1077 NE 96 St (5)MIRIAM S. ZAYAS (OR)
TIMOTHY W. BOWNE
1077 N.E. 96TH ST.
MIAMI.- L 33138 -2551
Pay
to the order o
BankofAm
Bank. of America . Advantage:.°".
Date
ACH H/F 083100277
Memo
1:0'' 300004 ?I: 00 L1,9 ? 4 4 2 2 ?811• 3 ?03
3703
2 e) 63-4/630 FL
I J 13
B ..
Dollars �a.�.
MIAMI SHORES VILLAGE
Paint Color'A.p rro and Agreement
J DATE: 4 O/
vOWNER'S NAME: 77407W/ 5 t3o /L/ 'PHONE: "3bS 7 7 O 2
DRESS: /0 7 7 Al ' 9
34 >C
/ADDRESS OF SITE: / 7 7 i(/
CONTRACTOR & LICENSE (if applicable) 11
COMPANY NAME: PHONE
kcrc�cx�cxxxxx *
All Elements on the site must be listed and in u cate th color 1
Walls a., do be. 10,e r 9 .e *AC- s id 1 ixo (
Fascia M v il-Ler_,,A %. • —
Drip Cap/Drip Edge
Soffit a/ u. NQ n9 o ek .s-t. F -.2_/ s---it) (7 M
Roof
Flower Bins
Shutters
Awnings
Chimney!
Doors and door jams
X X X X x X x
l�
(.t
X X X 3
* X X X X* X* x x X X x x X x X X X x x X x X x X X X X
x
>C x X x X X X X X X X X x X X X x X
/2' ai ccifl /accrue/ 0-.4e-ow
Garage Doors itl °-
Railings
Fences
Decorative Metal
All brick (simulated or regula
Stucco Banding
Any other stucco features
Accessory Buildings
Othr er� - °
an ? ewee'44119
— OWNER'S AFFIDAVIT: I certify that all the foregoing inform
and that all work will be done in compliance with all applicable
construction and zoning. I authorize the above -named contracto
do the work stated. Furthermore , the paint colors will be as per
samples.
4iiii
gnature wner Date Signature of Contractor
tern
APPROVED:
Building Offic f Date
12B1 W
El
El
* x X
AC -7
O'
U
6s
° durango dust
Date
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
4/23/01
PROPERTY OWNER
Name 77A4e r/9 y W "R /.4/1'i /30 WV E
Address
7 ) 7 7 ( J c ? & S 7 4 -
/ 7 2 /A-4i / S E-5 33/3V
Home Telephone C30s 'T�- O D s _ 7
/
Business Telephone
Fax (30i) 73 /L3
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'I Attachment
Other
Add'I Detachment
Other
1 INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Step I. Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures 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 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
VJob Address: /0 7 7 /U 9 l 0 .Ciree / Ma m / She r /' / 33 / 38
Address ON ' Apt. City State
Folio Number ( �� `1 33_1.70 /,, � Description of Work / ebtf' /1/1/Y
Lot l 0 — - Block 2 a--
Subdivisiorf se PB PG Zoning Linear Feet
Current Use of Property Square Feet Units Floors
Proposed Use of Property due of Wor1e€treCK 413 . 00 Bldg Value
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
<�
3 e
PERMIT APPLICATION
Master Permit No.
Subsidiary Permit No.
Zip
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
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 PROTECII,D 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.
STATE OF FLORIDA, COUNTY OF MIAMI -DADE
Signat e of Owner
RI iRIA -M 2 AYA -S BOct 7 ,1.7 E
Print Name
Swom to and subscribed before me thi
%7 % /r ._!
OF i `ota c- Stateof
day o
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:
.PERMIT APPLICATION
Personally known OR, Produced Identification (/ Personally known OR, Produced Identification
Type of Identification Produced: F� 1- B5O $Sq- p CDS 6 Type of Identification Produced:
ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPE
Dryer
QTY.
TYPE
Outlet, Appliance
QTY.
'1'V'PI:
Service Repair
Q'f\'.
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. Tvi'I.:
Generator
QTY. i'YI'E QTY.
Refrigeration, Tons
A/C Central, Tons
Cooling Tower
Heating Strips, each
Vent Hood, Cost
A/C WaWWin. 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.
TY
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
D E;
Zoning
� �- � /�✓
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
/- 2 - O C
.,
Page 4
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
PERMIT APPLICATION
O CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
PERMIT FEES
$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
$ Co
$ rho
$
$
$. o v
(sq.ft. = x/1000
x ¢.60)
(¢.005 / sq.ft.)
(¢.01 /sq.ft.)
TOTAL $
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
Date t O _Z t -C N Job Address (0 7 - 7 ki 9G.51
Legal Description
/ Lessee / Tenant ) t V' (Q Master Permit #
Owner's Address savor Phone 7 -COS
Contracting Co. Il (a- • 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 FENCE SIGN
WORK DESCRIPTION EalinA Iln C� c �(''�/` ) O 1/\ d Vl
de
Square Ft. Estimated Cost(value) Z (7 Q
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.
Signa re of owner and /or Condo President Signature of Contractor or Owner- Builder
Date:
Notary as
to Owner and or Condo President Notary as to Contractor or Owner- Builder
My o}e 16FiiWAtrAt1Y SEAL. My Commission Expires:
e■ SANDRA M MONTIEI.
i
* COMMISSION NUMBER
** A L ! r Q ',C401 * * * * * * * * * * **
4:p MY COMMIS -
N .EXP.
Op FL AUG. 098 03 m5
FEE . `�1' IT - RADON C.C.F. r SO NOTARY . - TOTAL DUE
Fire
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
'l ° /O- t9/-`/
Zoning Building
Mechanical Plumbing
Date:
Tax Folio 1833
Rhun
Other
¶iectri cal
Engineering