1170 NE 97 St (6)TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'l Attachment
Other
Add'I Detachment
Other
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Step 1.
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
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 submit-
ted along with this permit application.
in, 4,,, S' )4.6 ) FL 313 i - 0ss�'
City State Zip
MIAMI SHORES VILLAGE of Work ReFU4�' 57/1 QesKAL -te bfi vEw/ w
BUILDING DEPARTMENT S f Ps , r C- s s
305- 795 -2204 Linear Feet
Building Inspection Request
C7
Type I
Permit
Name
Address/
Compa
Phon a U
For Inspector: 9 /WO 13
Correction
-7O N q7' �7-
Re- Insp'n Fee ❑
A -F
PERMIT APPLICATION
Master Permit No.
Subsidiary Permit No. B ' fr'1 .., r_'
t Units Floors
brk OV0 0 Bldg Value
;ed/Appraised Value
ie 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 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.
STA G FLOR COUNTY OF `i'AMI -DADE
APArrile
Print Name
Swo
SEAL:
e of Owner
t2'7 W ysoc
and subscribed before me this a 7 of
Ika
e of otary Public - State of Fl
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
PERMIT APPLICATION
_ - SEAL:
Personally known Oit Produced Identification Personally known OR, Produced Identification
Type of Identification Produced: Type of Identification Produced:
ELECTRICAL
'nil
Minimum Fee
QTY.
'TYPE.
Dryer
QTV.
'rVPI:
Outlet, Appliance
()Ty.
'r\I'I
Service Repair
yry.
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
Q'rY.
'TYPE.
Condensate Drain
cm'.
TYPE.
Generator
QTv.
'TYPE
Refrigeration, Tons
Q'IV.
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
TV E
A/C Condensate
QTY.
TVPl.
Drains, Roof
Qi'Y
TN pu:
Miscellaneous Fixture
Q . Q . Y .
.
Soakage Pit
Q ' I ' V
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
DATE
1y -1- 7 / 0 ,
Zoning
f e �1s�.� ✓
Electrical
l/
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
. �
2i /
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)
$ (¢.005 /sq.fL)
(s .60) x/1000
x
(¢.01 /sq.ft.)
PERMIT APPTJCATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
PERMIT FEES
TOTAL $ - 2 - 7 ‘ i
ISSUING OFFICIAL
REVIEWED AND PREPARED BY: DATE:
CONDITION OF
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: BP2002 -1503
Printed: 8/27/2002
Applicant: GREGORY WYSOCKY
Owner: WYSOCKY GREGORY
JOB ADDRESS: 1170 NE 97 ST
Contractor
Local Phone:
Parcel # 1132050170150
Fees: Description Amount
FEE2002 -4801 Building Fee $70.00
FEE2002 -4802 Buildier's Bond $300.00
FEE2002 -4803 CCF $2.40
FEE2002 -4804 Notary Fee $5.00
Total Fees: $377.40
Total Fees: $377.40
Total Receipts: $0.00
Permit Status: Approved Permit Expiration: 2/23 /2003 Construction Value: $4,000.00
Work: REPLACE GARAGE DRIVEWAY RIBBON CEMENT STRIPS & GRASS
If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection
U fee is $50.00, which must be paid in advance before calling for another inspection.
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 regulatiorrp 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
C by hla auanln, norvantb 9( efhployoes. —
xcg
Signe
Building Permit
Contractor's Address:
BY:
Page 1 of 1
Legal Description: 5 -6 53 42 PB 43 -51 REV PL MIAMI SHORES SEC 8 LOT 2 LESS E25FT BLK
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, drab ings, statements or specifications 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, - ervants or employes.
(Contractor or Builder) BY:
•
tkIT-76Mtil=k1V
Gregory M. Wysocki 12-01
1170 N.E. 97th St.
Miami, FL 33138
Pay to the 7/
Order of \-v--
,
BankofAmerica.,..--
40-
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223
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This property described as:
Lot 2, less the Easterly 25.00
thereof, Block 181
REVISED PLAT OF TRACTS
TRACT 180C, TRACT 181A
OF THE REVISED PLAT OF
SEC. 8, according to the
thereof, as recorded in
Plat Book 43, Page 51
of the Public Records of
Dade County, Florida.
GOc,4 T /Oti/ HAP
feet
180B, S1 /2 OF
AND TRACT 1818,
MIAMI SHORES,
Plat
A BOUNDARY 5uflvEy
1 hereby certify that the Asrvey repre-
sented hereon meets the minimum
technical standards set forth by the Board
o(r Land Surveyors in chapter 61GT7 -6
Florida Administrative Code pursuant to
Section C2.027. Fla. 512nms There are no
enmachachnir ts. o•e*+•vs. ease+„er,ts
appearing on the /lac. other than if
shown hereto
Pt. *« MINV1.OA AP. MAMA 1q V7'7
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'BEALE SMITH #5238
(3051 666 -7909 19S-1) 523 -8663
Wysocki, Gregory M., 1170 N.E. 97th Street, Miami Shores,
Page 1 oI 2
Florida 33138
LANNFS AND (;ARCIA. INC.
LB. # 2098 - -
Nll RVEYORS- IMAPPER.S -1 4N1) PLANNERS
Office address: 359 Alcazar Avenue. (*oral Gables. Florida 33134
DRAWN BY DRWC. NO
A•D• 132302 -
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.I.D IttAKA
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This property described as:
Lot 2, less the Easterly 25.00
thereof, Block 181
REVISED PLAT OF TRACTS
TRACT 180C, TRACT 181A
OF THE REVISED PLAT OF
SEC. 8, according to the
thereof, as recorded in
Plat Book 43, Page 51
of the Public Records of
Dade County, Florida.
GOc,4 T /Oti/ HAP
feet
180B, S1 /2 OF
AND TRACT 1818,
MIAMI SHORES,
Plat
A BOUNDARY 5uflvEy
1 hereby certify that the Asrvey repre-
sented hereon meets the minimum
technical standards set forth by the Board
o(r Land Surveyors in chapter 61GT7 -6
Florida Administrative Code pursuant to
Section C2.027. Fla. 512nms There are no
enmachachnir ts. o•e*+•vs. ease+„er,ts
appearing on the /lac. other than if
shown hereto
Pt. *« MINV1.OA AP. MAMA 1q V7'7
v
'BEALE SMITH #5238
(3051 666 -7909 19S-1) 523 -8663
Wysocki, Gregory M., 1170 N.E. 97th Street, Miami Shores,
Page 1 oI 2
Florida 33138
LANNFS AND (;ARCIA. INC.
LB. # 2098 - -
Nll RVEYORS- IMAPPER.S -1 4N1) PLANNERS
Office address: 359 Alcazar Avenue. (*oral Gables. Florida 33134
DRAWN BY DRWC. NO
A•D• 132302 -
STATE OF FLORIDA)
COUNTY OF DADE)
The undersigned Affiant ,, r.voi Re l Y SOCVdoes hereby attest that the
(property owner) -
attached survey, performed by
performed on p) . , is an accurate representation of the existing conditions and •
to o survey)
locations of all structures on the property as of this date.
The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the
property without first providing a survey less than six (6) months old. The Affiant, as property owner, further •
agrees to remove or obtain permits for any structures which now may exist on the property which are not
permitted or which may violate zoning or building code rezulations. The Affiant further understands that the
existence of any such structures may affect final inspections as applicable to this or other permits..
Further, Affiant sayeth naught.
i' 'calm .__)horej (Attar
... AFFIDAVIT
(name of surveyor's corn :any)
Witness(sign and print) Witness(sign and print)
fnant/Property ovine
SWORN TO AND SUBSCRIBED before me this day of
Affiant is personally known to me, produced as identification.
otary