490 NE 96 St (5)/ CONTRACTOR
New Construction
Name
.,t l iiiL -Q
Name `pc[ /�
U/1 � / / / �� 6: A g JT -rep iv,
License No. O od fS
Address / (‘./. c' v &
( `
/ e�
3 / 7
Telephone Fax .30c =6-4672
0-5 , '
3 o o %
?
z-
Qualifier Name . ,/ 4 G . G1 c
Relocation of Structure
Fax
PROPERTY OWNER
New Construction
Name
.,t l iiiL -Q
Address
Repair
Ho elephone
0-5 , '
3 o o %
?
- 5 /s /
Q
Bsiness Telephone
Relocation of Structure
Fax
Shell Only
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
1.. J
IN (RUCTIONS - The follosving steps must be taken to obtain a perm from the'Miami Shores Tillage:
Step 1.
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.
APiPLICATION
mob Address:
I Address Apt.
Folio Numbei l � � t� () 1 1/ Q S� t
Lot Block 5 3
L / /h 5 S' D, PB 1 0
L- urrent Use of Property
Proposed Use of Property
Tenant Information
Subdivision
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.
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
PG
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
Master Permit No.
Subsidiary Permit No. c/g 2 Y
/1/44? smoter L* ,
City
State
"bescription of Work Ca /o'e r Coo /S r'p
too /a /. P• a , 95 72 ,V
PERMIT APPLICATION
Zip
- ro
Linear Feet
Zoning
Square Feet
> %lue of Work ) 5 O Bldg Value
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
Units Floors
ENGINEER
Name
License No.
Address
Telephone
Fax
Page 2
I\1 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.
AFFIDA\'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 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.
I STATE OF FLORIDA, COUNTY OF MIAMI -DADE
Signature of.Owner
Print Name Print Name
Sworn to and subscribed before me this day of
Signature of Notary Public - State of Florida
SEAL: 0
V 11 STAT F FLO DA, NT OF MIAMI- E
ignature of Contractor / Qualifier
fit_ L,/,4J L. 3 'e Z
Sworn to and subscribed before me this) 7 day
gnature .d Notary 'ub
SEAL:
. h. '..
c p.,6AY P VC`/ BICKER
,r n
* (t *
O "'111'4 Q et.: 8:3ES7
op
PERMIT APPLICATION
Personally known OR, Produced Identification Personally known OR, Produced Identification f�
Type of Identification Produced: Type of Identification Produced/ 1) 0 O- 41 3a -
NOTICE OF COJVI VI NCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
•
PERMIT NO. TAX FOLIO NO.
STATE OF hLORIDA:
COUNTY OF DADE:
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
1. Legal description of property and street address: ( At) i• (0 4i9t S A C Vtits2=eS
L
3. Owner(s) name and address: f kci22L-4 -- v r &v e 490 •) Gi
kAf4 s -
Interest in property: Oct Q.Q.
2. Description of improvement: 2 ) ( 1 4 1 2 .l p.lR
Name and address of fee simple titleholder: SNrC \t,=
4. Contractor's name and address: . E1y / fro liz l4 f •�—
e ist • 33 /z i t
5. Surety:(Payment bond required by owner from contractor, if any)
Name and address:
Amount of bond $
N �
6. Lender's name and address: IVO
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided
by Section 713.13(1)(a)7., Florida Statutes,
Name and address: ivD
8. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in
Section 713.13(1)(b), Florida Statutes.
Name and address: ✓dl
9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a
different date is specified)
Signature of Owner d nn � ('�
Print Owners Name )Q1 i `tom)
Sworn to and subscribed before me this (L d
tt-
I P iie e ARTNUA H st0AED0&
* COMMISSION NUMBER
c DD004689
MY COMMISSION EXPIRES
OFF. ".08.21,2005
Notary Public STNt"etoi
Print Notary's Name Nt , 0 1/24 STDti e lc--
My Commission Expires: 3)a-I I o f
cf circud County Courts
1 t - 3 2- -c� (o — Old —OSSO
01851471663 2001 SEP 18 13:00
Prepared by: A MA R
Address: � 3 g S W /4;
123.01-52 2193
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
_- R
Date ` (4( B Job Address 0 Pe 9.6 Tax Folio 11-3 20 (o— (NU.-- to SS ej
Legal Description CA S t4 2 r Uocg 53 N 2 Historically Designated: Yes No y
Owner/Lessee / Tenant 2061Q - - o u Master Permit # 9 9 g l�
Owner's Address 4aD NYE 91 k1 -&L S 33(34S Phone 3D S `7 g S"C E
Contracting Co. S 1% /17/t/ 0 L t / Z Address '/ S 3 8 S / S T '
Qualifier A f J fp le 6 3-
Phone 6 " C 3 6 v
State # Municipal # Competency # / 0 3 Ins. Co. p f'/a u C,
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL,/ROOFING PAVING FENCE SIGN
WORK DESCRIPTION CQ.4A� t L Ack — 5 -
( .E TA L PO iv c�
Square Ft. Zy0 0
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.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compli ce with all applicable laws regulating
construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
Signet o owner and/or Condo President
Jv "
1
1 NOTARY e
B! ARTHUR H STONELAKE JR
* COMMISSION NUMBER
DD004689
c,�� MY COMMISSION EXPIRES
OF F�� MAR. 21 2005
,,,
lb
Notary as to Owner and/
My Commission Expires
1i9.
FEES: PERMIT 1
APPROVED: \/ ^^
Zoning
RADON
- 7
Mechanical `i ti) S -50 ' ( Plumbin
« / 0 (
Date
cE 7R 4, top P/
Estimated Cost (value)
O j
Signature of C
My Commission Expires:
2 /
C.C.F. ✓ NOTARY S / BOND
TOTAL DUE ' )03
Building
Notary as ontractor or O r -Buil erGl.A ..' Yet@
CV
bt3fd CC/141
.• .4: t ♦ �F
Electrical
Structural Engineer
a L /d•To
- Builder - /' . Date
V0030 /2 o
-0/
ITEM
BATH 11.8
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT FEE
BIOET
LIGHT OUTLETS
CENTRAL HEATING / Q -- /D
a.]
DISHWASHER
RECEPTACLES
A/C (WIND) D
DISPOSAL
SERVICE TEMPORARY
X5;1
A/C (CENTRAL) 'M
�IIJ
DRINKING FOUNTAIN
SERVICE SIZE IN AMPS
DUCT WORK 1 j 6 •
FLOOR DRAIN
SERVICE REPAIR/IETER CHANGE
REFRIGERATI N t
GREASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TOP
UNDERGROUND TANKS
LAVATORY
OVEN
ABOVE GROUND TANKS
LAUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
MOTORS 0- 1 HP
STEAM BOILERS
SHOWER
MOTORS OVER 1- 3 if
HOT WATER BOILERS
SINK, POT /3 COMP.
MOTORS OVER 3- 5 HP
MECHANICAL VENTILATION
SINK, RESIDENCE
MOTORS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTORS OVER 8- 10 HP
ELEVATORS/ESCALATORS
TEMPORARY WATER CLOSET
MOTORS OVER 10- 25 HP
FIRE SPRINKLER SYSTEMS
URINAL
MOTORS OVER 25-100 HP
COOLING TOWERS
WATER CLOSET
MOTORS OVER 100 HP
VIOLATION
INDIRECT WASTES
A/C WINDOW
REINSPECTION
MATER SUPPLY TO:
AIR CONDITIONERS .
•
A/C UNIT
STRIP HEATER
FIRE SPRINKLER
GENERATORS TRANSFORMERS
HEATER -NEW INST.
GENERATORS TRANSFORMERS
HEATER - REPLACE
GENERATORS TRANSFORMERS
LAWN SPRINKLER -WELL
SPECIAL PURPOSE
SWIMMING POOL
-
OUTLETS COMMERCIAL
WATER SERVICE
SIGN TUBES
SEWER CONNECTIONS
SIGN TRANSFORMERS
'JTILITY -WATER
SIGN TIME CLOCK
JTILITY -WATER
FIXTURES
�■
SEPTIC TANK
ANTENNA
;ELAY
TELEVISION OUTLETS
)RAINFIELO, 4' TILE/RES.
VIOLATION
PUMP & ABANDON SEPTIC TANK
REINSPECT ION
SOAKAGE PIT CU. FT.
:ATCH BASIN
■
� v
( 0
IISCHARGE WELL
-/ 0
C,.
o
)OMESTIC WELL
'
.t
!AEA DRAIN
�
IGOF INLET
SOLAR WATER HEATER
'IRE STANDPIPE
'001 PIPING
.AWN SPRINKLER SYSTEM
;AS RANGE
ETER SET (GAS)
;AS PIPING
r
• ADDENDUM TO BUILDING PERMIT APPLICATION
(,AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B.
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ELECTRICAL
MECHANICAL
PERMIT NO.
ADDRESS:
MIAMI SHORES
BUILDING / ZON
VILLAGE
NG DEPARTMENT'
SECTION
BY
DATE
ZONING
ELECTRICAL
MECHANICAL
PLUMBING
FIRE
PUBLIC WORKS
STRUCTURAL
BUILDING OFFICIAL
1. Subject to cornptiancv with eft Federal, State,
County. Village rules tad regutattons. Waage assumes
no responstbllity for accvrecy oflor mutts (rota
these plans.
2. Thlt copy of plans must b• avttltbte on
tti idfng site or no Inspection Mail b• conducted,
•
JOB ADDRESS
APPLICANT
PHONE #
APPUCA11ON #
SHEET OF
MISCELLANEOUS (
490 iti 96 Si-
DATE COMMENTS INITIALS
CRITIQUE SHEET
SECTION
BY
DATE
Zoning
Electrical
Mechanical
Plumbing
�i (� 0
Fire
v
Public Works
Structural
Building Official
°F!
Page 4
OFFICE USE ONLY
iirTat
O 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
0 PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
0 OTHER
(Specify & Attach)
PERMIT FEES
• b
0
(sq.ft. = x/1000
x ¢.60)
(¢.005 /sq.ft.)
(¢.01 / sq.ft.)
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
Cl CONTRACTOR REGISTRATION
(On File)
TOTAL $ ' $-
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
ELECTRICAL
TYPE,;
Minimum Fee
QTY
TYPE
Dryer
QTY
TYP,l,
Outlet, Appliance
QTY
TYPE
Service Repair
QTY.
A/C Central 1 -3 Ton
Fan
Dryer Vents, Number of
Outlet, Wall
Ventilation, Cost
Service, Temporary
Air Handler, Tons
A/C Central 4 -7 Ton
- Piping, Flammable Liquid
Fire Pump
Outlet, Switch
Fire Sprinkler System
Signs
A/C Central 8 -15 Ton
Bath Fan - Vented, #
Fixture - Fluorescent
Pressure Vessel
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
v
Posts
Swim Pool, Commercial
Air Conditioners
Garbage Disposal
- jj,
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 Ileater
Dishwasher
Low -volt, Television
Service, Number of Amps
Water Heater New
MECHANICAL
'I'1'PE.
Minimum Fee
QTY. TYPE.
Condensate Drain
QTY. TYPm
Generator
QTY. TYPE
Refrigeration, Tons
QTY.
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
Solar Water Heater
Air Handler, Tons
Ductwork, Cost of
- Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
Process/Pressure Piping
Cap - Fixture
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
Pump and Abandon
PLUMBING
.
A/C Condensate
QTY
TYPE,
Drains, Roof
QTY
'l.Ypl.;
Miscellaneous Fixture
QTy.
TYPE
Soakage Pit
Q . Q . Y .
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 1'9-jr A
v
Pump, Re- circulate
Temporary Water Closet
Clothes Washer
Gas Piping 7o - /9.
- jj,
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 Ileater
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: