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390 NE 97 St (9)/4 c /56 , PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date "/- /6 ` v Job Address 396 At ' ' S' 7 Tax Folio Legal Description Historically Designated: Yes Owner/Lessee / Tenant /e /14 Master Permit # G � Owner's Address Phone 3 c� S) -2 -S r - C S G C Contracting Co. -tom S (3c-one r Address 3 c /V e 9 r 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 WORK DESCRIPTION ,R /I- /iJ Square Ft. C �a Signature of owner and/or Condo President Date c)("1 4z//N / 56 e:;Z) Estimated Cost (value) & I c) v ° 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. Sign •f Contractor or Owner- Builder Date cd- d s 0 S/ /4 fa ' , _ - _,, ` /G - CCJ Notary as to Owner and/or Condo President Date No as to Contractor or Ow[ u St. -• Date My Commission Expires: My Commission Exprrest° ; l ,,�, <s FEES: PERMIT 6. RADON C.C.F. 0 6 ° NOTARY BOND APPROVED: TOTAL DUE Zoning 1 lam' Electrical Building �g 1 Mechanical Plumbing Structural Engineer Date Lega. ex Owner PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY (OWNER TO RETAIN COPY) Contra Qualif Ix AV /V 4: vG 97 9� Address SS# - State 4fr Municipal I Competency # Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one)' BUILDING 'LECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION ; Square Ft. Estimated Cost(value) �o� 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 abo --nay stated. 0 JOSEPHINE CHURCH :Notary Public, State of Florida l tC�`CCPJ'! �A 30.19961 Signature of `owner and Date: A /92- APPROVED: r 7? Tax Folio/ o/ / . / Master Permit ff 7..c) c'S Phone ?- SC. Phone Signature of Contractor or Owner- Builder Date: / /�/�� j Print type or stamp name of Notary Public ' �rs i n ' irccd [.U. I tar as to Owner and / � � . 1,pr Notary as to Contractor or Owner- Builder ype an num t p duced: My Commission Expires: D My Commission Expires: DID take an oath, or DID NOT take an oath. ** * * * * * * * * * * * * * * * ** FEES: PERMIT g76 RADON C.C.F. r 25 NOTARY ,4 TOTAL DUE 3' 6210 Fire Other Zoning (IBuildin:I ✓ Electrical Mechanical Plumbing Engineering ■,h ecc;u,:a t fa0 Owl ) J \tr ',Oat 4414- CHEILMI ACH H/T 083100277 Memo Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 4/15/2002 Applicant: ANGELA Owner: SIMS JOB ADDRESS: 390 Contractor Local Phone: 0 r .e Parcel # 1132060135810 r LEE SIMS OR ANGELA L SIMS 390 N.E. 97TH ST. MIAMI SHORES, FL 33138 s , Pay ��yya Jd'' i elf .4) to the ord of j t 00-'464.44 Bank ofAmerica. 1:06 3 L00 2771: 0 20" NE 97 Date wilding Permit Permit Number: BP2002 -764 SIMS ANGELA ST Contractor's Address: Page 1 of 1 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 1 & 2 Fees: FEE2002 -2198 FEE2002 -2199 Description Building Permit Application Fee CCF Total Fees: Amount $60.00 $1.20 $61.20 Total Fees: $61.20 Total Receipts: $0.00 Permit Status: Approved ,t Mork: EXTERIOR PAINTING AS PER AGREEMENT (OWNER BUILDER PERMIT) Permit Expiration: 10/12/2002 Construction Value: $1,500.00 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. Bank of America Advantage 1 $ 0-D 1' Dollars 8 4456 63- 27/631 FL 995 Y: BLK•43 LOT SIZE t or device described in the application herefor in strict compliance with all ordinances sings, statements or specifications that may have been submitted to and approved by the such ordinances or if the plans are changed without authorization. A further condition upon usibility for a thorough knowledge of the ordinances and regulations pertaining to the work Imes responsibility for work done by his agents, servants or employees. ance with all ordinances and regulations pertaining thereto and in strict conformity with the Ming this permit I assume responisibility for all work done by either myself, my agent, MIAMI SHORES VILLAGE Paint Color Approval and Agreement DATE: 1 1 — /5- OWNER'S NAME: L ADDRESS: 3 90 A/� 9 v2 S'. ********************************** * * * * * * * * * * * * * * * * ** * * * * * * * * * * * ** ADDRESS OF SITE: �e CONTRACTOR & LICENSE (if applicable) COMPANY NAME: PHONE: ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All Elements on the site must be listed and indicate the color to be painted. Walls lc Fascia ioa(,)p! Drip Cap/Drip Edge 8 u/,-r Soffit I Roof Ai Flower Bins ,S jve" Shutters " /A- Awnings Chimney Doors and door jams Garage Doors c.4.J / Lr r&% Railings 6 /, e ,e Fences R/- Decorative Metal f ,6 All brick (simulated or regular) ,// Stucco Banding Any other stucco features ///A Accessory Buildings M7A 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 sampl PHONE: '3 os 75 5 S ignature of Owner Date Signature of Contractor Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED: Building Offi t4' Y/20 Date WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION 4/23/01 PROPERTY OWNER New Construction Name _ • �- - /V( -'»= .J;t Enclosure Address i / :t, /, -, o,e.'c; ,.i , ,r 2-6., / 6/-; 4 313 Home Telephone Repair 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'l Attachment Other Add'l Detachment Other r 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: , , ;C /j - 7 ,S % -) iC E E_ %— / / Address Apt. City Folio Number /(Description of Work Lot Block Subdivision PB PG 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 PERMIT APPLICATION Master Permit No. Subsidiary Permit No. (e P 0 ` +(.12. Zoning Square Feet 2 -C2a / L> /-'-t State Zip Linear Feet Units Floors Value of Work ' (` 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 Page 2 PERMIT APPLICATION 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. 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. o. 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, COUNTY OF MIAMI -DADE ` STATE OF FLORIDA, COUNTY OF MIAMI -DADS Al ( / �tiyy, A) Signature ature Own Signature of Contractor / Qualifier )iqni Fi_ A. L, 6';a1.5 'ti nt Name J Print Name Sworn to and subscribed before me this day of ! /1Ih.r.L-: , Sworn to and subscribed before me this day of 'UC .9/ . b !4Tiiiix orida RENEE J. CARSTO ;'. COMMISSION 0 CC776076 . SEAL: TATIf EXPIRES SEP 25, 21302 ' SEAL: F F LORIL A, A.UVA NTAQ BONDED THROUGH •K E NOTA Signature of Nota Signature of Notary Public - State of Florida Personally known OR, Produced Identification Personally known OR, Produced Identification Type of Identification Produced: Type of Identification Produced: "I BY D E ,& '• thing / y Electrical Mechanical Plumbing Fire Public Works Structural Building Official I Y AI NEG Page 4 OF`HCE 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 � G ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) $ $ (¢.005 / sq.ft.) $ (¢.01 /sq.ft.) REVIEWED AND PREPARED BY: (sq.ft. = x/1000 x ¢.60) PERMIT APPLICAT: :ON ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) PERMIT FEES TOTAL $ ( 1 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 ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer Q'TY. 'TYPE, Outlet, Appliance Q'I'Y. 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 Minimum Fee QTY. 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 Q'I'Y. 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 Pf PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: