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546 NE 97 St (11)1. Remarks (Signed) Permit No. '" .�' * Date Disapproved Date (Signed) Building Inspector MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village. Florida, and all provisions of the Lows of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. Date AA 19 Y6 t il Owner's Name and Address iLl.r �r ` v✓ ' • (� No. � Street e%_ i f' Registered Architect and /or Engineer i� L°,S 1 5 ►� C ® n ! AA6 .-q 1/4..t. �. e _ �A, .r -..e. �J 1 Name and address of licensed contractor `‘ Location and legal description of lot to be built on: // j 6 / 7 /5 c Lot 9 4-.5 Block 9 Subdivision K I Sr ` �J h �Ce -a-- .....eat • , Street and Number where work is to be done v 4 1 (0 n ` ` ` J State work to be done and purpose of building (by floors), state exterior colors (submit samples) S New Building Remodeling Addition To be constructed of (!,& h PAII.C. Kind of foundation Roof Covering Estimated Total cost of improvements 5 , 3 • .:::)O Amount of Permit 5 1 ° Zone cubage required Plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all plans and specifications for said building. All notices with reference to the building and its construction may be sent to Repairs No. of Stories IA) and for no other purpose. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatons as an employer of Labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida. Permanent Supplement. an he .rovisio• = of, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be perform nder this rmit; a.: will pos use to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees toply .nly such • bc . tors..n work to be performed under this permit, as are licensed by Miami Shores Village. 4 STATE OF FLORIDA COUNTY OF DADE. ss. Before me. the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known. and who, being by me first duly sworn. upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approved Date Disapproved Date NOTE: A charge of 525.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re- inspection fee of 525.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and/or workmanship. _ ...a.b". -: }e; • dam. _, I ESE PLANS ARE APPRO':EI5 R,:r; ;;:j. :..:_ O. DUILDING PERMIT ❑ WITH NO VARI4c'''Pr' 11 .101 :AR1A "'E': USTED IN "REMARKS" O OTHER DEVIATIO 'S &R: ^i T .,il, c.: F SPir,lr CALDINLISTED ZO ©N ORDINANCES WILL BE P.'?°,.: T i . �� ALL OTHER APPIIC: STATE / NO,,L :O;Ji: L ':;S MUST BE COMPLIED WITH BY ALL PARTIES. FIRE ©EPARL9ENT PUBLIC W9RKS e , P ,win 9 S!ttn ^taro U'to_ POLICE 5EPARTF.9EIdT BUILDING DIRECTOR. PLANNING b ZONING BOA:.0 VILLAGE COUNCIL PRELIMINARY: RE lA4KS: 1L e APPROVAL COMPLIANCE WITH THE SOUTH FLORIDA BUILDING CODE AS ADOPTED V MIAMI SHORES VILLAGE IS REQUIRED. THE ARCHITECT, BUILDER & SUB CONTRACTORS ARE C,HARGEn T "r Iti'OV'JLEP)rE OF ALL HUII_D• f:� z 3 IGULATEONS WHETPIER 'CI NOT SPCC CA LY N CAIri�D HtiRE Z. I ' I "7 " 51 • •1 y e • a • \ s) ik 9 ..i ''.'11... /0/ . s.,...../ / „.,/ 0 • . 7/ • / •t• . / ,■•■-••■...■1S.---A 1. / ::;r . .. . / \ // 1 r.:77 ------- ...". • .1., /..r• 1 1 k. Ye: : 4 .. I r ' ... 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El E1E'C. / 00,00' ,':,'� t '.�_..15 P6VED /1LLC.Y 20.//' J 8.80' 510' 16 6q 3,2'64TE — / (~0.7' C.B.W414. n 9.922' • 4� 'h , • .1 1 'n4 Type Insp'n ..taa MIAMI - SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date "In a Time Approved Correction Re- Insp'n Fee Permit No. _,,z3 :1 a. � D t Name f •,P)..4 Address Company a/0: (7/ e ` 7 J Phone # r e', tvgg ° � For Inspector: 7,„/03 Name & Date ➢c 4+ MIAMrSH:RES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date % Time Type Insp'n Permit No. Name Address Company Phone # For Inspector: Approved Correction Re- Insp'n Fee ❑ Name & Date Elm DATE L'" - RECEIVED F `-`1--.12-s-..... .4. ! L HEIRM - (71-4`?""-- - 4 , • - DOLLARS 0 FOR RENT e■ - I rys ,-,--"\ ----7 1 / U , 0 FOR t) ) , i ACCOUNT PAYMENT BAL. DUE --- C 0 (Th MONEY \--/ORDER BY CASH No. TO $R0... 0 0 cx3 sdafres 1182 Miami Shores Village 10050 NE 2nd Avenue Phone: 305-795 -2204 Permit Number: BP2003 -906 vl Printed: 6/6/2003 Applicant: KENNETH KODISH Owner: KODISH KENNETH M JOB ADDRESS: 546 NE 97 ST Q 0 Contractor ARTISTIC CONCRETE Contractor's Address: 10099 N. W. 89 AVE, UNIT 8 Local Phone: 305 - 888 -4565 Parcel # 1132060171520 Legal Description: MIAMI SHORES SEC 4 AMD PB 15 - 14 LOT 4 & LOT 5 BLK 99 LOT SIZE Fees: Description Amount FEE2003 -3380 Building Permit Application Fee $60.00 Total Fees: $3Q1.80 FEE2003 -3381 Builders Bond $300.00 Total Receipts: 0� KD FEE2003 -3382 CCF $1.80 Total Fees: $361.80 - y1 Permit Status: APPROVED Permit Expiration: 12/2/2003 Construction Value: $2,100.00 vl Work: PAY TO THE • ORDER OF DRIVEWAY APPROACH Sne beck7 Jria it e. ARTISTIC CONCRETE USA INC. 11 -02 PERMITS ACCOUNT 10099 N.W. 89TH AVE. UNIT 8 MEDLEY, FL 33178 -1421 n DATE /— BankofAmerica. 063100277 110:. ACH R/T FOR Building Permit II'00 L447v 40630000474 0054604P9730" 1447 63-4/630 FL 1351 DOLLARS. Page 1 of 1 3).A.L. 33 (. 3 0 ions pertaining thereto and in strict it I assume responisibility for all work ription: 5, Block 99, of MIAMI SHORES SECTION N0.4, 3 the Plat thereof, as recorded in Plat Book 15, Page 14, c Records of Miami Dade County, Florida. is )dish and Vala Kodish; Abbie R. Salt, Esquire; Attorneys' nee Fund, Inc.; Chase Manhattan Mortgage Corp.; Eastern Mortgage Corp., its successors and/or assigns as their �+ appear. Panel: 0093 Flood zone: X Date of fieldwork: 04/08/99 Completion date: 04/08/99 Survey number: G -19467 Property address: 546 N.E. 97 Street Miami Shores, Florida 33138 BOUNDARY SURVEY F ,v • R M CL £NCR Q C.M. rd. R. Ft. P. R/W N&D 0.E U.E. F0. P QH.L. P.P. TX CATV W.M. TEL. B.R. CH RAO N.R. A/C B.M. CB. C. GENERAL NOTES: 7) 2) 3) 4) 5) 6) 7) 8) 9) 10) 17) SICNED STATE Of FLOR/nA RALPH S7IEROLOFF REGISTERED LAND SURVEYOR NO. 3477 SIGNED STATE Of FLOR/QA CAR V/CHAEL ITN ;(1 STERED ;AND SURVEYOR N0. 3762 SIGNED 4700 FENCE 47RE FENCE NAIL PROPERTY CORNER RECORD FIELD MEASURED CALCULATED CLEAR ENCROACHMENT CENTERLINE CONCRETE PROPERTY L /NE CONCRETE MONUMENT FOUND IRON R00 FOUND IRON PIPE RIGHT OF WAY NAIL & DISC ORA/NACE EASENEN7 urLITY EASEMENT FOUND PLAT ASPHALT OVERNEAD UAL /TIES P0WER POLE TRANSFORMER CABLE RISER WATER NETER TELEPHONE FACILI11E5 COVERED AREA BEARING REFERENCE CHORO RADIAL NON RADIAL AIR C0N01 HONER BENCH MARK CATCH BASIN CALCULATED LEGAL DESCRIPTION PROVIDED BY OTHERS THE LANDS SHOWN HEREON WERE NOT ABSTRACTED FOR EASEMENTS OR OTHER RECORDED ENCUMB£RANC£S NOT SHOIWt' ON THE PLAT. UNDERGROUND PORTIONS OF FOOTINGS. FOUNDATIONS OR OTHER INPROVEM£NTS WERE NOT LOCATED. WALL TIES ARE TO THE FACE OF TI-I£ WALL. NOT VALID UNLESS SEALED W17)1 THE EMBOSSED SURVEYORS SEAL. ONE Y V1S/BLE ENCROACHMENTS LOCATED. NO /DENT7ACAflON FOUND ON PROPERTY CORNERS UNLESS NOTED. DIMENSIONS SHOWN ARE PLAT AND MEASURED UNLESS OTHERWISE SHOWN. FENCE OWN£RSH /P NOT DETERMINED. ELEVATIONS IF SHOWN ARE BASED UPON N.GV.0. UNLESS OTHERWISE NOTED. BEARINGS REFERENCED TO LINE NOTED AS B.R. I HEREBY CER77FY THAT THIS BOUNDARY SURVEY IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY PREPARED UNDER MY DIRECTION. A 0.8. 0. 0.14. 0/w (SIT E.L. F.F. F. C.M. F.P.K. L.A.E. M.H. MT.S. 0.R. 0.R.8. P.CP. P.R.N. PG PVM7. P.B. P.O.B. P.O C P.O.L. P. C. P.R.0 P.T. R. R.O.E. SLR. s/W T.B.M. T.O.B. TYP. W.0 70.50 CENTRAL ANCLE/DEL TA DEED BOOK DESCRIPTION OR DEED OR /LL HOLE ORIVEWAY EASEMENT ELEVATION FINISHED FLOOR FOUND CONCRETE MONUMENT FOUND PARKER -KALON NAIL LENGTH LIMITED ACCESS EASEMENT MANHOLE NOT TO SCALE OFFICIAL RECORDS OFF /CIAL RECORDS 0004 PERMANENT CONTROL POINT PERMANENT REFERENCE MONUMENT PAGE PAVEMENT PLAT 80014 POINT OF BEGINNING POINT OF COMMENCEMENT POINT ON LINE POINT Of CURVATURE PONT Of REVERSE CURVE POINT or TANGENCY RADIUS (RADIAL) ROOF OVERHANG EASEMENT SET IRON ROO & CAP SIDEWALK TEMPORARY BENCH MARK TOP OF BANK TYPICAL WITNESS CORNER ExISTING ELEVAflON 1 vC0 A(�ILAR REGISTERED LAND SURVEYOR NO 5577 STATE Of FLORIDA TH19 SURVEY IS INTENDED FOR MORTGAGE OR REFINANCE PURPOSES ONLY EXCLUSIVELY FOR NIS USE BY THOSE 70 WHOM IT is C£RTMi£0. THIS SURVEY is NOT TO BE USED FOR CONSTRUCTION. PERMITTING OESKN OR ANY OTHER USE WITHOUT THE WRITTEN CONSENT or FIRST FINANCIAL SURVEYORS INC First Financial Surveyors, Inc. 7700 North Kendall Orly* Sult. 409 Miami. Florida 33158 (306) 771 -3666 t x (306) 271 -8499 365 Aulln Avenue 4uat. 3 Oviedo. Florida 32786 (407) 977 -7010 Fax (407) 977 -7020 1187 Vulte. Boulevard Na.hvIll.. Tennessee 37217 (816) 366 -6432 PAX (615) 368 -8477 AND AFFILIATED COMPANIES L.B. 8387 Nationwide: 1- 800 -227 -2666 Pax: 1 -800- 227 -2680 0.30' 11T F.I.P. 3.00' • , hl Metal Shed b N } N.E. 97 Street 19' Asphalt Road o , Concrte Wall H=4' W41.70' o D 2' 22' Parkvray Barbecue } 0.20' 100.00 100.04 • ' - 3.00' V Asphalt Raid 15 Allay RESTRICTIVE COVENANT DECLARATION OF USE PREPARED BY: KNOV ALL MEN BY THESE PRESENTS: WHEREAS, the undersigned Md.. /VGS/.# is/are the fee simple owner(s) of the following described property situated and being in Miami Shores Village, Florida: - 4 , Lot(s) Il 5 Block f P of APN /5i ipv a (Subdivision), A.K.A. (address) ,Tcf G pa- 9 5 7 - according to the plat thereof, as recorded in the Plat Book / 5 Page /41 of the Public Records of Miami -Dade County, Florida, and . Whereas, the undersigned owner(s) t' 9 A- ect7vs desire to utiliie said Lot(s) as a single building site, and the undersigned owner(s) do(es) hereby declare and agree as follows: - 1. That the property will not be used in violation of any ordinances of Miami Shores Village or Miami -Dade County nOwin effect or hereinafter enacted. 2. That the property will be used for a single family residence only. 3. That the use of the property or building will be as follows: NOW, THEREOF, for good and valuable consideration, the undersigned do(es) hereby declare he/she will not convey or cause to be conveyed the title to the above property without requiring the successor in title to abide by all terms and conditions set forth herein. FURTHER, the undersigned declare(s) that this covenant is intended and shall constitute a restrictive ' covenant concerning the use, enjoyment and title to the above property and shall constitute a covenant running with the land and shall be binding upon the undersigned, his/her successors and assigns and may only be released by Miami Shores Village, or its successors, in accordance of said Village then in effect. IN WITNESS WHEREOF, the undersigned has/have caused M)/ hand(s) and seal(s) to be affixed ).U&"20 0? . hereto on this ,4" day of WITNESS(ES) v. 6. k;. Signature and Print Vhm Jfrs# • ignature and Print TATE OF FLORIDA): OUNTY OF MIAMI - DADE): commission expires DECLARATION OF USE Signature and Print -REBY CERTIFY that on this day personally appeared before me Y.A" / ),. who is ers� onal own to me or has produced (type of identification) as identification and 7knowledge that he/she executed the foregoing, freely and voluntarily, for purposes there in expressed. (ORN TO AND SUBSCRIBED before me on this 5 day of /WA"' , 20 03 . " "!" , Thomas Fitzgerald 4 18fAlaliitQ FLORIDA <5 Expires Oct. _ 28, 2006 4 414 ' 0 4 Atlantic Bonti°ngOOM CONTRACTOR New Construction Name /J,il e_ -�� _ / Noo k C - License .. 2-3/00 J ,-- ✓/ Address /6699 /04.d g 7 � /Y�� -z / A- 33 16 Repair Telephone '4J7_ g Q Fax Qualifier Name RJ 'o &2', ,,, a Fax PROPERTY OWNER New Construction Name o A C' A ife /� Enclosure Address Q . C , ii / 7 ,-- ✓/ Home Telephone 7 , YL/ T �T . ct 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'I Attachment Other Add'I Detachment Other PERMIT APPLICATION Master Permit No. J.) 1003 Subsidiary Permit No. INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shore `.'i.Iage: Step 1. Complete the attached permit application which must be signed by the property owner and qualifie -. Both signatures muat 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 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 , /i9/ S/ra , City Job Address: ' / 97 5 Address Apt. Folio Number 32C) - b l7 / , Description of Work Lot , Block 99 Subdivision A , 5. SR. y P11_41 / `{ Current Use of Property 5F, Proposed Use of Property sr( Value of Work 2/ca Bldg Value Tenant Information Tax Assessed/Appraised Value Flood Zone Base Floor Elev. Name License No. Address Telephone Fax 17 ,4 State 33 /3? Zip Zoning Linear Feet Square Feet 660 Units Floors ENGINEER 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 13E 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. A FFIDAVIT - 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, P' 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, COU . Y OF MIAMI -DADE / i • Si i attire of • caner Olt* 44 )14 H- Print Name Sworn to and subscribed before me this day of 44)6 2-4'6 3. � . , `ppra' , ,, Thomas Fitzgerald B= Commission # DD161337 c , Expires Oct. 28, 2006 l . <1. nded n„ ot - Sta flia101on 1antic Bondin8CO„10e, Signature SEAL: Personally known OR, Produced Identification SEAL: STATE OF FLORIDA, CO Y OF MIAMI -DADE Signature of Contractor / Qualifier RuBroJ - z PERMIT APPLICATION Print Name .rte Sworn ✓ to and subscribed before me this day of `O /lkr Zoo 3 . „ Thomas Fitzgerald 2o`f"' e� Commission # DD161337 = �., 1 ME Expires Oct 28, 2006 of otary Pub A a n� "al n Bondingaa.bir. Personally known OR, Produced Identification Type of Identification Produced: Type of Identification Produced: ELECTRICAL TYPE, Minimum Fee QTY. TITS Dryer ()Ty. 'rl'1'I{ Outlet, Appliance Q11. '11'1'1•: Service Repair O1 1. A/C Central 1 -3 Ton Fan Outlet, Wall Service, Temporary A/C Central 4 -7 Ton Fire Pump Outlet, Switch 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 Disposal Refrigerator, Domestic Interceptor Temp for Test - 30 days Roof Inlet Deep Freezer Water Closet Low -volt, Fire Domestic Well Renew - Temp Service Laundry Tray Septic Connection Demolition Water Heater Low -volt, Intercom/Teleph. Drainfield, 4" Tile/Res. Repair Circuits Lavatory Septic Tank Dishwasher Water Heater New Low -volt, Television Drains, Area Service, Number of Amps Meter Set (Gas) Sewer Connection MECHANICAL TYPE Minimum Fee QTY. TYPE: Condensate Drain (fry. T) 1 Generator (?'I'1'. '11 PE Refrigeration, Tons OI 1. 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 Supply, AC Well Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Temporary Toilet PLUNIBING TYPE; A/C Condensate QTY. Tl'1'1', Drains, Roof ()Ty. Tv1'1•: Miscellaneous Fixture Q 11. 'rl'1'N Soakage Pit (11 1. 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 Relay Repair Utility - Water Vacuum Pump Dishwasher Indirect Wastes 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. j RECEIVED AND REVIEWED BY: DATE: SECTION B p , D • TE Zonin: f,` _ c, Electrical ' Mechanical Plumbing Fire Public Works Structural / , Building Official 0Ael) Page 4 OFFICE USE ONLY CHECKLIST O OWNER - BUILDER FORM (Attach) LI 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) $ (0.005 / sq.ft.) ISSUING OFFICIAL REVIEWED AND PREPARED BY: DATE: ( x . 60) '1000 (0.01 /sq.ft.) PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) o c�e X31. 2 aiks TOTAL $J V (% 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