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95 NE 95 St (4)PROPERTY OWNER Name I _ t v i d ( n 1 k Address 9 NE 95 ST Home Telephone ( ) 75 - 0 6 ft0 Business Telephone 12 y B ......34 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'l Detachment Other , INSTRUCTIONS- The following steps must bet 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. 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. APPLICATION Job Address: l5 3 . Address Folio Number Lot Block Subdivision PB PG Current Use of Property Proposed Use of Property Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Master Permit No. Subsidiary Permit No. M tam l 5hort,a EL. Apt. City State d escription of Work (Zuni Rouse, PERMIT APPLICATION 33 t38 Zip Zoning Linear Feet Square Feet Units Floors Value of Work l CO Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. Address Telephone Fax Qualifier Name IMPORTANT NOTICES Page 2 1. DO NOT BEGIN ANY WORK WITHOUT HAVING RE the right to begin construction. HOURS OF CONSTRU to 5:00 p.m. No inspections will be conducted on weeken 2. All construction of demolition areas MUST BE MAINTAI 3. STREETS AND NEIGHBORING PROPERTIES SHALL 4. SWALES MUST BE PROTECTED FROM BEING DAM required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON which requires a separate permit. PORTABLE TOILETS for a construction site require a se AFFIDAVIT - Please read carefully. 6. 7. 8. 9. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 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 Se er Department (MDWASD) approval is required for applications involving sewers. Application is hereby made to obtain a permit to o 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 percen (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor e evation. 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 p rcent (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 spe your attorney or lender before recording your 22 N.W. 1st Street, 1" Floor, (305) 679 -1078. accordance with Section 713 -35 of Florida Choosing a Contractor. TE OF FLO , 7ci ,A f 1 ... COUNTY OF MIAMI Se of Owner vtel i Print Name w. to and subscribed before me this ...psi ry Public - tatj t CtLER 'i • -'• �� ACa�E BO UC"DE I CC7 66697 Personally known OR, Produced Identification gnature of No SEAL: Type of Identification Produced: EIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant ON are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. or holidays. ED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. E KEPT FREE FROM DIRT AND DEBRIS. GED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is INGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer arate permit. PERMIT APPLICATION tding more than $2,500 or intend to obtain financing, you may wish to consult with Notice of Commencement. The Notice of Commencement must be recorded at: nce recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in Statutes. Review the brochure at Village Hall on Construction Lien Law and DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE Signature of Contractor / Qualifier Print Name Sworn to and subscribed before me this day of Signature of Notary Public - State of Florida SEAL: Personally known OR, Produced Identification ^D Type of Identification Produced: ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. Ti Outlet, Appliance QTY. 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 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 MECHANICAL TYPE QTY. Minimum Fee TYPE Condensate Drain QTY. TVP1: Generator QTY. TYPE QTY 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 TYPE A/C Condensate QTY. TYPE 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 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 • PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: Page 4 OFFICE USE ONLY • OWNER - BUILDER FORM (Attach) LI FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ® CONCURRENCY (New Construction) LI 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 SUING OFFICIAL LI PR ( • HR ( • I ( OF OF OWNERSHIP ttach) / DERM APPROVAL eptic / Sewer) ACT FEE ew Construction) ❑ OHER (Specify & Attach) 0 ^ 00 acv REVIEWED AND PREPARED BY: g BY ?/' 3%7 3_ SECTION Zonin Electrical Mechanical Plumbing Fire Public Works Structural Building Official DAT (sq.ft. = x/1000 x ¢.60) (¢.005 / sq.ft.) (¢.01 /sq.ft.) PERMIT'APPLICATION LI CONDO ASSOCIATION APPROVAL (Attach) BPR APPROVAL (Restaurants) CONTRACTOR REGISTRATION (On File) TOTAL $ 6' Co , b DATE: CONDIiTION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, 0 (305) 795 -2207 0 FAX (305) 756 -8972 0 http : / /www.miam.ishoresvillage.com Jiv Afiejt The Sunshine State R552-171-70-382-0 DAVID KENNETH ROMANIK 196 NW 103 STREET • MIAMI, FL 3316041000 &PITH DATE SEX HOT. REST. INDORSE 10-22-70 M 6-10 ISSUED 09 -16-08 , EXPIRES 10 -22-02 DUPLICATE 00-0040 SOSS009150202 Operation of a Rotor vehicle constitutes consent to any sobriety test re wired by law DATE: 3/6/0a OWNER'S NAME: _ZAVICL t Y1ar� 1 k PHONE ( 5) 7 5 - B ,1 S ADDRESS: q5 rJ P. QJ 3 I . M Lam hare *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ADDRESS OF SITE: CONTRACTOR & LICENSE (if applicable) COMPANY NAME: PHONE: ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All Elements on the site must be listed and indicate the color to be painted. r Walls Pri3` Lne YeA (al) Fascia NIA Drip Cap/Drip Edge JA Soffit ON. Roof Q& Flower Bins Wh Shutters KIA P4ztv%C Awnings K Chimney jl k Doors and door jams W h ►-k Garage Doors \A/h t4- Railings Fences Decorative Metal All brick (simulated or regular) Stucco Banding NA Any other stucco features 1,14 Accessory Buildings 1,1,E 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 f les. � A U — X411 Signature of Owner Date Signature of Contractor Date ********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED: cia StIORES VILLAGE Paint Color Approval and Agreement Building g l 3 ate Whrk c) 0 0 cn ro rxj cn H cn rTi WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION 4/23/01 Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 3 /11/2002 Applicant: DAVID Owner: ROMANIK Contractor Local Phone: Parcel # 1132060130730 Job Address: 95 NE 95 ST Fees: FEE2002 -1443 FEE2002 -1444 FEE2002 -1445 Permit Status: Approved Description Amount Building Permit Application Fe*60.00 CCF Notary Fee Total Fees: Permit Expiration: 9/7/2002 This Permit is granted to the contractor or builder named above to construct thi ordinances pertaining thereto and with the understanding that the work will be per and approved by the proper municipal authorities. This Permit may be revoked at authorization. A further condition upon which this permit is granted is the understi ordinances and regulations pertaining to the work covered hereby whether shown by his agents, servants or employees. Signed: (1 SPECTOR) In consideration of the issuance to me of this permit, 1 agree to perform the work with the plans, drawings, statements or specifications submitted to the proper auth o myself, my agent, servants or employes. 1-- Signed: (Contractor or Building Permit Permit Number: BP2002 -501 Address: Cellular: N co co cis 0 0 a ROMANIK DAVID $1.20 $5.00 $66.20 Construction Value: Work: EXTERIOR PAINTING AS PER AGREEMENT (OWNER BUILDER PERMIT) If there is no permit package accessible on the job -site for insper` ---- - fee is $50.00, which must be paid in advance before calling fc DAVID K. ROMANIK 95 N.E. 95TH ST. MIAMI SHORES, FL 33138 -2706 $2,000.00 V & aelar w_ Bank of America. Pay to the y order of 1 I I A MTU ACH H/r 063100277 For PamiA" 02-00 Page 1 of 1 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 23 & 24 BLK 5 LOT SIZE Total Fees: $66.20 Total Receipts: $0.00 Date 3 ,:0630000471: 00306917348311' 0880 880 63 -4/630 FL 1348 $ !c>(o. � f (Xi Dollars el 0.1.cnOck C a ro °a"*S(S `) cU' (- 1 - 1? ..0(3 #11 Dat Owner's Address Contracting Co. Qualifier PERMIT APPLICATION FOR MIAMI SHORES VILLAGE z 5 e e - ,40/y. Legal Description Owner / Lessee / Tenant _ Master Permit # SS# - Address Tax Folio // �° (s`J e 7 3 Phone ; r �� /g /Moat__ Phone State # Municipal # Competency # Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION er v Square Ft. Estimated Cost(value) 4627 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 onstructio and zoning. Furthermore, I authorize the above -named contractor to do the work state Signature of owner and /or Condo President Date: Notary as to Owner and /or Condo President My Commission Expires: Notary as to Cont My Commission Exp ** * * * * * * * * * * * er- Builder Owner- Builder res . FF1CCA ' OTAR 'EAC NOTARY PUBLIC STATE OF � COMMISSION NO. CC � , 1c6o D MY C EXP. I Y 26 IgP.I 1 FEES: PERMIT / 1 5 a RADON C.C.F. e r l NOTARY TOTAL DUE , 4" : 65 : 65 APPROVED: Fire Other Zoning Building , )) 1 4” Electrical Mechanical Plumbing Engineering PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY (OWNER TO RETAIN COPY) /ti 9 .S 4 fon a 6i °_ %g ' /4 ster Permit # Tenant .6,1 C Job Address Legal Descri Owner / Lessee / Owner's Address Contracting Co. Qualifier State # Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): I LDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN WORK DESCRIPTION .2 ��24 ,e e,'/f 460,/x... 664 reilawe 4-s egosese Square Ft. Estimated Cost 4 D6, 424° 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. 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. Further ore, I authorize the above -named contractor to do the work stated. Si nature Date: PERMIT FEE: .6 - b ea r 060 Owner and /or Condo resident ,i4e,aaefx/ SS# Address phone phone Competency # Ins. Co. Signature of Contractor or Owner - Builder Date: Tax Folio / ...7.2,04/s1 10 `' Not °ry =s to Owner and /or Condo President Notary as to Contractor or Owner - Builder My ommission Expires: NOTARY PUBLIC. STATE OF FLORIDA My Commission Expires: * * * Mlir COMMISSION EXPIRE#APRIL 10 * * * * * * * APPROVED: BONDED THRU STEMBLER•ADAMS & IErETe Other Zoning Building, �bl91t Electrical r� Mechanical Plumbing Engineering MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing 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. �, ,Q , Date (D �y `� , 19 -C C� c No Street Registered Architect and /or Engineer eye t (/ Name and address of licensed contractor � j !r -tom - 8? - Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done State work to be done and purpose of building (by floors) Owner's Name and Address._..._ c 9S ,,4 and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ .__Amount of Permit $ 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 the 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 pennit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida, Pennanent Supplement, and has 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 under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. t Remarks (Signed) STATE OF FLORIDA, COUNTY OF DADE. j ss Disapproved Date (Signed) Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared 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. Permit No ? 7 Date Read, Sworn to and Subscribed before me. Notary Public, State of Florida ing Inspector My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member ... Member Council Approved Date Disapproved Date NOTE: A charge of $1.00 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 $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.