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339 NE 96 St (4)AType Ins — "Permit No. Name Address Company Phone # For Inspector: ' O Name & at Approv . Correction MIAMI SHORES VILLAGE BUILDING DEPARTMENT • X05- 795 -2204 .Building Inspection Request Date Time Re- Insp'n Fee 6P Q/)(vt. CONTRACTOR New Construction Name /,lr7 / ..— /otij L PAS'. W(aTi= e,00OAty License No. c 6 C 5 q/c2 6 Alteration Exterior Address 33 01 NE % sT /v1 iAA. 5E- ( {C- 3 3t 3 Address 3 9..s 't� , a'7 U'� z/ l��Nai loom, - -.-.7- Telephone9 .906 704. Fax c,6_ / , Qualifier Name 0 9 vim `� Business Telephone 30G- _ b d. ' 9,c 2 Relocation of Structure PROPERTY OWNER New Construction Name WAYrj.G V� f^1ur1 TE I Alteration Exterior Address 33 01 NE % sT /v1 iAA. 5E- ( {C- 3 3t 3 $- L 14 Home Telephone Demolish `� Business Telephone 30G- _ b d. ' 9,c 2 Relocation of Structure Fax 30 L — 1p /9- g5 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 l\liami Shores Village: nE cCEO AP j1 2003 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 submit- ted 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: 339 /J' 5 961h. Si. Address Apt. 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. , PERMIT APPLICATION Subsidiary Permit No. /A / Shb46 ,c 33/33- Z7/7 City State Zip Folio Number tie 3206_0/ 3 -S`V 00 Description of Work ' &to cCAO L OF 5013 Lot Block /'7 Z/ OA' oic ,,ci- P4v &eS Subdivision PB PG Zoning Current Use of Property Resi °'7''9 G S ffare Feet 929 0 Units Floors Proposed Use of Property S7 6N L trValue of Work Bldg Value Tenant Information Tax Assessed/Appraised Value Flood Zone Base Floor Elev. Linear Feet ENGINEER Name License No. Address Telephone Fax Vt, Kr Page 2 IN1P()R'I'A Norm ES 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. AFFI 1'1' - 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 reouired 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. Si Print Name Sworn to and subscribed before me this day of S L: ure of Notary JOA C.DANSBY MY COMMISSION # OD 036136 a EXPIRES: June 24, 2005 x,,4•• Bonded Thru Notary Public Underwriters Personally known OR, Produced Identification Type of Identification Produced: • 1 n f`�5 ' Ser Ge.. SEAL: *PERMIT APPLICATION STA 0 /Y. ORIDA, COUNTY OF MIAMI -DADE Signature of ontractor / Qualifier 'AVID — MI S:TIZA NI Print Name S o om to and subscribed before me this � CY�3 Signature of Notary Pub da day of n , =q` Y' Tori 1 Tanner : := MY COMMISSION # CC912159 EXPIRES ._. tail March 14, 2004 sF. BONDED THRU TROY FAIN INSURANCE, INC. Personally known I OR, Produced Identification Type of Identification Produced: Miami Shores Village 10050 NE 2nd Avenue Phone: 305 -795 -2204 Printed: 5/1/2003 Applicant: WAYNE ,- Owner: WHITE (� JOB ADDRESS: 339 Contractor Local Phone: 954946 -7119 Parcel # 1132060135900 NE 96 (INSPECTOR) Building Permit Permit Number: BP2003 -687 WHITE WAYNE ST NATIONAL PAVING & WATERPROOFING Contractor's Address: 3450 N FEDERAL HWY Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 17 & 18 BLK 43 LOT SIZE 100.000 Fees: Description Amount FEE2003 -2537 Builders Bond $300.00 FEE2003 -2597 Building Permit Application Fee $60.00 FEE2003 -2598 Notary Fee ` 0 FEE2003 -2599 CCF $0.60 FEE2003 -2600 Inpector State Educational Fund $4.90 $370.50 Total Fees: 5 Total Fees: $370.50 Total Receipts: $0.00 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans. drawings. statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume resporiisibility for all work done by either myself, my agent. servants to employes. l Signed: 4' CI (Contractor or Builder) BY: ACCOUNT ( 5 06 PAYMENT ( ' -- BAL. DUE r¢ — DATE AS RECEIV SIFROM BY K No. 197r32 • — sR RENT aFOR �► I T , DO LABS 3 / �o � Q CASH ECK MONEY ' ORDER en &i 9 gr adorns 1182 PAY OR Fri VOA( ORDER OF C t 1 y ^ Ni M. A 1( 51 k Z I$ 50/ico Bank of Americ . ACH HIT 063100277 CARMAC STONES 1NC. GATE /9 /03 DOLLARS B 63 -4/630 FL an " of mertca 4 Vanti° ADILA CARLA DUTRA 252 S.W. 34TH AVE. DEERFIELD BEACH, FL 33442 Date �r ee& 3 Si _ f 1 $ a, a r v • V nc O 'ri1d '/d Dolltt Bank of America %1 00),06711 nn • mono jP2 ✓a - 64 1:06 300004 71: 00 36 598644 7n• 1653 1653 63 -4/630 FL a5.02 &J0203 1131 ■ following described property: Legal description/folio#: flh/iami SJore Vi��ac�e Tax Folio #: 4 - - 013-5 00 requests permission to install: [ J Asphalt, concrete, brick pavers [ J Landscaping Other Bra scK. PA■/2S SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE SIGNED. SEALED AND DELIVERED in the presence of: 10050 N.E. SECOND AVE. MIAMI SHORES. FLORIDA 33138 -2382 Telephone: (305) 795 -2207 Fax: (3051756 -8972 COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY WHEREAS, Y VW({ (t-F- , hereinafter referred to as the Owner of the (owner) Lot 1 7 1 U Block 3 Subdivision within the public road right of way of (address) IN CONSIDERATION of the approval of this permit by the Village, the Owner agrees as follows: 1. To maintain and repair, when necessary, the above - mentioned item(s) installed within the dedicated right of way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said items within public right of way including restoration of street by reason of the Owner's failure to do so, such expense shall be paid by the Owner or shall constitute a lien against the above described property until paid. 2. The owner does hereby agree to indemnify and hold Miami Shores Village or dade County harmless from any and all liability, which may rise by virtue of permitting the installation of these items within the public right of way. 3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days notice by the Village to do so. Failure to comply with this notice will result in the Village causing the item(s) to be removed and a lien being placed on the property and/or assessed against the Owner for all costs incurred in the removal and disposal of the item(s). 4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such time as this obligation has been canceled by an affidavit filed in the Public records of Dade County, Florida by the Village Manager of Miami Shores Village (or his fully authorized representative). n this 5 'lLL&. -u ry Ulf Nilda Montalvo * !�9 My Commission CC906155 'o,,,,or' Expires January 30, 2004 Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Permit Number: BP2003 -687 Printed: 5/1/2003 Applicant: WAYNE WHITE Owner: WHITE WAYNE 1 l JOB ADDRESS: 339 NE 96 ST Contractor NATIONAL PAVING & WATERPROOFING Contractor's Address: 3450 N FEDERAL HWY Local Phone: 954 - 946 -7119 Parcel # 1132060135900 Signed: In consideration of the issuance to me of this permit, I agree to perform the work cov conformity with the plans, drawings, statements or specifications submitted to the prop done by either myself, my agent, servants or employes. Signed: ` G,> (Contractor or Bi Building Permit ACH RR 063100277 Memo fiP2003- 6 g Page 1 of 2 Bank of America Advan Legal Description: MIAMI SHORES SEC 1 PB 10 -70 LOT 17 & 18 BLK 43 LOT SIZE 100.000 Fees: Description Amount FEE2003 -2537 Builders Bond $300.00 FEE2003 -2597 Building Permit Application Fee $60.00 FEE2003 -2598 Notary Fee $5.00 FEE2003 -2599 CCF $0.60 FEE2003 -2600 Inpector State Educational Fund $4.90 Total Fees: $370.50 Total Fees: $370.50 Total Receipts: $0.00 1653 ADILA CARLA DUTRA s3 ais30 r� • 252 S.W. 34TH AVE. D5 7 2 0 3 1131 DEERFIELD BEACH, FL 33442 Date V . cl v ee &? 1$ 0'0 Pay /�1/t'L /d2 o 'erg 17 '✓l d � � to L."( Dollars 8 r---• BankofAmerica® NP 1 • • STATE OF FLORIDA) . •'•.... •• COUNTY OF DADE) The undersigned Affiant, VAY w ► + --- - does hereby attest that the (p roc ! wk4rn:0 attached survey, ` y performed by �� t• o��,��_ (name of surveyor's company) performed cr. ' y , is an accurate representatio of the existing conditions and date of 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 perrnit for the .• property without first providing a survey less than six (6) months old. The Afnant, as property owner, further agrees to remove or obtain ermits for any structures which now ma • exist on property which are not • P y structu i y P P permitted or which may violate zoning or building code regulations. The Afdant further understands that the existence of any such structures may affect final inspections zs applicable to this or other permits.. Further, A ffiant sayeth naught. Witness(sign and print) Witness(sign and print) SWORN TO AND SUBSCRIBED before me this )5 day of Afant is personally Imown to me, roduced ... AFFIDAVIT Afnan weer o' o Nilda � � � Montalvo *My Commission CC906/55 „ „ne. ExP'rea January 30. 2004 • • as identification. COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY WHEREAS, al/? YAJJE / y! 7Z2 , hereinafter referred to as the Owner of the (owner) following described property: • Legal description/folio #:"4/ sffvr -&S- SEC. / 4)nn_D J2 /Q -?0 ter /7 / /d' 3 to+S t 2 S /CCO.6o0X A/s 02 /a690 - Lot 0 ,f /cy) Block 4 3 Subdivision 2a?7 Z o 6 ,0 M iami Sh,oreJ G O P ` 10050 N.E. SECOND AVE. MIAMI SHORES. FLORIDA 33138 -2382 Telephone: (305) 795 -2207 Fax: (305)_756 -8972 10.- 3 2 x 6 - 0 /3 -S9o? Tax Folio::: requests permission to install: [ J Asphalt, concrete, brick pavers ( ) Landscaping (tTOther /J7 f'e LOG,C /'v di 2,4 724-C/6- within the public road right of way of 33 9 Ai E 74- 3 "4 -sifibP6s Ft 33 13a? (address) IN CONSIDERATION of the approval of this permit by the Village, the Owner agrees as follows: I . To maintain and repair, when necessary, the above - mentioned item(s) installed within the dedicated right of way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said items within public right of way including restoration of street by reason of the Owner's failure to do so, such expense shall be paid by the Owner or shall constitute a lien against the above described property until paid. 2. The owner does hereby agree to indemnify and hold Miami Shores Village or dade County harmless from any and all liability, which may rise by virtue of permitting the installation of these items within the public right of way. 3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days notice by the Village to do so. Failure to comply with this notice will result in the Village causing the item(s) to be removed and a lien being placed on the property and/or assessed against the Owner for all costs incurred in the removal and disposal of the item(s). 4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such time as this obligation has been canceled by an affidavit filed in the Public records of Dade County, Florida by the Village Manager of Miami Shores Village (or his fully authorized rep .. Y. ve)_ SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on thi / S d SIGNED. SEALED AND DELIVERED in the presence of: wner A C ELECTRI Tvi,I; Minimum Fee QTY. nil.: Dryer Q.I.y. . I . vi , I.: Outlet, Appliance `ITV . n . I , I.: Service Repair Q . I . Y . 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 QTY. Condensate Drain TYPE Generator Q'I'V. 'I'YI'I: Q'I'V. 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 Q'I'Y. TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture QTV. 'I'VI'li 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 Zoning t �! v , 9 14 r %3 Electrical Mechanical Plumbing Fire Public Works Structural Building Official 5.\° ! j Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) O FIRE DEPARTMENT APPROVAL (Commercial / multi - family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) PERNII'I' 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 Notary ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) ( x Q 0)'1000 (¢.005 / sq.ft.) (¢.01 /sq.ft.) PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) Cl CONTRACTOR REGISTRATION (On File) 3 5 5-° TOTAL $ ISSUING OFFICIAI. REVIEWED AND PREPARED BY: 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