526 NE 97 St (4)Date 3 Job dA dress -5 ALE < 7 S`r
Legal Description 1j✓
e OE ner / Lessee / Tenant 71 ,i\cK
Owner's Address STZ 6 N E (77 S
Contracting Co. ®,�,u .//
Square Ft.
Signature of owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Zoning Buildi
Address
Signat
Date:
Tax Folio // 0 e6 / q � ,,„74
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 (4) wt'S 1 l; e-- erP (A,P A I
e./4,4 0 000
Estimated Cost(value) c2
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 co tion and zoning. Furthermore, I
authorize the above -named contractor to do the work stated
My Commission
Master Permit
Phon 7 Scf 7,
FEES: PERMIT L/ 7 RADON C.C.F. r �,O NOTARY TOTAL DULf ° e 2
**
Fire Other
��1%1� D r
. 1� 1 v
Electrical
Mechanical Plumbing Engineering
Pay to the
Order of
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 1 /13/2003
Applicant: 'MARY
Owner:
JOB ADDRESS: 526
Contractor
Local Phone:
Parcel # 1132060171530
Fees:
FEE2003 -224
FEE2003 -226
If there is no permit package accessible.
fee is $50.00. wh ^`
Cl( ; P. OR MARY C. ULMER
97ST.
PECIAL ACCOUNT
,
26 N. E.
AIAMI SHORES, FL 33138
NE 97 ST
Description
Building Permit Application Fee
Notary Fee
Total Fees:
DATE
^w LL
Building Permit
Permit Number: BP2003 -52
ULMER
Contractor's Address:
Legal Description: MIAMI SHORES SEC 4 AMD PB 15 -14 LOTS 6 TO 8 INC
63-27/631 FL
988
•� DOLLARS 6
,i3ankgf America Advantage -
Amount
$60.00
$5.00
$65.00
Permit Status: Approved Permit Expiration: 7/12/2003 Construction Value: $500.00
Work: EXTERIOR PAINTING AS PER AGREEMENT
Page 1 of 1
Total Fees: $65.00
Total Receipts: $0.00
. erify, there will be no inspections. Re- inspection
4063 ection.
BLK 99 LOT SIZE
the equipment or device described in the application herefor in strict compliance with all
with any plans, drawings, statements or specifications that may have been submitted to
s not done in compliance with such ordinances or if the plans are changed without
ctor or builder named above assumes the responsibility for a thorough knowledge of the
igs or in the statements or specifications and that he assumes responsibility for work done
BY:
Bankof America,
ACH FU[ 083100277'
Y M �
For ,•0040L3382462tt'�■ m wwe_:
3 i �� 2 7 st': .�.orort3ti er) BY:
� • � =n °_*'� • 1,1.E
, ompliance with all ordinances and regulations pertaining thereto and in strict conformity
Village. In accepting this permit I assume responisibility for all work done by either
MIAMI SHORES VILLAGE
Paint Color Approval end Agreement
DATE: J I'
/OWNER'S :TA( IG tAt P'1 PHONE :,,30S758370
ADDRESS: c(
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
1DRESS OF SITE: (+6
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME: PHONE:
************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site,must be listed and indicate the color to be €j
Walls 60 c/ f.7,
Fascia
Drip Cap/Drip Edge i ;
Soffit 14)(4
Roof ,ti /A
Flower Bins w /N-
Shutters on (.wee
Awnings L.) l/i, {-e
Chimney 1 ' /lr1 .
Doors and door jams 5 l.S'
Garage Doors A) 1J-
Railings 4/a, Fences 1 �
"
Decorative Metal
All brick (simulated or regular
Stucco Banding IN) 4
Any other stucco features N
Accessory 0)//i
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
e paint colors will be as per the attached
do the work stated. Furthermo
sa • • es. ,
_� £4
Ai
C DS1
1 1 ure of Owner Date Signature of Contractor Date
** ****************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED:
/ 19/6 3
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
e .9
ULTRA PURE l: IITr
•H
z
C
Building Official Date 4/23/01
iliOPERTY OWNER
II VJ
Name (' 1 OR/ c LIr r/► e R Cr--R7)
Address
S 6 O NE T7 s-f-
Home Telephone 1 , 3 , 0 . 5 ' —2 5 >- 37 "?„3
Business Telephone y� �° C 7 r6 6
4L.7 7 0 l �
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 l\liami 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 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.
A PPLICATION
• kioaAddress: NE T7 5F 10/ /how 5ioies PL 33j38
Address
Apt. City
//
Folio Number /if � ofd � o/7 /5.3D /5.3D P R , 0 4— r Description of Work .e °�.. TA )P1
Lot
Subdivision PB PG
Current Use of Property
Proposed Use of Property
Tenant Information
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other Ra.mh
Block
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
Master Permit No.
PERMIT APPLICATION
Subsidiary Permit No.
State Zip
Zoning Linear Feet
Square Feet Units Floors
)(due of Work /SOO ® 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
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.
Signat e o
Print Name
1-0
worn to and subscribed before me this .- 4 day of / 1 SJ
\
Signat e of Notary Public - State of Florida
Irene Toleno
SEAL: = 'i> ;L MY COMMISSION # DD050178 EXPIRES
ry September 12, 2005
BONDED THRU TROY FAIN INSURANCE, INC
Personally known
F FLORE =Y OF MIAMI -DADE
I I
Owner
719-c-14 (itoviiGAK
OR, Produced Identification
STATE OF FLORIDA, COUNTY OF MIAMI - DADE
Signature of Contractor / Qualifier
Print Name
Sworn to and subscribed before me this day of
Signature of Notary Public - State of Florida
SEAL:
PERMIT APPLICATION
Personally known OR, Produced Identification
Type of Identification Produced: Type of Identification Produced:
ELECTRICAL
T1"PI'.
Minimum Fee
Q"I'1".
FYI'E
Dryer
QTY.
'J'VPE
Outlet, Appliance
Q1'1
"IA PI(
Service Repair
Q'I1.
A/C Central 1 -3 Ton
Cooling Tower
Fan
Outlet, Wall
Service, Temporary
A/C Central 4 -7 Ton
Paint Booth
Fire Pump
Ventilation, Cost
Outlet, Switch
Air Handler, Tons
Signs
Ductwork, Cost of
A/C Central 8 -15 Ton
Fixture - Fluorescent
Oven
Space Heater (kw)
Process/Pressure Piping
A/C Central 16-20 Ton
Fixture Light
Bath Fan - Vented, #
Parking Lot Lights
Fireplaces, Number of
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
1■1ECHANICAL
TYPE
Minimum Fee
()
TYPE:
Condensate Drain
(1 . I . 1 . PI?
Generator
QI'1'
11 PE
Refrigeration, Tons
()I 1.
A/C Central, Tons
Bath Tub
Cooling Tower
Heating Strips, each
Vent Hood, Cost
A/C Wall/Win. Tons
Dryer Vents, Number of
Paint Booth
Filter Replace
Ventilation, Cost
Pool Piping
Air Handler, Tons
Sprinkler Repair
Ductwork, Cost of
Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
Process/Pressure Piping
Cap - Water
Gas - Appliance
Bath Fan - Vented, #
Pump, Domestic
Fireplaces, Number of
- Pressure Vessel
Cap - Sewer
PLUi\IBING
TYPE:
A/C Condensate
QTY.
'Fyn
Drains, Roof
QTY.
TYPE
Miscellaneous Fixture
QT1
"I'v1'li
Soakage Pit
Q'I1.
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
ssp
PERMIT APPLICATION
INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below.
RECEIVED AND REVIEWED BY: DATE:
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
Notary
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
$ 00
BY
SECTION
Zoning
Electrical
Mechanical
Plumbing
Public Works
Fire
Structural
Building Official
•
( x .60 x/1000
)
(¢.005 /sq.ft.)
$ (¢.01 /sq.ft.)
$ L,
$ `J ' Db
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ (d) . D
ISSUING OFFICIAL
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