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1210 NE 96 St (7)MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Approved Correction Re- Insp'n Fee Date ' , D Time Type Insp'n MVO/ f' n9 d ` ?t 0 Permit No. OP I 2 - i 0 30 Name Nl.'tG�r� Address av i 1.)T-616 J4 Company ONn) Phone # For Inspector: Name & Date 0 "' f AMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date " 6 1 .L. J Time Type Insp'n 1 I Up n9 J ?l U Permit No. Octilqw 0. � - P 2 - 0 30 Name . Address RO I 1�+ -� t� SA Company n i()' 1 . Phone # For Inspector: Approved Correction Re- Insp'n Fee u Name & Date 30(.0 4 MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date Type Insp'n ('� (� Permit No. 5r - 2 w �' ^ 1 Zile, ptotn Time O. Name ' 3 (: I I Cl fl Address `g--01 1 . — l 51 Company G O 1✓I \ Phone # For Inspecto 5j 21 Approved Correction Re- Insp'n Fee ❑ Name & Date Np c 3 5 I 3 5Li g MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 " Building Inspection Request Date UI „L.T Time Type Insp'n 164), 14). piG3I r Permit No. ec 10 O Name t"!O (!X I GIG n Address 1 ).V 1 1 N SF _ ci o S+- Company � �) o 1 , Phone # For Inspector: 2512 Approved Correction Re- Insp'n Fee ❑ iB 41A, 11/ ._ __ Name & Date 1 MIAMI SHORES VILLAG BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request)( Date 70 Time Type Insp'n I 11 e(Q Permit No. 6P 20(53 -ICS G Name 11•-‘Q vcicin Address 001 •� I S Company aCt I Phone # S 9-s1- U For Inspector: l3 e { ► '3 Name & Date Approved ❑ Correction ) Re- Insp'n Fee ❑ /6069 MIA VII SHORES VILL BUILDING DEPARTMENt) 305- 795 -2204 Bui ding Inspection Request Date Type Insp'n M0\2 I ■ CO U Permit No. 6P 2003 - I U O Name 0 r, \ 4-1 Address l�.J' Cr 11 1\ 'L C V( ,Or Company 6). al i ‘<<-' Phone # a S1 - °0 ��K For Inspector: >? l hiS" Name & Date Approved Correction Re- Insp'n Fee ,may Time 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. 1. 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_0 FLORIDA, COUNTY OF MIAMI -DADE Signatur Print Name Sworn to and subscribed before me this / e T' [ day of H 1, SEAL: Personally known OR, Produced Identification STATE OF Signature Personally known 1/ 1) PERMIT APPLICATION • ' Sd trac IDA, / Quali ter Y OF MIAMI -DADE Print Name /� Sworn to and subscribed before me this / day of 0 rcL, OR, Produced Identification Type of Identification Produced: D.C. # M ciso - Z11<J' (P6 •1 L Type of Identification Produced: CONTRACTOR NameH m; 4' C kit . 'a i E)N t' O. License No Lx _.,,. '__ _ � Address 705 N L J a /` l i . ‘ `� ,_ JT NOeTH Mzp,� L, .'L- - 531(01 Telephone 7 �y y Fax ) T99- C� `O O Qualifier Name /J to , , &oz. j PROPS Y OWNER .. .0 .,,, ` Name ' ` r Enclosure Address 1 L-, C , - _ . tA*MM 5\ S, = .v .4 A..f.x L 33138 Home Telephone (-.05) 9 'L ( V „� J 3 — q' z 3 Business Telephone Alteration Interior Fax 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'I Detachment Other INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. 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 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 x Job Address: • Address Apt. Apt. Folio Number Lot Block Subdivision PB PG Current Use of Property e-e_.J . I-D€N ✓a., Proposed Use of Property �Pt"l6 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.6 000 ea' 3 65 Msf�,Mz 51 -'l2E5 , City Zoning 5, 2. 0-c.” State PERMIT APPLICATION 35I3g Zip escription of Work �?... -1OD n be:C/ E I Linear Feet Square Feet . Units Floors slue of Work Tax Assessed/Appraised Value Flood Zone Base Floor Elev. Bldg Value ENGINEER Name License No. Address Telephone Fax ELECTRICAL TYPE Minimum Fee QTY. TYPE: Dryer QTY. TvPE Outlet, Appliance QTY. TYPE. Service Repair QTV. 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 TVPI.. QTY. Minimum Fee TYPE Condensate Drain Q'I'V. TYPE Generator QTY. TYPE QTY. Refrigeration, Tons 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 Bath Fan - Vented, # Fireplaces, Number of - Pressure Vessel PLUMBING . A/C Condensate QTY 'rvi'E Drains, Roof QTy. TYI,I; Miscellaneous Fixture ()Ty. .rvI,I,. Soakage Pit Q'ry 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: Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) LI PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) 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 $ 3_ b 0 (sq.ft. = x/1000 x ¢.60) $ (¢.005 /sq.ft.) $ (¢.01 /sq.ft.) REVIEWED AND PREPARED BY: SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE 3 -22- PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ 33, tv d ISSUING OFFICIAL 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 PAY TO THE ORDER OF Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 3/21/2002 Applicant: Owner: Contractor MIAMI SKYLINE CONSTRUCTION Cd(dFbss: 705 NE 130 ST Local Phone: 305 - 754 -2700 Cellular: Parcel # 1132060143950 Legal Description: 5 -6 53 42 MIAMI SHORES SEC 3 PB 10 -37 LOT 17 LESS E1/2 & ALL LOT 18 Job Address: 1210 NE 96 ST Fees: FEE2002 -1645 FEE2002 -1646 Permit Status: Approved Permit Expiration: Work: REMODEL EXISTING BATHROOM MIAMI SKYLINE CONSTRUCTION CORP. 705 NE 130 STREET NORTH MIAMI, FL 33161 (305) 754 -2700 MEMO Mom jevr.,� eusl ox,u� ?ett -frT Description Building Fee CCF Total Fees: building Permit Permit Number: BP2002 -585 Amount $130.00 $3.60 $133.60 9/17/2002 Construction Value: v11- Ai,,ictteot 44 e e GLn COMMERCEBANK NATIONAL ASSOCIATION MIAMI, FLORIDA 33181 63- 1050 -670 Il ■00 104 ill' I:06 70 10 509i: 1 18 SOO i689006 $5,200.00 Page 1 of 1 Total Fees: $133.60 Total Receipts: $0.00 1041 616/z5/Oz $ /3 6 c) 0 DOLLARS 0, ispection n herefor in strict compliance with all ons that may have been submitted to f the plans are changed without ibility for a thorough knowledge of the he assumes responsibility for work done rertaining thereto and in strict conformity onisibility for all work done by either PERMIT NO. TAX FOLIO NO. STATE OF FLORIDA: COUNTY OF DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Legal description of property and street address: 1,2)1D iUf- 967)/ 377, 1 5 3,313V 2. Description of improvement: 2.F M0 eDPlk 01"1 3. Owner(s) name and address: tU'—. to ( /2 /vim 9l m sr, Interest in property: S\) SR L Name and address of fee simple titleholder: 4. Contractor's name and address: IMS'N'A, 6 K lT1J % &e) Y5 -tie rob 0 • 'yob l o71 5T, /v, FL 33 1 Co 5. Surety:(Payment bond required by owner from contractor, if any) I'A Name and address: Amount of bond $ 6. Lender's name and address: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name and address: 8. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. M s i.s 3x.y O — cTroio &) (2-1). (. 3 31 (o Name and address: NOTICE OF COMMENCEMENT 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date i edified) Signature of Owner ` Print Owners Name Sworn to and subscribed before m this ZZ of H P t Notary Pu Print Notary's a My Commission Expires: MAYLIN Y: MADRID My Comm Eim. laffD4 No. co 007315 llama* Mom }{&rraa / PITY OF DADS STATE OF FLORIDA, COU HEREBY CE RTIFY that this is a true cow of the day of � f 7- ori ginal fil in this office on hand and Official Seal. n Courts tifel WITNESS IN, LE • , of Circuit and Cou N D.C. By 02R181514 2002 MAR 25 1114 Prepared by: � A r L ") I "fAUT O Address: 7 2' ran P} 1 M, 0 , f-( 331 Col 4/y r' 0 N VI u► E D.2 S a — -f— 4) J J "-A * r1 o v► d 3 o ,_ 1AM SKYLI eor • r CONSTRUCTION CORP. ,L 2 - L O \` E 41 6 Strut : e- - I , . STATE CERTIFIED BUILDING CONTRACTOR E g, 5, Li C o s-at t 0 try, ►� e-v C3 i t;,, Ce => f o b, e. s , tel N � S /17 , Licensed & Insured • CBC 057075 • PHONE: (305) 754 -2700 • FAX: (305) 754 -1547 VLrii lAS :1 ;6 to re- occupy the single family residence known as : (address) . Legal Description: Lot: Block I hereby certify that I understand that the zoning of the ro e and that it is unlawful for more than one family to reside therein is I also understand that dential use any Certificate of Re- Occupancy that may be issued by Miami Shores ViIIage, certifies only tht referenced property is being used for single- family purposes and that such Certificate oes not the constitute any representation, warranty or certification as to the condition of the dwelling or other structures on such property. I P ∎(a S ' i **************************************_******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Applicant Print Name For purposes of conducting the inspection required by Section 902 of the Miami Shores Land Development and Zoning Code, please contact: Contact Name: Buyer Inspected by: Comments: APPLICATION FOR CERTIFICATE OF RE- OCCUPANCY Seller Realtor 1 Company Name Application Fee ($50) paid: Cash Check No. PAGE I OF 2 Miami Shores, Florida. Date v.; Approved Denied PB & PG: hereby apply for a certificate Telephone: 3 Ens- & l a -81 f 0 Date 1 /1b ZZ t z • CER'11F1CATE OF RE- OCCUPANCY On behalf of Miami Shores Village, Florida, the undersigned certifies that the property described in the above application has been inspected for purposes of re- occupancy pursuant to Sections 901 and 902 of the Miami Shores Land Development and Zoning Code property may be re- occupied by the above applicant for single - family residential p rp ses such PAGE 2 OF 2 MIAMI SHOD VIL ORIDA B Date of Certification: 1 21:2 THIS CER I"11.ICATE VERIFIES THAT THE REFERENCED PROPERTY HAS BEEN INSPECTED BY SHORES VILLAGE AND HAS BEEN DETERMINED TO PRESENTLY COMPLY WITH THE SCHEDULE OF REGULATIONS OF THE MIAMI SHORES LAND AND DEV CODE PERTAINING SOLELY TO THE REQUIREMENT THAT EACH ONE- FAMMY DWELLING IS USED AND INTENDED TO BE USED FOR A ONE- FAMILY DWELLING PURPOSE ONLY; HOWEVER, THIS CERTIFICATE DOES NOT CONSTITUTE ANY REPRESENTATION OR WARRANTY AS TO THE CONDITION OF THE DWELLING OR OTHER STRUCTURES ON THE PREMISES DESCRIBED HEREIN, OR ANY ASPECT OF SUCH CONDITION, AND INTERESTED PERSONS ARE ADVISED AND ENCOURAGED TO MAKE THEIR OWN INSPECTION OF THE PREMISES IN ORDER TO DETERMLNE THE CONDITION, THEREOF. Chainnan Member MIAMI SHORES VILLAGE SUP R_DING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be k pt at building during progress of the work. Ate/ Owner's Name and Address ii "" r .,� n Date / ry� g 19 7 o Registered Architect and/or Engineer. .\,_ . --- /6 (If Narne and address of licensed contractor____? ?e,k)4±' t ____JIAA.i A Location and legal descri0t2f lot to No ) e1 / G Street__ t C3 / , , c' 1 1 A 2 Street and Number where work is to be done }} State work to be done and purpose of building (by floors) 1�'�� ��'° `' ' PLANNING BOARD__ ____ . DATE Member Member Member ____ __ __ ___________ Member Council Approved __Date Disapproved and for no other purpose. New Building 1 ' PP ^� Remodeling Addition �p - Repa s No. of Stories To be constructed of __ _ Kind of foundation___ ..�'1 „ Covering , Estimated Total cost of improvements $ Amount of Permit $ � ' g Zone cubage required _ 1:L.C________________ ____ plan Cubage 6 2 ' 43 Distance to next nearest building ® _ Size of Building Lot -5 __Y / q0 •. 0 Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Pennanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such su ntractors, on work to be performed under this permit, as are licensed by Miami Shores Village. JJII '' Remarks__ (Signed) STATE OF FLORIDA, COUNTY OF DADE. Ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the. of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Permit No / Date 3 7 v Read, Sworn to and Subscribed before me. Disapproved _.__ __ Date ,j Notary Public, State of Florida ( Signed) ('f Building Inspector My Commission Expires Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspa tion or faulty materials and /or workmanship. e • 43 411, 9 rt. ri I — )3f 4 304, • 2- -a. 1 Application is hereby made for the approval of the detailed statement ut tree plans and specifications herewith submitted for the build • inc or other structure herein des This application Is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida. and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the i3uilding Division of Miami Shores Village shall be complied with. 'whether herein specified or not. A copy of approved plans and specifications must be kept at building during progreu of the work. Owner's Name and Address 0 . 0 st, Ig at Registered Architect and/or EngineerbOROB.....frktimea _ A Name and address of licensed contractor 400v atioin4 legal of lot to be bugs on: 1....16TVA kit i 1 Block 4 3 4 f Subdivision OF PO iklitet and Number where work is to be done.. late A 6.p State wo4. be done and purpose of building S.. bas -Gr live,- kr\ in New Building Remoddling To be constructed of 115 Kind of foundation ex t S .1 Amount of Permit _Plan Cubage Size of Building Lot Estimated Total cost of improvements $ Zone cubage required Distance .to next nearest building. Maximum live load to be borne by each floor I hereby submit all the plans and spefifications for said building. All notices with reference to the building and its construction may be sent to. i aK IOE 'lei Th4 01 C , ÷ . 33/3E The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida ‘Vorkinen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Siqmlement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as arc required by the Act. The undersigned agrees to employ only such su1qtractors, p wor to performed under this pennit, as are licensed by Miami Shores Village. Remarks (Signed) STATE OF FLORIDA, COUNTY OF DADE. I Ss ' Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared .......... ..... and who, being by me first duly sworn, upon oath deposes and says that he is the. of the above described construction, that he has careful y read the foregoing application, and that he did sign the same, and that all facts therein by him stated sta4 re true.. Permit No. Disapproved (Signed) Building Inspector MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Date 6 11 I Date. 000 Chairman Nfernbcr Member Connell Approved Date Addition t/ Re PLANNING BOARD DATE , Sr.4 1Y) :s.., Metnbers ar- pafrs No. of Stores CarpC.iffr Roof Covering.eX.I.ShY) Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires -.2: so sex-vey and for no other purpose. to me well known, Member....... _ ....................... -.-....-....— ....... Member — Member Disapproved Date NOTE: A charge of 31.00 will be made for making corrections or changes to this application after approval has been obtained from the Plannir.g Board. A rc-in.pection fee of 31.00 will be charged when such re-inspection is made necessary by Improper notice for inspection or faulty materials anci/or workrnanship. ELECTRICAL TYPE Minimum Fee QTY' TYPE Dryer QTY. TYPE Outlet, Appliance QTY 'I'YI'E Service Repair QTY A/C Central 1 -3 Ton Fan Dryer Vents, Number of Outlet, Wall Ventilation, Cost Service, Temporary Air Handler, Tons A/C Central 4 -7 Ton Piping, Flammable Liquid Fire Pump Outlet, Switch Fire Sprinkler System Signs A/C Central 8 -15 Ton Bath Fan - Vented, # Fixture - Fluorescent - Pressure Vessel 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 Violatio.is Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Dap 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. TYPE 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 Solar Water Heater Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Cap - Fixture Bath Fan - Vented, # Fireplaces, Number of - Pressure Vessel Pump and Abandon PLUMBING TYPE A/C Condensate Q.1.V' 'f\.PI. Drains, Roof QTY. TYPE Miscellaneous Fixture QT1' TV 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 Sliower 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: Page 4 OFFICE USE ONLY CI- IECKLIST ❑ 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 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 (sq.ft. = x/1000 x ¢.60) (¢.005 /sq.ft.) $ (¢.01 /sq.ft.) REVIEWED AND PREPARED BY: SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ ISSUING OFFICIAL DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2"° AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com 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. STATE OF • RIDA, COUNTY OF MIAMI -DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE Signatur K Print Name worn to and subscribed before me this • Art gnature of SEAL: Personally known e r p. I Type of Identification Produced: OTARY SEAL 2 lam( Cr G ANGELA M BECKER * COMMISSION NUMBER 4'r CC786697 MY COMMISSION EXPIRES 0 FAO NOV. 15,2002 OR, Produced Identification Signature of Contractor / Qualifier Print Name day of , Sworn to and subscribed before me this day of Signature of Notary Public - State of Florida SEAL: PERMIT APPLICATION Personally known OR, Produced Identification 1 -1,S - 0- 41 ` 0'4+p�e of Identification Produced: PROPERTY OWNER Name i , 4 1/05 eva I ✓) Address a/0 jc q . RAW' Sit - 331 3 16 Home Telephone ) q 6 - 9/ 5 2 ? s- Business Telephone ( t0 as) 93 ! - f ') J 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'I Detachment Other INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. 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 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 Job Address: / a/ O N e 9&6/- l r Apt. Folio Number // 3.)-o co 1 -3 � Lot Block Subdivision Current Use of Property Proposed Use of Property Tenant Information Address PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other PB PG PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address, Telephone Fax City l�l a State escription of Work 11€0) 11€0) Ti (' , Square Feet X Value of Work W PERMIT APPLICATION Master Permit No. Subsidiary Permit No. i(e°' 33/38 Zip Zoning Linear Feet Units Floors 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 Village of Miami Shores 10050 NE 2nd Avenue Miami Shores, FL 33138 Phone: 305 - 795 -2204 Local Phone: Cellular: Fees: Description Amount FEE2002 -1273 Building Permit Application Fe$60.00 FEE2002 -1274 CCF $2.40 FEE2002 -1275 Notary Fee $5.00 Total Fees: $67.40 Permit Status: Approved Permit Expiration: 8/27/2002 Work: LAY NEW TILE FLOOR Building Permit Permit Number: BP2002 -433 Printed: 3/1/2002 Page 1 of 1 Applicant: GLORIA & CARLOS CURRLIN Owner: Contractor Address: Parcel # 1132060143950 Legal Description: 5 -6 53 42 MIAMI SHORES SEC 3 PB 10 -37 LOT 17 LESS E1/2 & ALL LOT 18 Job Address: 1210 NE 96 ST Construction Value: $3,800.00 Total Fees: $67.40 Total Receipts: $0.00 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. 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. Signed: (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 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, servants or employes. • Signed: (Contractor or Builder) BY: The Sunshine State LPZERSE *AMER M450-2Z0-66-629-0 GLORIA MOUNA 19101 MYSTIC POINTE DFL 01203 AVENTURA, FL 33190-4517 BIRTH DATE SEX MGT. REST. ENDORSE. 040946 F SOB A ISSUED EXPRES OUPUCA7E 074601 0409417 00.00-00 WE DRNER X520101160113 Operenors at ornate.' vehicle constitutes cansentto toy sobrielytest Tittered by law.