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PAINTPERMIT APPLICATIION FOR MIAMI SHORES VILLAGE Date — -2 - F / Job Address /� � / .. Tax Folio `� �' Cir 1� / ,� r Legal Description Historically Designated: Yes No Owner/Lessee / Tenant s l ■4 2 L 0 / Master Permit # Owlet's Address( / 6 / ' 7 Phone Contracting Co.; " Address Qualifier SS# Phone State # Municipal # Competency # Ins. r - Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION Signature of owner and/or Condo President Date Notary as to Owner and/or Condo President Date My Commission Expires: FEES: PERMIT RADON C.C.F. Square Ft. Estimated Cost (value) Signature of C L C� 40 324.4(WW) 3 -4 (WW) WARNING TO OWNEG': 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 W1TH 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 contract )r to do the work stated. ntractor or .� t. �-' Date Date tary as to Contractor or Owner - Builder My Cri' i �y i i''" IAL NOTARY SEAL SANDRA M MONTIEL / l- (0 4 * COMMISSION NUMSER 0 DAV COMMISSION Q CC401261 EXP. F OF F\ AUG. 17 APPROVED: 0 I/� �� % t / / Zoning Building �) I � Electrical Mechanical Plumbing Engineering Date Legal Description Owner / Lessee / Owner's Address / APPROVED: Zoning PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Job Address" 1 Tenant f r O2 ,1Z4714.;// :(/ ;%'/ Y 'A Notary as to Owner and /or Condo President My Commission Expires: Tax Folio Contracting Co. %% / Address Qualifier SS# - - Phone State # Municipal # Competency # Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN WORK DESCRIPTION „//-72 I Square Ft. Estimated Cost(value) 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. i Notary as t My ConIIni s s i Master Permit # 3(; Phone 4c k= 1 Signature of owner and /or Condo President Signature of Contractor or Owner- Builder Date: Date: 7etRp1 P FFICIAL NOTARY SEAL ARBARA ANN FUOAZZi 4c S * COMMISSION NUMBER y ,� ® CC360191 der ** * * * * * * * * * * * ' met COMMISSION E P. ** OF W8 * 9 19913 tq r ..i9wss 01.E FEES: PERMIT �� 7 RADON C.C.F. r NOTARY TOTAL DUE Fire Other Building No Electrical Mechanical Plumbing Engineering MIAMI SHORES VILLAGE BUILDING DEPARTMEN 305- 795 -2204 Building Inspection Request Date a Time Type Insp' u ice_ Permit No. Name Address E t/ D / i , Company (n---,s2...„ Phon is — For I ctorN 1 ame; /,Late Correction ❑ Re- Insp'n Fee ❑ Job Legal Description ��� �� / � C/���1 �f�C,. Master Pe it # / Y / Lessee / Tenar Pkiatjet * akGia" • i Owner's Address IOa v Crl phone # / Am' • Contracting Co � � /e0ILDe,12 PERMIT APPL"IGATION FOR MUNICIPALITIES OF DADE COUNTY 411m7 (OWNER TO RETAIN COPY) AddresiDicil o 1:4- Qualifier SS# - - phone State# Competency # Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one : BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN WORK DESCRIPTION Square Ft. Estimated Coo', 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 FINAmmmn. CnNsnr.T WTTH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTI( Application is hereby ma+ that all work will be pea jurisdiction. I underst POOLS, ROOFING, and MEC1 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. 0 ignatu of Owner and /or Condo President Signature of Contractor or Owner - Builder Date: Date: f\ 1 No ry as to Owner and /or ondo President Notary as to Contractor or Owner - Builder My Commission Expires: G / // 9Z My Commission Expires: * * * * * * * * * * * * * PERMIT FEE: APPROVED: Fire Other V j Zoning Building 161 ( Electrical 7 /1/4rg IV 7i echanical Plumbing Engineering 'fib Address 'ovum. Tax Folio // :3 .o /7 7't/ Ins. Co. is indicated. I certify ng construction in this UICAL, PLUMBING, SIGNS, PROPERTY OWNER Name X„ /if/ 1 �ar/ fi `/ 14/ / +r Addre G / , R �� � A / e $f I1( / S/( Pe 3 ?/3� Home Telephone 30s . - 76?- - 237 2 Business Telephone .30Si P 377 - Z g 2- Fax TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'l Detachment Other INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. ete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submit - ted'ldu'g 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 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. PERMIT APPLICATION () QO ' (r Apt. City State Zip Description of Work i "6 ( PivA /r /A/6" Zoning Linear Feet Square Feet Units Floors V....-Argue of Work /0 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 Page 2 IMPORTANT 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 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. STATFIOF,,/FL • 'j P . , COUNTY OF MIAMI -DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE ( v S i g nae of I • er J am \ i o -- Print Name Swom to and subscribed before me this r . ignature o otary Pudic - StatB of orida Signature of Notary Public - State of Florida SEAL: dsoN Angela M Becher , , My Commission 00150048 Expires November 15, 2006 day of Signature of Contractor / Qualifier Print Name Sworn to and subscribed before me this day of SEAL: PERMIT APPLICATION Personally known OR, Produced Identification Personally known OR, Produced Identification Type of Identification Produced: )LLIbL 1 Q 0 °1 41- 7 l - D l b' of Identification Produced: ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. 'fV'1'E Outlet, Appliance Q'I'V' TYP1: Service Repair (1' 1'1' 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. Tvl'l Generator QTY. - I Refrigeration, Tons QTY. A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood Cost A/C WalUWin. 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 work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: SECTION BY DA Zoning 4 4 6 1f % ® �, Electrical C/ Mechanical Plumbing Fire Public Works Structural ran' Building Official 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 Inspector State Educational Fund $ State DCA (Radon) Code Enforcement Fine Zoning Review Notary $ ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) PERMIT FEES $ !� Q P Metropolitan Dade County (C.C.F.) $ o 60 ( sq.ft. = x/1000 x ¢.60) $ 5To) REVIEWED AND PREPARED BY: DATE: (¢.005 /sq.ft.) (¢.01 /sq.ft.) PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL 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 ( 1v1111.1V1.1 inoo_tt_r_4 3 V ILLA( -L+ Paint Color Approval and Agreement DATE: /2 - C- 1-6 WNER'S NAME: o (' s- PHONE: - 76 - 73 7 LADDRESS: 7 ************************ 1********* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ADDRESS OF SITE: /d94) . /(J 92T .o j �`,� i � �l fid • CONTRACTOR & LICENSE if applicable) ( pp able) _. /V J �, COMPANY NAME: PHONE: **************** ***************** * * * * * * * * * * * * * * * *i * * * * * * * * * * * * ** All Elements on the site must be listed and indicate the color to be painted.... ails >+�c,�o(�� - Facia Dr p Cap/Drip Edge S • ffit oof Flower Bins Shutters Awnings Chimney et.1.0 Doors and door jams Garage Doors fT Railings Fences Decorative Metal 1 ITG All brick (simulated or regular) Stucco Banding Any other stucco features Accessory'Buildings Other Ala v Nue, 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 wo k s ated. Furthermore , the paint colors will be as per the attached / ig "ature of O er Date Signature of Contractor Date * * * * * * * * * ** ********************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** sam APPROVED: -4 Building Official Date WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION t //t U7 4/23/01 Applicant: DOUGLAS Owner: PALEY JOB ADDRESS: 1096 Contractor Local Phone: Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 12 /13/2002 Parcel # 1132050170180 rmit Status: Signed: X Signed: APPROVED Permit Expiration: 6/11/2003 Work: EXTERIOR PAINTING AS PER AGREEMENT Building Permit Permit Number: BP2002-2160. �Fage 1 of 1 PALEY DOUGLAS NE 97 ST Contractor's Address: Legal Description: REV PL MIAMI SHORES SEC 8 PB 43 -51 LOT 6 Fees: FEE2002 -7168 FEE2002 -7169 FEE2002 -7170 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 Construction Value: $1,000.00 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. BLK 181 LOT 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. (INSPECTOR) 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 specifi . tions 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, sery or employes. RFG C01 17170 1137 I`if:llf1 1103 l:H RGF $6!;.60 (Contractor or Builder) BY: