294 NE 97 Stip
Miami Shores Village
BUILDING
PERMIT APPLICATION
FBC 2001
Building Department
Permit Type (circle). Building ` Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) ' • 1/4) \ \ �' \ \t: ' Phone # `% L =,
'Owner's Address J. \ ■ 1 k t
VCity \ i Vt 3 State "✓ ` Zip :!)fl 0 '3
c)r
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Permit No.
Master Permit No. 2 no 3 - / D/
l
Tenant/Lessee Name Phone #
Job Address (where the work is being done) L 1 \ 1 C C L X s AV t l` ,= ∎
City Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES NO tir
Contractor's Company Name Phone #
Contractor's Address
City State Zip
Qualifier
Architect/Engineer's Name (if applicable) . Phone #
Architect/Engineer's Address
City State Zip
$ Value of Work For this Permit
Square Footage Of Work: Z -
Number of: Bays Stories Families Bedrooms Baths
Type of Work: A,Addition ['Alteration New ❑ Repair/Replace [I Demolition
Describe Work:
C. - K \_ v0 ‘4,1C k. 1 .L \0\ti : r At', :v ).■ (,)'C \ \LA -
u
* * * * * * * * * * * * * * * * * * * * * * * * * ** *Fee Calculation -Mist Permits * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
County Escrow Fee $ . X n Permit Fee $ Z 0 A Notary $ 5. 0 C
Education/Training Fee $ Tech $ Scanning $ Radon $
Code Enforcement $ Bond $ / Struct. $
Minus Plans Check Fee $) t;: , F. (, Fee Totals $ L� ., 4 0 (Continued on opposite side)
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
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.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
f ,(! t
Signature
Print:
chc6 /18/03
nail
R
Owner or Agent
The foregoing instrument was acknowledged before me this
day of
who is p
State Certificate or Registration No.
APPLICATION APPROVED BY:
3
,20 ,),by tilef. - _ n Lta 1 , ,
known to me or who has produced
As identification and who did take an oath.
NOT ' Y PLIC:
Sig IF .
- Ct'' 1 C;i T
My Commission Expires: 04 Angela M Becker
xP ° y prt � � I �S�� (' d My Commission Expires:
* ** * * * * * * * * * * * * * * * * * ** 'fIk, **** 'i1�iFiriFlt�,F, `�iY r**, t***, t*****, t*************** �Ul r****, t*, t, t * * * *tk�tr*** *ir*** * *tr,t *,t * * **
o,�.o Expires Novembe i ..e r t i ncate of Competency Holder)
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of
- _. JUN 3 0 2003
,20_,by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Certificate of Competency. No.
Plans Examiner
Zoning
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2'-0"
Owner's Side
4" 4" X 4" Wood post
2" X 4" Wood kad 4' -0" High or Less = 6' -0" O.C.
5' -0" High or Less = 5' -0" O.C.
I "X6 "crl "X8"
Wood pickets
Concrete
WOOD FENCES
3' -0"
Concurred
2915 Fences
Wood Posts
2915.1 Wood fences, so located on a property
that by zoning regulations they cannot be used
as a wall of a building, shall be constructed to
meet the following minirnum specifications.
(a) Fences not exceeding 5 feet in
height shall be constructed to meet
the following minimum
requirements: from nominal 4 inch
by 4 inch by 8 feet -0 inch long
posts spaced 5 fee -0 inches on
centers, having a fiber stress of
1200 p.s.i. in bending, and shall be
embedded 2 feet -0 inches into a
concrete footing 1 fcot -0 inches in
diameter and 3 feet -0 inches deep.
Other components shall be
designed to comply with the
provisions of this Chapter and
Chapter 23.
(b) Fences not exceeding 5 feet and 4
feet in height respectively shall be
constructed as provided in
paragraph 2915.1 (a) herein,
except that the spacing of posts
may be increased to 5 feet -0
inches and 6 feet -0 inches on
centers for these heights.
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ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPE
Dryer
QTY.
TYPE
Outlet, Appliance
QTY.
TYPE
Service Repair
QTY.
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
Discharge We
Clear Violations
'Ice Maker
Heat Recovery
Pump, Sump
Refrigerator, Comm. (p/PH)
Utility - Water
Temp Serv., Construction
D:shv✓aster
Compactor
'Indirect Wastes
Low -volt, Burglar
Relay Repair
Refrigerator, Domestic
Vacuum IPaaanp
Temp for Test - 30 days
Disp sal
Deep Freezer
'Interceptor
Low -volt, Fire
Roar Ilniet
Renew - Temp Service
Water CZoset
Domestic We
Demolition
Laundry ¶'ray
Low -volt, Intercom/Teleph.
Septic Connection
Repair Circuits
Water Heater
Drain field, 4" 'Il'e e 8es.
Dishwasher
Lavatory
Low -volt, Television
Septic ¶'ank
Service, Number of Amps
Water Heater New
Drains, Area
MECHANICAL
TYPE QTY.
Minimum Fee
TYPE
Condensate Drain
QTY. 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
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 C :oset
Clothes Washer
Gas Piping
Pump, Replace - Pool
Urinal
Dente Chair
Grease Trap
Pump, Sprinkler
Utility - Sewer
Discharge We
'Ice Maker
Pump, Sump
Utility - Water
D:shv✓aster
'Indirect Wastes
Relay Repair
Vacuum IPaaanp
Disp sal
'Interceptor
Roar Ilniet
Water CZoset
Domestic We
Laundry ¶'ray
Septic Connection
Water Heater
Drain field, 4" 'Il'e e 8es.
Lavatory
Septic ¶'ank
Water Heater New
Drains, Area
Meter Set (Gas)
Sewer Connection
Water Re-pipe
Drains, Piccr
Minimum Lee
Shower
Water Service
Drains, French
Miscellaneous Equipment
Sink
We:, 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:
T-// - D/
SECTION
BY
D TE
�01
Zoning
«
Electrical
Mechanical
Plumbing
Fire
Public Works
.
Structural
,
Building Official
° % ,
, i
Page 4
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
❑ IMPACT FEE
(New Construction)
PERMIT FEES
$3.00 per page (Scanning Fee)
Miami Shores Village
Bond
Metropolitan Dade County (C.C.F.) $ D r (p®
Inspector State Educational Fund $
State DCA (Radon) $
Code Enforcement Fine
Zoning Review
$
ISSUING OFFICIAL
REVIEWED AND PREPARED BY: V 1 (k c-
O PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ OTHER
(Specify & Attach)
(sq.ft. = x/1000
x t.60)
(¢.005 /sq.ft.)
(¢.01 /sq.ft.)
TOTAL $ /D 02,.
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
DATE: 9 `- /
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2N AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com
PROPERTY OWNER
Name in , 4 C \ r .
l co
Addresss ag , ` E t-
� 9 io�� 1 r1c S f- 33)3
Home Telephone 26 _ 75G Jc�1 " �3
lJ / V
Business Telephone
Fax
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 Miam'l Shores Village:
Step 1.
Complete the attached permit application which trust 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: l A ° A. 0 C- &A ....
Addre'ss Apt.
Folio Number \ 30 ( 3 ieD
Lot ! d> -, Block 3 0
1 BA.L) PG ( 0
Subdivision
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.
CS1 01)��` fire
City State
Description of Work Ten
Square Feet
PERMIT APPLICATION
5 e
Zip
Zoning Linear Feet
Units Floors
Value of Workr/ i(Q3 .. 0 Bldg Value
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
ENGINEER
Name
License No.
Address
Telephone
Fax
CONTRACTOR
Name
License No.
(014724....0)
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, P' 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
Signature of Owner Signature of Contractor / Qualifier
Print Name 0 Print Name
Sworn to and subscribed before me this l 0 day of _ p Sworn to and subscribed before me this day of
PQUI .
`Signature of Notary Public - State of Florida
+ .o N w„ Dana O'Brien -Brown
** My Commission CC939867
14 1. 0 Expires May 25, 2004
SEAL:
F MIAMI -DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE
Signature of Notary Public - State of Florida
SEAL:
PERMIT APPLICATION
Personally known O en 'cation Personally known OR, Produced Identification
men nation ed: Type of Identification Produced: