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302 NE 97 St (8)Date 1 PERMIT APPLICATION FOR MIAMI SHORES N Job Address 302- OE 11 I Tax Folio Legal Description Historically Designated: Yes Owner/Lessee / Tenant SV x1(211 RE e S E Owner's Address Contracting Co. /� t Address Master Permit # Phone IC 1-0 3 2'6, 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 "Ak 1 vt_Se WORK DESCRIPTION Square Ft. Estimated Cost (value) 6 0 D • bi) 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. A.0.41,111-7)( 'fig 7 Signature of owner and/or Condo President Date ignature of Contractor or Owner - Builder je D e Notary as to Owner and/or Condo President Date Not as to'ontractor or Owner- Builder My Commission Expires: My Commission Expires: a. ik -OFFICIAL N'O' 7FN SEAL MARY LOU BLOCKER NOTARY PUBLIC STATE OF FLORIDA COMMISSION NO. CC472323 MY axvimissioN MCP. UNE 141 %9 a�l �t 7 Date r♦JU Inetroa FEES: PERMIT 27/ - RADON C.C.F. NOTARY BOND TOTAL DUE4V/ .6e) APPROVED: , Zoning Building - ° li Electrical Mechanical Plumbing Engineering PERMIT APPLICATION FOR MIAM Date :J - 7" 90 Job Address a NE 97 S Tax Folio Legal Description Historically D( Owner essee / Tenant J 6 Q Jeod p JGt five a) me r t Owner's Address 30 a N E 71'I/ $ t Contracting Co. O NA- /A I Er 02- Add 0 Qualifier SS# rJ State # Municipal # Competency Tr Architect/Engineer GU/ A Address Bonding Company / /4- Address Mortgagor A)// v / d / Address WORK DESCRIPTION QPvO A *- 7 K d/or Condo President Date Notary as to Owner and/or Condo President Date My Commission Expires: FEES: PERMIT 4 7 ( 0 RADON APPROVED: Zoning Building Mechanical pu/k9 N/ii Electrical Bermuda Notary as to Contractor or Owner - Builder My C6 xPI P €twat. VOYaav . tv/- a Z' � N QUO C1V :0 l�713 •�Y1f . I . 1 op GOAcl. d7 s o Permit Type (circle one BUILDING) ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN r o t r £ x r o r wok / 15 -77; o 5o �£T � u/ I, (1)O V'/ rtLA P- E Fie 0 .0 ©off , Square Ft [g 00 Estimated Cost (value) 4:2)06 DO 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. Date C.C.F. .60 NOTARY BOND TOTAL DUE Engineering PROPERTY OWNER Name e)CCX0r1 A ddrea 303 WE ctc 3 N'ree-i illi am; 3`noces E_ 33 i 3 fi Home Telephone 3E _ )Lo —O Fc 1 Business Te1ephore30S_e" --% A 0 3 1 101 Fax a)S EsS' TYPE OF MANAGEMENT ( 1 ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Addl Attachment Other Add'I Detachment Other iNSTRUCTIOSN - The following steps must be taken to obtain a permit from the Miami Shores Village: Step I. 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. 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. Subdivisio Current Use of Propert Square Feet Units Floors Proposed Use of Property Prdlue of Work 10 0.4 0 1) Bldg Value Tenant Information Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT TYPE (/) Building Electrical Mechanical Plumbing LPGX Roofing Fence PERMIT CHANGE ( ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Zoning PERMIT APPLICATION Master Permit No. Subsidiary Permit No. Dn10n6( 3horr5 Address Apt. City State 6 v Description of Work e6er1 or- • ?can Linear Feet 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 $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1 Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. ORIDA, COUNTY OF MIAMI -DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE a Print Name �a Print Name S �ornn to and subscribed before me this day of Sworn to and subscribed before me this day of nnAture of I5l'df Public - State of Florida YANICK KOLBJORNSEN Notary Public - State • Florida My Commission - , - Jun 16, 2003 Personalcbm . , •: ' ta'r oduced I ntification e I enh ica ion uced: Signature of Contractor / Qualifier Signature of Notary Public - State of Florida SEAL: PERMIT APPLICATION Personally known OR, Produced Identification Type of Identification Produced: DATE: A -Q OWNER'S NAME: Qa.c\ PHONE: c tSi OS\ ADDRESS: c Shutters Awnings Chimney MIAMI SHORES VILLAGE Paint Color Approval and Agreement 4cxxYc3cx>ciexhc*****x***** eacae****aiAe$cacaescicicac*** *$c$c** c*$c**** ADDRESS OF SITE: err• -Q .N9v.1 -( CONTRACTOR & LICENSE (if applicable) COMPANY NAME: PHONE: *; exxxcx *****icxaeacac*scxac>e$c** ***x3cxxae*xc*xx*o(c$ex*** All Elements on the site must be listed and indicate the color to be painted. Walls (a--t Fascia O t 0 Drip Cap/Drip Edge At 0 o Soffit n t'A zl Roof 018 3 Flower Bins 'I 03 .1-. Doors and door jams `, Nt Garage Doors {�I� Railings \ ,,,,phi Fences n\C Decorative Metal "ur %\-Q All brick (simulated or regular) , \n Stucco Banding fl\NA Any other stucco features ,n Accessory Buildings Other Signature of Owner APPROVED: fi/ Building, ficial Date hcxx***** U9 z Cn 'b\ Date Signature of Contractor Date 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. I authorize the above -named contractor, if applicable, to do the work stated. Furthermore , the paint colors will be as per the attached sa .les. WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION 4/23/01 MIAMI SHORES VILLAGE Paint Color Approval and Agreement DATE: \ - �� - O OWNER'S NAME: Q s ( PHONE: 1,pc, =1S6- o 'S\� ADDRESS: 0• ck t e'(■eoN (1(1Izm \ �\ 3 ** *********************** * ***** * * * * * * * * * * * * * * xxxxx**** * * * * * ** *** ADDRESS OF SITE: ' z \90.1 -( CONTRACTOR & LICENSE (if applicable) a COMPANY NAME: PHONE: * * * * * ** ** * * * * * * * * * * * * * ** **** * * * * * * * ** ** * * **** * *** ** * * * * * *** All Elements on the site must be listed and indicate the color to be painted. Walls Fascia tl Drip Cap/Drip Edge (l( ' Soffit A Roof n \8 Flower Bins (Ic'i Shutters Awnings ,01 fi Chimney Doors and door jams N Garage Doors Railings Fences (stet Decorative Metal All brick (simulated or regular) \' Stucco Banding f *A Any other stucco features Accessory Buildings fl \A Other 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. I authorize the above -named contractor, if applicable, to do the work stated. Furthermore , the paint colors will be as per the attached sa .les. r) 0 0 i \b\ Signature of Owner Date Signature of Contractor Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED: WHEN PAINTING IS FINISHED, / CALL FOR FINAL INSPECTION Buildin g ficial Date 2 .(v+°°n 4/23/01 Shutters 10) A- Awnings Chimney 4 DATE: j O- 1-1 OWNERS NAME: J IrdL r ■ .HONE :3OS 9O8S >° ADDRESS: G 'OE cit a ''��° ` ) a(�1t Sores �- 3313j ADDRESS OF SITE: 3c 0L3 C* v €- CONTRACTOR & LICENSE (if applicable) COMPANY NAME: PHONE: ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All Elements on the site must be listed and indicate the color to be painted. Walls 2 a W Fascia tiJ 1- o Drip Cap/Drip Edge 31g- o Soffit I� Roof d / A Flower Bins MIA4MI SHORES VILLAGU Paint Color Approval and Agreement APPROVED: Doors and door jams t. J\r\ % Garage Doors [A- Railings \iJlri ► 1-e Fences L)1A- Decorative Metal All brick (simulated or regular) 1 A Stucco Banding ti3 1 Pr Any other stucco features 01 Pr Accessory Buildings A)) Other 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. I authorize the above -named contractor, if applicable, to do the work stated. Furthermore , the paint colors will be as per the attached Signature of Owner Date Signature of Contractor Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Building Official Date WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION 1 � 4/23/01 • 228 ) ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. TYPE Outlet, Appliance QTY. TYPE Service Repair QTY. A/C Central 1 -3 Ton Drinking Fountain Fan Miscellaneous Repairs Outlet, Wall Solar Water Heater Service, Temporary A/C Central 4 -7 Ton Fire Pump Outlet, Switch Cap - Fixture Signs Fountain A/C Central 8 -15 Ton Pump and Abandon Fixture - Fluorescent Sprinkler System Oven Space Heater (kw) A/C Central 16-20 Ton Fixture Light Cap - Sewer Parking Lot Lights Gas - Natural Spas/Hot Tubs Pump, Fire Stand A/C Central 20+ Ton Temporary Toilet Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window Clothes Washer FPL - Load Central Gas Piping Posts Pump, Replace - Pool Swim Pool, Commercial Urinal Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Discharge We Chiller }Ice Maker Generators, etc. Pump, Sump Receptacles Utility - Water Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Dispcsa: Temp Serv., Construction 'Interceptor Compactor Roof ffnlet Low -volt, Burglar Water Coset Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire yrair Lc_f., 4 "'T e/Res. Renew - Temp Service Lavatory Septic Tank Demolition Water Heater New Low -volt, Intercom/Teleph. Repair Circuits Sewer Co nr.ection Dishwasher Drains, 7:aar Low -volt, Television Minim= Yee Service, Number of Amps Shower Water Service MECHANICAL TYPE Minimum Fee QTY. TYPE Condensate Drain QTY. TYPE Generator QTY. TYPE Refrigeration, Tons QTY. .A/C Central, Tons Drinking Fountain Cooling Tower Miscellaneous Repairs Heating Strips, each Solar Water Heater Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Cap - Fixture Ventilation, Cost Fountain Air Handler, Tons Pump and Abandon Ductwork, Cost of Sprinkler System Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Cap - Sewer Process/Pressure Piping Gas - Natural Pump, Fire Stand Bath Fan - Vented, # Temporary Toilet Fireplaces, Number of Pressure Vessel . Pump, Re- circulate ' PLUMBING TYPE A/C Condensate QTY. TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. TYPE QTY. Soakage Pit 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 !t:min Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Tap Pump, Sprinkler Utility - Sewer Discharge We }Ice Maker Pump, Sump Utility - Water Dishwasher IIcf:irect Wastes Relay Repair Vacuum Pump Dispcsa: 'Interceptor Roof ffnlet Water Coset Domestic We :: II,z.:.nofry Tray Septic Connection Water Heater yrair Lc_f., 4 "'T e/Res. Lavatory Septic Tank Water Heater New Drzi .s, Area Meter Set (Gas) Sewer Co nr.ection Water Re -pipe Drains, 7:aar Minim= Yee Shower Water Service II;:rair.s, Yre_ncI M_sce:.aneous ]Equipment Sink Weil, S_pp,y 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 Zonin• tri,,i/ -' • 2 .7 O/ Electrical r Mechanical Plumbing Fire Public Works Structural 2 Buildin Official Building �� ' k z . z S a / z3 7 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 ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) PERMIT FEES 6a $ (sq.ft. = x/1000 x ¢.60) (¢.005 / sq.ft.) (¢.01 /sq.ft.) REVIEWED AND PREPARED BY: PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ ‘6 : 6 v 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