1.80
FEE2002 -4115 Building Permit Application Fee $60.00
FEE2002 -4116 Notary Fee $5.00
Total Fees: $66.80
Total Fees: $66.80
Total Receipts: $0.00
Permit Status: Approved Permit Expiration: 1/21/2003 Construction Value: $2,980.00
Work: EXTERIOR PAINTING AS PER AGREEMENT (OWNER BUILDER PERMIT)
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 building or to install the equipment or device described in the application herefor in strict compliance with all
ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to
and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without
authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the
ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done
by his agents, servants or employees.
BY:
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity
with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either
myself, my agent, servants or
(Contractor or Builder) BY:
LEAH A. SIMMS
67 NE 941H ST. PH. 757 -0849
MI y I, FL 33138
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003253246
DATE J1- r
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DATE: z,,60-/o
OWNER' S NAME:
ADDRESS:
***** * * * * * * * * * * * *::: * * * * ** * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE: Ov V /
CONTRACTOR & LICf,NSE (if applicable)
COMPANY NAME: &IL y y y PHONE: y
* * * * * * * ail * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * i� * * * * * * * * * * * * * * * * * * * *
All Elemen _ on thesite must be listed and indicate the color to be painted.
Walls
Fascia
•
Drip Cap/Drip Edge ,
Soffit 0/P VC,
Roof _
Flower Bins -e_
Shutters
Awnings
Chimney
Doors and
Garage Do
Railings
MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
Fences /U,fi
Decorative Metal /Ufr
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 appli,eable laws regulating
construction and zoning. I authorize the above -named contractor, if applicable, to
do the work-sttatcoi Furthermore , the paint colors will be as per the attached
sa
Building Offici
//
)
door jams j1,
ors jams,
ignature of Owner
* * * * * * * * * * * * * * * * * **
APPROVED:
7 `/ c 2
ate
PHONE: g v6 d m cypplog
Date Signature of Contractor Date
****************** * * * * * * * * * * * * * * * * * * * * * * * * * * **
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
4/23/01
ute ✓ Job Address
Owner's Address
£tom w'
1 Description
/ Lessee / Tens
Commission Expi
£PP1OVED :
Zoning
E! ": MIT APPLICATION FOR MIAMI SHORES VILLAGE
4.
Al
Contracting e AtZ-11-1 Address
O-za L ifier SS# - Phone
State Sl Municipal # Competency # Ins.Co.
I,rcHtact /Engineer Address
TiondinB Company Address
Pam: - tgagor Address
Per.nit Type(circle one) BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING F1E SIGN
Z
OR DESCRIPTION `zv / 2/ !m ?
Sczlmre Ft. / Estimated Cost(value) 94
f ,'1R' I NG TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FA I LUE +0 )
SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YC IYTOD
`zO a3TAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDN-YO0
XC' ,°CN OF COMMENCEMENT) .
AT?..ication is hereby lade 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 Lo meet the
standards of all laws regulating construction in this jurisdiction. I understand zuit separate
sr_2:.ts are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICALWO�•
O.Nfl 'S AFFIDAVIT: I certify that all the foregoing information is accurate and the all work will
`:s done in compliance with ail applicable laws regulating construction and zoning. Furthermore, I
r.uta p ize the above arced contractor to do the work stated.
//5
S :Sature of o aaer and /or Condo President
t' 0( kry,s to Owner
(p / ,f/F N(3 - Tax FolioJ/ / a
k&1
-
RIEtffiEtx0030,1996
o ? ° No. '',
23ES: PERMIT r if !r RADON C.C.F.
fk
AL, 44
lay
Signature of Contractorar Owner- Builder
Date:
Notary as to Contractor or Owner- Builder
My Commission Expires:
Fire a Other
* * * * * * **
NOTARY
0 416 TOTAL DUE I t$' 416
Building Electrical
Mechanical Plumbing Engineering