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540 NE 96 St (4)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 Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regula- tions 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. Owner's Name and Address j Registered Architect and /or Engineer Name and address of licensed contractor Location and legal description of lot to be built on: Lot Block_ Subdivision Street and Number where work is to be done State work)to be done and.urpose of building ,.(by floors) Disapproved Date (Signed) MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT Date .-------------- - - -- ��° _____— _______ ____and for no other purpose. New Building - -___ Remodeling__ —_ —__ Addition__________ _ Repairs No. of Stories To be constructed of_—__— __— _______ Kind of foundation _ Roof Covering__ —___ Estimated Total cost of improvements $_____e_220' - -_ ------- - - - - -- Amount of Permit $ 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 the plans and specifications for said building. All notices with reference to the building and its construction may be sent to The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement. and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the wa k such p lie notice or notices as are required by the Act. The undersigned agrees to employ only such subs tr tors, o rk to f this permit, as are licensed by Miami Shores Village. } Remarks (Signed) Building Inspector My Commission Expires PLANNING BOARD DATE Chairman Member X 9_121.1f No SYZ' _— street _46 Notary Public, State of Florida Member Member Member Member Council Approved Date Disapproved STATE OF FLORIDA, u . COUNTY OF DADE. 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 be did sign the same, and that all facts therein by him stated are true. Permit No Date Read, Sworn to and Subscribed before me. __Date NOTE: A charge of $1.00 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 $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. Lot__ Street and Number where work is to be done State wo o be done an rpose of buildin New Building STATE OF FLORIDA, COUNTY OF DADE. u. Permit No Disapproved ______________ Date (Signed) 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 Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regula- tions 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. Owner's Name and Address —res+— Registered Architect and /or Engineer Name and address of licensed contractor Location and legal description of lot to be built on: floors) _.. Remodeling Addition__ Date Block �_ Subdivision and for no other purpose. Repairs No. of Stories__________.__ Building Inspector My Commission Expires_ No.srL fL Stree l�� — �1 -- Roof Covering_ To be constructed of_______________ Kind of foundation_ ________________ Estimated Total cost of improvements $____ L —_! ______ Amount of Permit $ Plan Cubage Size of Building Lot Zone cubage required Distance to next nearest building Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to The undersigned applicant for this building permit does hereby certify that be understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the such p lic notice or notices as are required by the Act. The undersigned agrees to employ only such subs tr tors, o - rk to f this permit, as are licensed by Miami Shores Village. Remarks (Signed) Z••■"' Date Read, Sworn to and Subscribed before me. Notary Public, State of Florida 3 z 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. PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approved_ Date Disapproved __ —Date NOTE: A charge of $1.00 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 $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. U(T) pletonu. MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT *Queen Anne Pink HC -60 CATION 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 Laws 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. Owner's Name and Address Registered Architect and,or Engineer Name and address of licensed contractor Tff ' Date ( 1_ N Q C t 6 t Street C1 t Location and legal description of lot to be built on: Lot I ir Block 3 .'--X / Subdivision IL} • V 20 � i� ° ./- Street and Number where work is to be done s-ct 0 • L . ` Cye (� State work to be done and purpose of building (by floors), state exterior colors (submit samples) _ (.7 t 1 - r - Cr f n E P ' ( 31- ( ? it Cr 6 F H 0 f 1. S_(- New Building Remodeling Addition Repairs No. of Stories _ To be constructed of Kind of foundation Roof Covering_ _ Estimated Total cost of improvements S 9 <c0 • 0 0 " Amount of Permit $ '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 Remarks (Signed) 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 _ _ . _ 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, and has complied with the provisions thereof. and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be p. :•d for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on ork o be performed under this permit, as are licensed by Miami Shores Village. 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. Permit No. / Y — Date Disapproved Date (Signed) Building Inspector PLANNING BOARD Read. Sworn to and Subscribed before me. Notary Public. State of Florida My Commission Expires DATE Chairman Member Member Member — - Member Member Council Approved Date Disapproved Date NOTE: A charge of $25.00 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 $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and or workmanship. MIAMI SH9RES VILLAGE' Paint Color Approval and Agreement DATE: ID '''/ —0 OWNER'S NAME: L i�ej GLH-I4'7 PHONE: 305 75/ g5 3 ADDRESS: 51-0 7 F, s+ ********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ADDRESS OF SITE: 5.te-np, OS 0.loo v CONTRACTOR & LICENSE (if applicable) 1 f� COMPANY NAME: PHONE: ************************ ******************* All Elements on the site must be listed and indicate the en a FA Walls - ��avC't, Ili' 13 7, Fascia 1 1:}e seit'n4 L Li / , Drip Cap/Drip Edge w(f , ic' " y)d cup 1.1 Soffit t/ tA,PAn.k( So, y01 ct to q z E Roof 1 C7 w Flower Bins Q 0 g Shutters N 0 c Awnings N\ 0 w o Chimney VU Doors and door j ams t - f e v el L OL A. , Garage Doors N 0 Railings r uo ro Vy -- ∎roe') ~ b (ode, Fences WeA).t; G1.¢ n CISaf-k' Decorative Metal ✓W Abu k L R��1 All brick (simulated or regular)`' ") 0 Stucco Banding J0 dedbthi Any other stucco featureCtAo m n5 t,U k € Accessory Buildings 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 samples. ,, 11 n) Io/ 6 Sign � ure of Owner 1 Date Signature of Contractor Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED: WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION / Building Official ' Date 4/23/01 0) a a) SN CC- n 3 T SECTION BY DAT Zoning a 1��/' 7 ' / 0 (`' u Electrical / Mechanical Plumbing Fire Public Works Structural /0� t4� Building Official Page 4 OFFICE USE ONLY CIIECKLIST LI 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 Inspector State Educational Fund $ State DCA (Radon) Code Enforcement Fine Zoning Review L.li1G ._r ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) PERMIT FEES Metropolitan Dade County (C.C.F.) $ $ $ (sq.ft. = x/1000 x ¢.60) (¢.005 /sq.ft.) (¢.01 /sq.ft.) REVIEWED AND PREPARED BY: PERMIT APPLICATION • LI CONDO ASSOCIATION APPROVAL (Attach) LI BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ c ISSUING OFFIGAL 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. TYPE Outlet, Appliance QTY. TYPE Service Repair QTY. 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 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 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 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 PLUMBING TYPE A/C Condensate QTY. TYPE. Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. 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 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: PROPERTY OWNER New Construction ��{ �� ')'� Namt o1l1 :10- � � ��/ I6I� i Address 305 751 - ' to - F‘ c I Home Telephone 1 pe r , 91 Ft NA red t V Business Telephone Alteration Interior Fax '�,t 6 -16 i - to & / 3 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 Step 1. Job Address: 5 )10 A/6 96 cal' Address Apt. PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other ARCHITECT Name License No. Address Telephone Fax PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection PERMIT APPLICATION Master Permit No. Subsidiary Permit No. 5 ' INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must he 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 rQ i Sl wees _ City State Folio Number 1 0 t ON 0( D " Description of WorkC4 4' '! O `" pi it h 9 Lot) d- S Block S . Subdivision C ) CPC_ PB t( PG �j / Zoning Linear Feet Current Use of Prope Square Feet Units Floors Proposed Use of Property `°Value of Work Tenant Information Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. Address Qualifier Name Bldg Value Telephone Fax 33/ 3,? Zip Page 2 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. 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, COUN Y OF MIAMI -DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE / ill Signature, Owner ' Signature of Contractor / Qualifier Print Name Print Name of Nota S . om i t and subscribed before me thi day Signatur s lic_ Sta(P Flori a Sworn to and subscribed before me this day of Signature of Notary Public - State of Florida PERMIT APPLICATION t, OFFICIAL STAY PU B ANGELA M SEAL: O r SEAL: 2 411 r\ k COMMISSION NUMBER 0 ` ' Q CC786E97 a-. , y p •l w MY Co"w:ss :oR EXPIRES ��G/F�C NOV i5 "'+ Y. Personally known OR Y O R, Produed Identification l c Personally known OR, Produced Identification Type of Identification Produced: Type of identification Produced: Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 11 /18/2002 Applicant: DANIEL Owner: WEINGRAD JOB ADDRESS: 540 Contractor Local Phone: Parcel # 1132060140690 NE 96 Building Permit Permit Number: BP2002 -1969 Legal Description: MIAMI SHORES SEC 2 PB 10 -37 LOTS 7 & 8 BLK 54 LOT SIZE 100 X 143 OR Fees: FEE2002 -6487 FEE2002 -6488 FEE2002 -6489 Description Notary Fee Building Permit Application Fee CCF Total Fees: Amount $5.00 $60.00 $1.20 $66.20 Total Fees: $66.20 Total Receipts: $0.00 Permit Status: APPROVED Permit Expiration: 5/17/2003 Construction Value: $2,000.00 Work: EXTERIOR PAINTING AS PER AGREEMENT (OWNER BUILDER PERMIT) 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. This Permit is granted to the contractor or builder named above to construct the bu ordinances pertaining thereto and with the understanding that the work will be perfo and approved by the proper municipal authorities. This Permit may be revoked at any authorization. A further condition upon which this permit is granted is the understandir ordinances and regulations pertaining to the work covered hereby whether shown on ti by his agents, servants or employees. Signed: (INSPECTOR) In consideration of the issuance to me of this permit, I agree to perform the work cove with the plans, drawings, statements or specifications submitted to the proper authorities myself, my agent, servants or employes. Signed: C 2 t.euz (Contractor or Build( WEINGRAD DANIEL ST Contractor's Address: DANIEL N. WEINGRAD ELIZABETH M. WEINGAD 540 N.E. 96TH ST. MIAMI SHORES, FL 33138 Pa the 114. rder of BankofA erica. ACH R/T 06310 11 -00 fib' -ice Page 1 of 1 Battle of America Advantage Date Memo inn ?.7 ?1: 00373 ?482901,11' 111 L6 1116 63- 27/631 FL 988 $ ZPb Zv ° `°"' D,llars 1V11,E'!.l'V11 orl'UJ�' V 1LLALr_t_J Paint Color Approval and Agreement ;.OWNER'S NAME. aAbDRESS: Syn s• * * ign * * ** of 74`. lower Bins - APPROVED: Building 0 icial . 7< 7< +es�re *ss+ srrs * *•. sstr: * * * * * * * * ** * * * * * * ** * * * * * * * * * * * * * * * ** ADDRESS OF SITE: ,_4171Te CONTRACTOR & LICENSE (if applicable) z COMPANY NAME: *********** * * * * * * * * * * * * * * * * * * * * * * * * * * * * *. All Eleme is on the site must be listed and indi( Walls g mire W itd scia D ip Cap/Drip Edge w S • ffit //// r/ Date V W Shutters Awnings Chimney t40" c1^ -')Doors and door jams Garage Doors Railings Fences Decorative Metal G ,ry h w o 21G — 1 @t°, - All brick (simulated or regular) — Stucco Banding Any other stucco features Accessory`Buildings Other PHONE: 754,,53 White 01 IA n3 /P)iii`944- WNER'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 sa tales. e ic -0V re of Owner / Date Signature of Contractor Date ****************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION 4/23/01 Ease ELECTRICAL TYPE Minimum Fee Q1'l'. TYPE Dryer QTY. I'YPE Outlet, Appliance Q'I'1'. '1 1 IT Service Repair Q 11. 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 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. Tl'I'E Generator QTY. '1 1 PE Refrigeration, Tons Q 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 PLUMBING TYPE A/C Condensate QTY. TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. 'l Y 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 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 AT Zoning r2a L(/ > /d A Electrical Mechanical Plumbing Fire Public Works Structural 1 t ((, Building Official Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) ❑ OTHER • ❑ OTHER (Specify & Attach) ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) (Specify & Attach) PERMIT FEES $3.00 per page (Scanning Fee) $ Miami Shores Village $ 0 4► Bond $ Metropolitan Dade County (C.C.F.) Inspector State Educational Fund $ (¢.005 /sq.ft.) State DCA (Radon) $ (¢.0I /sq.ft.) Code Enforcement Fine $ Zoning Review Notary /, 0 (x sq.ft. x/1000 PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) Cl CONTRACTOR REGISTRATION (On File) TOTAL $ f� O 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 Page 2 IMPORTANT NOTICES I. 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. STATE OF FLORIDA, COUNTY OF MIAMI -DADE .ice. ,oe✓ 1 Signatur f Owner Print Name Sw • - . and subscribed before me this SEAL: elc e-1-4 I � R Angela M Becker • My Commission DD150048 o , p Expires November 15, 2008 Personally known OR, Produced Identification rad ) �. tate of Fldrida 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: PROPERTY OWNER New Construction . Name ti` 0 DA /l N' f� rJ�'J Ad• i m / Sh ares PG 3313g • one me Telep Demolish N Relocation of Structure of 6 L6"'f'sl iness Tee • • • cat P5 )zi - 817. > whit Fax ins 7�i1 4 6 (gi Foundation Only 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 Step 1. Master Permit No. Subsidiary Permit No. PERMIT APPLICATION INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: 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: ....6 N6 4, ro Si. ' l�u. 944 r'S Fc, 33 (38 Address Apt. City r State �j Zip Folio Number 'Description of Work e �T &/ O r r G c� o S e p ai #i i i 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 ARCHITECT Name License No. Address Telephone Fax PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection Zoning Square Feet alue of Work Tax Assessed/Appraised Value Linear Feet Units Floors 000% OD Bldg Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. Address Telephone Fax Qualifier Name MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date / Time Type Insp'n �r�Vir w`t 7 &I Permit No. �a p l l� ck 1 6 1 I} Name Address Company Phone # For Inspector: Approved Correction Re- Insp'n Fee Date Name