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67 NE 94 St (3)CONTRACTOR New Construction d Enclosure Aitreration Exterior License No. Y Addreess ,-;-2,-9 �4/f j�lnn ��� iv i,* 62 �,� .. Ai'teratiam Interior 1I r9 lime�hem j-,4' � ° rg� d G' : 7 Fax 7 , G ( Qualifier Nam /54 . /"' Shell Only 'TYPE OF MANAGEMENT (1 New Construction Enclosure Aitreration Exterior Repair Ai'teratiam Interior Demolsh I eIcta:4ion of Structure Shell Only IF©u ncriztlenn 0 .'y Add'I Attachment 0c er Add'i Detachment OQuner '' Step 1. Step 2. APPLICATION Job Address: : ?olio Number � ;I '� ' . " ,„ :,ot ( M Iock S Subdivision���G.�ii ^ �?��PB PG Current Use of Property ;/./41 /42 l y Proposed Use of Property ',Tenant Information LLMIIT IllluiEdInnp EiecCricai ARCIHJJTEC'li' _s¢ se No. Ac:fress Complete the attached permit application which m st be si ned b the 'ro . ert owner and • ualifier. Both si na ure must he 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 submittzd along with this permit application. 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. Address E (/) 1 ix ittiiii6e taken to &Wahl a permr r - t;iit the Miami Shoes V Ia e: Apt. PE tIVdl'II' CHANGE ( J ) Chg. Co ntra:ctaDr enewe Revision ExtensIon S:�biD;� :erne Rein nectIonn .;FROhhE t'fY OWNER Ae aSress Herm 'lce9eghone '1 eephone City Master Permit No. Subsidiary Permit No. I1/ P ' O O ° / Y'� / Description of 13 ,^� ✓ 3 c 12� nl V • Zoning Linear Feet Square Feet Value of Work • c) Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENOIINEE Name iJ ]L ;_censa No. Adeross Teephone Fax /7 State PERMIT A PP L'ICATICN Zip Units Flocrs 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. S[AT' • FLORIDA, CO J• Y OF MIAMI -DADE Print Name Sworn to and subscribed before me this 7.-g day of Signature of No ry, ; State CAKING • ; MY COMMISSION # DD 031747 '•. . a EXPIRES: June 20, 2005 SEAL: Personally known A 4 ch 5" Bonded Thai Notary Public Undenvtltors OR, Produced Identification STATE OF FL IDA, COUNTY OF MIAMI -DADE PERMIT APPLICATION Signature of Contractor / Qualifier go' Signature . Notary ' blic - S . to of Florida Print Name orn to and subscribed before me thin b SEAL: Personally known OR, Produced Identification Type of Identification Produced: Type of Identification Produced: Tali' Tub ' 1 QTY. Drinking Fountain QTY. Miscellaneous Repairs QTY. Solar Water Heater 1 T QTY. det 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 - Naturd Pump, Fire Stand Temporary Toilet Catch 3casicra Gas - Propane Pump, '!' e-circulate Temporary Water Closet C:cthes Washer Gas Piping pump, eplace - Pool Urinal Der."„a 2 cher Gs 2 Trap Pump, Sprinkler Utility - Sewer Discht..7ge We li Chilier lice Maaer Generators, etc. Pump, Sump Receptacles Utility - Water 7,isr:n,yasher 1h:direct 'Wastes Rely Elebair 1 Vacuum :I'spcsa.: Temp Serv., Construction Intercepter Compactor Moe Iln:ea Low-vo t, It urglar Water Closet Dentestic Wel] Laundry 7Przy Temp for Test - 30 days Septic Connection Deep Freezer Water Heater arainfield, 4" rilIefiRes. Lavatery enew - Temp Service Septic 'alma Water Ileater New 3 7s, Area Meter Set (Gas) Low-volt, Intercom/Teleph. Sewer Connection Repair Circuits Water Re-pipc Drains, Floor Mman Fee Shower Water Service are.r-s, 'French Misce::ameous Equipment Sink Wen, Supply ELECTRIC AL TYPE Minimum Fee ' 1 QTY. TYPE Dryer QTY. TYPE Outlet, Appliance QTY. TYPE Service Repair 1 T QTY. A/C Central 1 Ten Fan Outlet, Wall Service, Temporary A/C Central 4 Ten Fire Pump Outlet, Switch Signs AJC Central 8-15 Ton Fixture - Fluorescent Oven Space Heater (kw) A/C Central 16-20 To Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ To Flood Lights Plugmold/Strip Suhfeeds, No of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garage Disposal Range/Range Top Swim Pool, Residential Chilier Generators, etc. Receptacles Switchboards C:ear Violations Eleat '''ecovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low-vo t, It urglar i! efrigerator, Domestic Temp for Test - 30 days Deep Freezer Low-volt, Fire enew - Temp Service Demolition Low-volt, Intercom/Teleph. Repair Circuits Dishwasher Low-volt, Television Service, Number of Amps MECHANICAL TYPE Minimum Fee QTY. TYPE Condensate Drain QTY. TYPE Generator QTY. TYPE Refrigeration, Tons - I QTY. AJC Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Eryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Buctwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping ath Fan-Vented, 0 Fireplaces, Number of Pressure Vessel .a":1114,164.narAlt~lOug...1$64P Cf■O SU 4 Page 3 PE 1•111111111111111111•11111111 MIT APPLICATION \ISTRUCTIONS: Please inc.lica: the type of work being performed and quantity(ies) in the space provided be:ow. PLUMBING TYPE QTY. TYPE QTY. TYPE QTY. TYPE QTY. A/C Condensate Drains, Roof Miscellaneous Fixture Soakage Pit :1ECEIVED AND REVIEWED BY: DATE: Page 4 OFFICE USE ONLY CHECKLIST ❑ 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 ® PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) $ 0 ( sq.ft. = x/1000 x ¢.60) $ (¢.005 / sq.ft.) $ (¢.01 /sq.ft.) REVIEWED AND PREPARED BY: SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE O PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) PERMIT FEES TOTAL $ ISSUING OFFICIAL DATE: Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com f FLORIDA DEPARTMENT OF HEALTH APPROVED (305) 623 -3555 CONSTRUCTION PERMIT FOR: [ ] New System [ 1 Existina System [ Holding Tank [ ] Temporary/Experimental [ 1 Repair ] Abandonment [ ] Other(Specify) APPLICANT: AGENT: PROPERTY STREET ADDRESS: LOT: PROPERTY ID #: BLOCK: SUBDIVISION: SYSTEM DESIGN AND SPECIFICLTIONS 0 T E R STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SE?AGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 321, FS & Chapter 10D-6, FAC JH 4015, 10/95 (Replaces HRS-H Form 4016 (page 1] which may be used) (S1cek Number: 5744-001-4016-0; PERMIT # DATE PAID FEE PAID $ RECEIPT # [SECTION/TOWNSHIP/RANGE/PARCEL NUMBER] [OR TAX ID NUMBER] SYYITM MUST BE CONSTRUCTE) ).N ACCORDANCE WITH SPECIFICATIONS AND STANDARDS CHAP:ER 1CD-G, VAC. REPAIR PER=TS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE CF ISSUE. ALL CTHER EMITS EXPIRE ONE YEAR FROM THE DATE OF ISSUE. DEPARTMENT OF HEALTH AP?ROVAJ, OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME, ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A BiAS FOR ISSUANCE OF THIS PERMIT REQUIRE THE APPLICANT TO MODIFY THE PE= APPLICATION. SUCH 4=FICATIONS MAY RESULT IN TENS PERMIT BEING MADE NULL AND VOID. T [ 1 [GALLONS / GPDI SEPTIJ: TANK/AEROBIC UNIT CAPACITY MULTI-CHAMBERED/IN SERIES:[ ] A [ 1 [GALLONS / GPD] CAPACITY MULTI-CHAMBERED/IN SERIES:[ ] N 1 1 GALLONS GREAEE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] X 1 1 GALLONS PER DCSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ] D [ ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ j SQUARE FEET SYSTEM A TYPE SYSTEM: 1 j STANDARD [ ] FILLED [ ] MOUND [ CONFIGURATION: TRENCH [ BED N F LOCATION OF BENCHMARK: ELEVATION OF PROPOSED SYSTEM SITE [ j [INCHES/FT1 [ABOVE/BELOW] BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ [INCHES/FT] [ABOVE/BELOW] BENCHMARK/REFERENCE POINT D FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: [ ] INCHES SPECIFICATIONS BY: TITLE: APPROVED BY: TITLE: CHD DATE ISSUED: EXPIRATION DATE: Page 1 of 2 STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number PART II - SITEPLAN Sca:e: Each block represents 10 feet and 1 inch = 40 feet. Notes: site Plan submitted by: Mart Approved Not Approved Date i y County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT 401"a, 10/96 (Reptaces HRS -H Form 4015 w :rich may be used) Page 2 of 4 tack NJmber. 5744-002 -4015 -6)