1065 NE 96 St (5)MIAMI SHORES VILLA E
< 4 BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Type Insp'n
Permit No.
Name
Address
Company
Phone #
Date % - 9 - x.3
Approved
Correction
Re-Insp'n Fee
,/g
2 z,sO , i3
l - U Name & Date 3
For Inspector: �
/
Time
MIAMI SHORES VILLAGE
BTiILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date - ®3 Time
Type Insp'n � ,kik.i
Permit No. , T04.3 4 3 .
Name e""°`
Address / &C 4JJ 9'4 s?
Company
Phone #
For Inspector: 7 -/. ® 3 Name & Date
Approved
Correction
Re- Insp'n Fee ❑
-o
MIAMI SHORES VILLAGE
' BUILDING DEPARTMENT
- 305- 795 -2204
- Building Inspection Request
Date
- /1- O3 Time
Type Insp'n ! / r. AA/2. ,5 it 9 1
��
Permit No. P fO ooC� 3 �-
Name ,4;h : d X /L •
Address �✓ ® ( � 9 d
Company 4{% ' `� -11/ fl„;
Phone # 794 2. Xi 5 e9 J
For Inspector: 7 - /7 ®3 Name & Date
Approved
Correction
Re- Insp'n Fee
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 constn+clim•aobris. •
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 FOI4 WAAGE. ;bond • •
required for work in or near the street/sidewalk. — - • • • •
5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES.. D2hei constructiotf 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, CIinning and Zonis 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. De of Envirovmental Resources •
Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sew er. • •
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.
�Mf - � �-
f
/i4 iL
of O :er
(5 (5-p/ Dr
Print Name '
SEAL:
Sworn to and subs rib d before me this T day of . i)
Personally known
OUNTY OF MIAMI -DADE
OFFICIAL NOTARY SEAL
P (2Y PU� GLADYS J VILLAS
Signature otary Public - Sta COMMISSION NUMBER
MY Q DD091094
7 e • MY COMMISSION EXPIRES
OF FA MAR. 1,2006
OR, Produced Identification //
PERMIT APPLICATION
•
• • • • • •
ign`afure of
t
-State Florida
day o
STATE •- •RID OUN• -I:!.
: , 9 M w• ilfrr -
yip /A - 11‘)/
Pnnt Name
Sw orn to and subscribed before me thi
SEAL:
Personally known
ry
4 c\ Angela M Becker
My Commission DD150048
VP; Expires November 15, 2008
OR, Produced Identification
Type of Identification Produced)L 0632-3 fif--63, -i) Type of Identification Produced:
PR O' ' � -
Nam ,j 74i ",
Addr:.
Home Telephone 3 7s-; r' b ' 7 P 'J
7S 7
Business Telephone
F ax
CONTRACTOR
New Construction
Name �/'�
e
Enclosure
License No. 4 -2 3
Alteration Exterior
Address ,y:� 4/ ? 9 ,/
Repair
Telephon r? . 7 /gl!F 7. 7 3. D
F
f
Qualifier Name e V /
Demolish
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
•• ••
( the attached permit application which must b i ned b the ro.ert owner and i ualifier. Both i nature mu t be notarized. Please
• • pria g.type to allo:v t% a more accurate processing of your application. If roofing work will be done, a roofing application must be submit-
•••••• ttd • • alo •• ng with this permit application.
• • •
• • •
Submit the comalCRCtipplication with all necessary documents to the Building, Planning and Zoning Department for processing. During the •
••• • • p r o cess i ng of yQt# eeplication, you may be asked to submit additional information.
• • • ••• ••••••
•
•
•
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
tStep 1. •
•• •••
•
•'Lest �.•
APPLICATION
•
• leb, ,dress:
• • •
•
•
••••••
Addres 1 •
• • •
• •
•
Folio Number
Lotft�el /o v/
«:f� .� PB /, PG 77
��Zr
Subdivision 7"
Current Use of Property
Proposed Use of Property �1, -1/ >f'
Tenant Information
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
Block q
Apt.
I >X)5 ?1 s /; '
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
Master Permit No.
Subsidiary Permit
City
State Zip
Description of Work
Zoning Linear Feet
PERMIT APPLICATION
Square Feet
Value of Work /7r) Bldg Value
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
Units Floors
ENGINEER
Name
License No.
Address
Telephone
Fax
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 4/24/2003 1
Applicant: `- n .\ S \ n iN
Owner: RN O rt g O
JOB ADDRESS: 1065 NE 96
Contractor DECORATIVE MASONRY INC Contractor's Address: 842 N. E. 99 St.
Local Phone: (305)757 - 7765
Parcel # 1132060143700 Legal Description:
Fees: Description Amount
FEE2003 -2335 Building Permit Application Fee $60.00
FEE2003 -2336 Builder's Bond $300.00
FEE2003 -2338 CCF $1.20
FEE2003 -2339 Inpector State Educational Fund $3.00
FEE2003 -2340 Notary Fee $5.00
Total Fees: $369.20
Permit Status: APPROVED Permit Expiration: 10/18/2003 Construction Value: $1,900.00
-- -- -- •i. - .....:u ho nn insoections. Re- inspection
If there is no permit pac
fee is $50.00, which must !
This Permit is granted to the col
ordinances pertaining thereto and
and approved by the proper munic
authorization. A further condition
ordinances and regulations pertair
by his agents, servants or employ(
Signed:
Si
In consideration of the issuance
with the plans, drawings, stateme
myself, my agent, servants or err
Building Permit
Permit Number: BP2003 -635
Ord z
9E
ST
DECORATIVE MASONRY, INC.
PH. 757 -7765
842 N.E. 99th STREET
MIAMI SHORES, FL 33138
Page 1 of 2
MIAMI SHORES SEC 3 PB 10 -37 LOT 11 & W1/2 LOT 10 BLK 82 LOT SIZE
Total Fees: $369.20
Total Receipts: $0.00
--z7 20
63 -4/630
0749
PAY TO THE
ORDER OF
BANK OF A ERICA
BANK OF AMERICA N.A.
9190 BISCAYNE BOULEVARD
MIAMI SHORES, FLORIDA 33138
FOR
11 '000 ?Will 9 I:06 30000 t4 70: 00 L8 L048 2 5 211°
$ Z 7
DOLLARS
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PERMIT NO.
ADDRESS: •
MIAMI SHORES VILLAGE
BUILDING / ZONING DEPARTMENT •
SECTION
BY
DATE
ZONING •
ELECTRICAL
'
MECHANICAL
PLUMBING
FIRE
- PUBLIC WORKS
STRUCTURAL
BUILDING OFFICIAL
1. Sutlect to compliance with ett Federal, State.
County.Ydlage rules and regulations. Village mums
no responsibility for accuracy oflor results from
these plans,
2. Thls copy of plans must be available c0
building site or no Inspection will be conducted.
CRITIQUE SHEET
JOB ADDRESS jo S E. 96 sr
APPLICANT
PHONE ft
APPUCATION ,6ce1 UC-w
SHEET OF
MISCELLANEOUS
DATE ZONING ' COMMENTS
`?, (0} <i � ' //9 5 � " 7�9 G� /S ./D 6 % /),e/ye
I
/V L / f /
INITIALS
.�ti'`• Imo- �►�A f /��
ELECTRICAL
TYiw.
• Minimum Pqe • • • _
01
TYPE
Dryer
QTY.
TYPE
Outlet, Appliance
(j'1'1'.
'fYl'E
Service Repair
QTY.
•
• 11/C Central l.3 Ton •
• - •
Fan
Outlet, Wall
Service, Temporary
' I+de•Centra1.4 --7 Ton ,
• • •
Fire Pump
Outlet, Switch
Signs
• /{I•Centrsl 8-U on •
•
Fixture - Fluorescent
Oven
Space Heater (kw)
v• rf/t: • Centr #PP -29 Ton •
• • •
Fixture Light
Parking Lot Lights
Spas/Hot Tubs
•AM Central' 204 Ton •...
•
Flood Lights
Plugmold/Strip
Subfeeds, No. of Amps
m Ae Window • •
• • •
•
FPL -Load Central
Posts
Swim Pool, Commercial
,Air Condi i iers•
Garbage Disposal
Range/Range Top
Swim Pool, Residential
Cpiller • :
,*•.
Generators, etc.
Receptacles
T
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
Disposal
Demolition
Low -volt, Intercom/Teleph.
Repair Circuits
Domestic Well
Dishwasher
Low -volt, Television
Service, Number of Amps
Drainfield, 4" Tile/Res.
MECHANICAL
TYPE
Minimum Fee
QTY.
TYPE
Condensate Drain
QT1'
'TYPE
Generator
QTY
i'VP[
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
Cap - Water
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
Cap - Sewer
PLUMBING
TYPE QTY.
TYPE
QTY.
TYPE
QTY.
T1'1'E QTY.
A/C Condensate
Drains, Roof
Miscellaneous Fixture
Soakage Pit
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
T
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
Df1� `
��
Zoning
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
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
Metropolitan Dade County (C.C.F.)
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)
$ 4io, bb
$ 3
$ / • AD ( sq.ft. = x/1000
x ¢.60)
$ 3 - d 0 (¢.005 /sq.ft.)
(¢.01/sq.ft.)
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach) • • • •
• • •
• ❑
BPR APPROVAL• �Restaurapt�).
• •
• ••••
• • • • •
••••••
•• •• ••
❑ CONTRACTOR:REGISTRATION
(On File) •••••. • •••.
•••• •• •
..••••
• .• .•
• • •
• • •
• •
•
• • •
• •
..••••
• •
•
•
•
•.••••
•
•
PERMIT FEES
TOTAL $ 3401 a=)
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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