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PAINTCONTRACTOR New Construction Name j vhf ' g pLb Name C v/ca l / "'`./ ] "I ' '. ,...., License No. o 4 ./g / , �J Business Telephone Address ,, K,,4 /j0 £7 fir el "`,/ R 3 3 /i/ Telephon( Of !J '/J 4 Fax Demolish Qualifier Name . fie .!/, q`� Relocation of Structure `-"e--- PROPERTY OWNER New Construction Name j vhf ' g pLb Address /02f •e_ 7 ,rr ,(0te7 , 33 /e Home Telephone Alteration Exterior Business Telephone Repair Fax Alteration Interior 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 Job Address: PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other /02C ti .lf " Address Apt. • •• • PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax • • . • • • • _ • ••• • • • • • • • • ••• • •• • • Tilasttr jerrflit No. $ubsidlaiy farmit No u INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: • Step 1. Complete the attached permit application which m in signal I t ov/ner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate process of yc 1r':plicatioa. 4f voila work will be done, 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. APPLICATION tam/, mil. R. 33/-d City State Zip Folio Number Description of Work / a..,, 4-' e / Lot Block / t &14 Subdivision PB PG Zoning Linear Feet Current Use of Property Square Feet a Units Floors Proposed Use of Property Value of Work f!I 5 Bldg Value Tenant Information Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT APPLICATION 03 <=2 ENGINEER Name License No. Address Telephone Fax Page 2 • .•• • ••• • •. • . IMPORTANT NOTICES DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED 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 o or holidays, , • • 2. All construction of demolition areas MUST BE MAINT AWJED 14A CLCAM, NEAT £N13N4NITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEI F 101E 1 itND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAIvjAGE13BY E OR V - IICLES, 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. STATE OF FLORIDA, COUNTY OF MIAMI -DADE .l i( 141.4fU �C 02 Signature of Owner ern 4 &owes 7 day of _ _ , Swom subscribed before me this Signature of Notary Pu is - State o SEAL: Personally known OR, Produced Identification Type of Identification Produced: ••. . • eo o ••. - ; • • • • • ••• . •• o STATE OF FLORIDA, CTI)I,TY MIAMI -DADE Signature oTContractorfQualifier Print Name Sworn to an subscribed before me this Puc -State o'f Flori . fc: •o, Angela M Becker _ � My Com mission DD150048 '? i �o Expires November 15, 2006 Personally known OR, Produced Identification SEAL: • • • • • PERMIT APPLICATION day of - , Type of Identification Produced: ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer • • • ■YI t'. • • T`'I' Outlet, Appliance QTY. 'FVPE. Service Repair QTY. A/C Central 1 -3 Ton Fan Outlet, Wall Service, Temporary A/C Central 4 -7 Ton Fire Pump Outlet, Switch 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 Minimum Fee QTY TYPE Condensate Drain QTY . 1 . 1 . 1 , E Generator QTY TYPE Refrigeration, Tons QTY 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 Supply, AC Well Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Temporary Toilet 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 wosk being pdf quantity(ies) in the space provided below. ••. • RECEIVED AND REVIEWED BY: DATE: SECTION BY DATE ...7-h th Zoning 4:t0 Electrical Mechanical Plumbing Fire Public Works Building fficial Building Official /J �� // 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 Notary ••• • • •• • • ••• • • ••• • • • • ••• • • • • • ❑ PROOF OF OWNERSHIP �Q�tadlt)• . . •� • • . • ❑ Hr&/ ; (Septic / Sewer) • • • ❑ IMPACT FEE (New Construction) , 6� • • .• ❑ OTHER (Specify & Attach) PERMIT FEES (X .ft. = x/1000 $ (¢.005 / sq.ft.) $ (¢.01 /sq.ft.) $ s 'b 0. PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ D ISSUING OFFICIAL REVIEWED AND PREPARED BY: DATE: CONDITION OF A PPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com Shutters Awnings Chimney MIAMI Syl4nS•YILLAGE Paint Color Ap}3roval and Agreement • •••• • • • DATE: Z A 03 • .- OWNER'S E: TOM , . c rwrJ : ' • PHONE: ADDRESS: /02 ,= 9 7 5t ****** * * * * * * * * * * * * * * * * * * *4r *. * *4 *0 ** * * * * * * * * * * * * * * * * * * * * * ** • .• • ADDRESS OF SITE: /02s CONTRACTOR & LICENSE COMPANY NAME: All Elements on the site must Walls Fascia Drip Cap/Drip Edge GJ Soffit — Roof wk Flower Bins (14TaPprilica.b:1P.Le)C1-749",../..c4 7 &p � • 4/�/ 3 / ��ify _�c j �' PHONE: (3 ? /fi *** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Doors and door jams Garage Doors Railings Fences Decorative Metal All brick (simulated or regular) Stucco Banding Any other stucco features Accessory Buildings Other samples. ` 4 owe 2/7/3 . Signature of Owner Date APPROVED: a& /d43 Building Official Date be listed and indicate the color to be painted. 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 Signature o Contract Da *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION 4/23/01 Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 2/11/2003 Applicant: CLAUDINE Owner: BOWES JOB ADDRESS: 1025 NE 97 Contractor COMPLETE HOME PAINTING Local Phone: 305 - 895 -1368 Parcel # 1132050170110 This Permit is granted to the contractor or builder named above to construct the ' ordinances pertaining thereto and with the understanding that the work will be perfc 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 understai ordinances and regulations pertaining to the work covered hereby whether shown c by his agents, servants oyees. Signed: ��SPECTOR) In consideration of the issuance to me of this permit, I agree to perform the worts with the plans, drawings, statements or specifications submitted to the proper autl myself, my agent, servants or employes. Building Permit Permit Number: BP2003 -223 BOWES CLAUDINE ST Legal Description: 5 53 42 Contractor's Address: 1476 NE 130 STREET Fees: FEE2003 -861 FEE2003 -862 FEE2003 -863 Description Building Permit Application Fee CCF Notary Fee Total Fees: Amount $60.00 $0.60 $5.00 $65.60 Total Fees: $65.60 Total Receipts: $0.00 Permit Status: APPROVED Permit Expiration: 8/10 2003 Construction Value: Work: EXTERIOR PAINTING AS PER AGREEMENT �.{ If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. fee is $50.00, which must be paid in advance before calling for another inspection. (Contractor c PAY TO THE ORDER OF PB 43 -51 REV PL MIAMI SHORES SEC 8 LOT 11 $850.00 COMPLETE HOME PAINTING BY MICHAEL MICHAEL IWASKEWYCZ 1476 NE 130TH ST. PH. 305- 895 -1368 NORTH MIAMI, FL 33161 r • Washingto .i�u><uar/ Washington Mutual Bank, FA North Miami/125th Street Financial Centa '2728 900 NE. 125th Street 1-8t 1.788.10 ) North Miami, Fl. 33181 41 le Cuatan r Senior Page 1 of 1 . , ,, crnirr rmmnliance with all- - Re- inspection 63-8413-2670 da 3658 /z o3 BLK 180 MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Bui1 in Inspection Request Date Type Insp' n Z1 1 NT Permit No. Inspection Date Approved Correction Name DavvEs. Address Company CO Phone # Re- Insp'n Fee ❑ 41,000