PAVINGPage 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 FLORIDA, cvrry OF MIA)DADE
Signature of Owner
Print Name
Sworn to and subscribed before me this day of
Signature of Notary Public - State of Florida
SEAL:
ature of Contracto
ualifier
Print Name
worn subscribed before me tht dayQ ,
ignature o o . Pubh S e of#ldri dl
SEAL:
s - it.
O. Iaat •..o;
P fyY °a l ANGELA VI BECitE
p g 2 C CONW ^,�;ou vutaoan
PERMIT APPLICATION
C C73669 7
• Q �y rxst
Personally known OR, Produced Identification Personally know
A• CFf -
'Type of Identification Produced: Type of Identification-Produced:
CONTRACTOR
New Construction
Name e _ _ " _ ,/f
l�i j�✓7�,y �f
r
/.%-e D'
/..%-
License No.
C�C /
l ic��
Address
A', '
��
17 .) s ' /
�i;
Telephone ,7®S. 77 77 Fax
77A .ax
. 73 _ 7 � Y 7c7
Qualifier Name ,f � �,/
Relocation of Structure
/
PROPERTY OWNER
New Construction
Name PTA' T
Address
, cS
/,,1‹
.% // rri/ r ": 0 -5
Home Telephone a,.3��7
Business Telephone
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.
Job Address:
•
PERMIT APPLICATION
Master Permit No.
Subsidiary Permit No ' og-CD)
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
Address Apt.
Folio Number // 3Z4e6' 0/3 ae..3e2
Lot - -� / � Block
Subdivision
Current Use of Property
Proposed Use of Property
Tenant Information
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other /.7r/7
PB PG
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
PERMIT CHANGE (✓ )
ARCHITECT
Name
License No.
Address
Telephone
Fax
}}�� �� � ( State Zip
Description of Work , d% ? ( i )
City
Linear Feet
Zoning
Square Feet 7 !! ,56 Units Floors
Value of Work*;/40e Bldg Value
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
ENGINEER
Name
License No.
Address
Telephone
Fax
a/4%4 .57/3,5-,9
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
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. TYPI:
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 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
4
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
DiTE
/7/
Zoning
afe-
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)
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
VIEWED AND PREPARED BY:
r %
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL ❑ BPR APPROVAL (Restaurants)
(Septic / Sewer)
Cl IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
(
$
$
S-oo
(sq.ft. = x/1000
x ¢.60)
(¢.005 / sq.ft.)
(¢.01 /sq.ft.)
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ D
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
PERMIT NO.
ADDRESS:
MIAMI SHORES
BUILDING / ZON
VILLAGE
NG DEPARTMENT
SECTION
BY
DATE
ZONING
ELECTRICAL
MECHANICAL
PLUMBING
FIRE
PUBLIC WORKS
STRUCTURAL
BUILDING OFFICIAL
i. Subject to carepfiancv with aft Federal, State
Coar ty,Ydlage rules and rogutaticns. Wage assume
na responstb(llty for accuracy oflor results fray
these fans.
2. Thla copy of plans must be rtallabte o
twAding site or no InspectIon Mil ha coadoctec
•
JOB ADDRESS 2 / I" E ?s6 5
APPLICANT ��JCe5
PHONE #
APPUCA11ON D /1 ve.A.tp parr
SHEET OF
MISCELLANEOUS
DATE
0 g9 0/ 4'ee,c1 s uTvef
IV I ,31 0 / ...: A fJFl / iAtfc D ' re f okeu ' rebe
ZONING
tUo4. 54ow 5 " KrPC4 ce7AcsV7 6 A•67 . °4ZI
CRITIQUE SHEET
COMMENTS
INITIALS
‘4,
COungmskt4 C-,
uNAr
iU 1AMC1
4 - 3 /
/7 04,tf
ipEa%A-r IC_
9es15
• • ••• • • • •••
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• • •
• • • • • •
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v
Village of Miami Shores
10050 NE 2nd Avenue
Miami Shores, FL 33138
Phone: 305 - 795 -2204
Printed: 1 /18/2002
Applicant: URLIE
Owner: LEZAMA
Contractor DECORATIVE MASONRY INC
Local Phone:
Parcel # 1132060130830
Job Address: 29 NE 96
Fees:
FEE2002 -364
FEE2002 -365
FEE2002 -366
Permit Status: Approved
Work: REPLACE BORKEP
If there is no permit packi
fee is $50.00, which must be
This Permit is granted to the contr
ordinances pertaining thereto and wii
and'approved by the proper municipi
authorization. A further condition up.
ordinances and regulations pertainin
by his agents, servants or employee
Signed:
In consideration of the issuance ti
with the plans, drawings, statement
myself, my agent, servants or empl
ST
For
Signed:
Address: 310 NE 99 ST
Cellular:
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 15 & 16 BLK 6 LOT SIZE 100.000
Description Amount
Building Permit Application F460.00
CCF
Notary Fee
Total Fees:
Permit Expiration: 7/17/2002
DECORATIVE MASONRY, INC.
PH. 757 -7765
310 N.E. 99TH STREET
MIAMI SHORES, FL 33138
Pay to the
order of
BankofA rica.
Building Permit
Permit Number: BP2002 -124
(Contractor or Builder)
FRANCES (BARBARA RAY)
JEAN
$1.20
$5.00
$66.20
Construction Value:
AC PFR CODE VIOLATION
o 1 .
$1,100.00
Page 1 of 1
0 0089 2011' ' :06 300004 71: 00 1 18 1048 2 5 2
Total Fees: $66.20
Total Receipts: $0.00
8920
63 -4/630 FL
987
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date _®,i 3) d i Job Address 2 9/1/Z-7- 5;40/.. Tax Folio 1/ 3 Zo 6
Legal Dewriplion /4 /A Su.94 Sea 1 4rt o PO /o- 7o Historically Designated: Yes No
4 I s l t• 8 tK to
Owner/Lessee / Tenant IX F-� c / OA Ju l P`, c.rs a)
Owner's Address /-re z� Sr; Bi )OKL - yx) IVY 1 1 1 1 2-
Notary as to
My Cons nission E
I. ELAINE LOWY
trty Cc.nm box 11/22/01
CC 110O 1
mom MINIM
ttyl!►M
FEES: P/ RM1T RADON C.C.F.
Master Permit #
or,3 a43a
CIO dAR43.4eA- gay , p128F Attp- oz..
Phone - 34 II Se .23
Contracting Co. U ee o) 11;e e •
Qualifier o bAii 9 /4 d4 V SS# - Phone_.1 S 77 77
4.
State # 4/ 1 Municipal # //- 9 9 Competency # /,3SS�` Ins. Co. i& / `' )
Architect/Engineer Address
Bonding Camino) Address
Mortt;r Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING AVINTG FENCE SIGN
WORK DESCRIPTION e Atev } " - ' ,d 'C/ z //W
/V e ea,tre refit!" G//fg.. � Al /irf _ 7 „-re:
Square Ft. Ac(, T Estimated Cost (value) /aj
Address a2� /// 9Yr/'
WARNING TO OWNER YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENT'S TO YOUR PROPERTY (If YOU INTEND TO OBTAIN FINANCING, CONSULT WIIIi YOUR LENDER
OR AN 1.TTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Applicatin:t 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 pc. famed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL
PLUMBTtO, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
constructim and zoning. Furthermore, I authorize the above - named contractor to do the work stated.
Signature of Contractor or Owner Builder Date
Notary as to Contractor or Owner - Builder Date
My Commission Expires:
NOTARY BOND
APPROVED: TOTAL DUE
Zoning _ Building Electrical
Mechani,ral Plumbing Structtuel Engineer
L; 7
6.4,
;t,1
3` ---/
- "r
(.4g 96
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