665 NE 97 St (9)CONTRACTOR
Name ecxxc Alc aq
4n,
License No. c 3a c -
Address 5 0 / 0 7
M450/ p 7gOrt
Telepholu 226 -2616 Fat cag 3 _ vyao
Qualifier Name .1---- 0
tiZArlk C-11A 6.-
PROPERTY OWNER
Name a L.k.- °I 644 eLLE-1 J417/4, t,
Address e 5 r 4e ei sr
H/A+41.51.koPeS, FL 33
Home Telephone 3 (55 _ 3.4 14, - S, 5 6
Business Telephone q54 _ C - (c 4 60
Fax
ARCHITECT
New Construction
Name ,,,,
W6
Alteration Exterior
teiC/A
Licens No. A
fIL/1 00/ c 2 5:c
Repair
Address
& S6, / g e•Af ? Co r to r x i c,„,
-ft,z4-0-007 -pc_ 7 -7 3"/
- 3
Telephone
Demolish
Fax
Shell Only
TYPE OF MANAGEMENT ( 1 )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
/
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'l Attachment
Other
Add'I Detachment
Other
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
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.
APPLICATION
Job Address:
4/0/C
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.
Address
Folio Number 4' - 3.2.0‘ - 0 / 7- /7/0 Description of Work 0 2- /cm/ L/Avii:
Lot Block
Subdivision PB PG Zoning Linear Feet
Current Use of Property it/M17/,-"W--X- Square Feet Units Floors
Proposed Use of Property Value of Work V/40 Bldg Value
Tenant Information Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
PERMIT TYPE (/)
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
66 AO: .7 M
Apt.
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
PERMIT CHANGE ( 1 )
Master Permit No.
Subsidiary Permit No.
City
State
PERMIT APPLICATION
2, 6,r
Oea
Zip
ENGINEER
Name
License No.
Address
Telephone
Fax
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.
STATE OF FLORIDA, COUNTY OF MIAMI -DADE STATE FLORIDA, COUNTY OF MIAMI -DADE
3@c - L (k
Signature of Owner -
l✓1�.�1 G3 Lb - L\ (1 k
Print Name
Sworn to and subscribed before me this � day of 1 ,
SEAL:
Signature of N
Public - State of Plonda
Set Enrique Chau
* *My Commission CC796757
. .0°2
47 Expires Ja
Personally known 010.4,
OR, Produced Identification
Type of Identification Produced:
Signature of Contractor / Qualifi
Print Name
Sworn to and subscribed be
21704,
Signature of N
SEAL:
ry
PERMIT APPLICATION
e this day of J / ,
i-li.. Qt.-qr.-0f Florid-1 _
P
ti n VICENTE FERRER
; ., c!� . MY COMMISSION # CC 930884
Ilril
:,� -a EXPIRES: April 24, 2004
of *i°p Bonded Thai Notary Public Undernritats
Personally known OR, Produced Identification
Type of Identification Produced:
SECTION
BY
DATE
Zoning
Electrical
(3(.0z-
(
Mechanical
n
f ..rD 4
Plumbing
Fire
Public Works
Structural
Building Official
Page 4
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
Cl 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
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
7
5-
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
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $
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.
TvPF.
Dryer
QTY.
TYPE
Outlet, Appliance
QTY.
TYPE
Service Repair
QTY.
A/C Central 1 -3 Ton
E
Fan
Vent Hood, Cost
Outlet, Wall
Service, Temporary
w Paint Booth
A/C Central 4 -7 Ton
Fire Pump
Air Handler, Tons
Outlet, Switch
Ductwork, Cost of
Signs
AJC Central 8-15 Ton
Periodic Inspections
Fixture - Fluorescent
Oven
Process/Pressure Piping
Space Heater (kw)
A/C Central 16 -20 Ton
Bath Fan - Vented, #
Fixture Light
Fireplaces, Number of
Parking Lot Lights
Spas/Hot Tubs
AJC 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.
MI Refrigeration, Tons
A/C Central, Tons
1 -
ww
/ 1 ooli
�-il ng Tower
Heating Strips, each
E
'`
Vent Hood, Cost
A/C Wall/Win. Tons
I. Dryer Vents, Number of
w Paint Booth
Bidet
Ventilation, Cost
Air Handler, Tons
Pool Piping
Ductwork, Cost of
c/ la Piping, Flammable Liquid
Cap - Fixture
Periodic Inspections
Barbecue
Fire Sprinkler System
Process/Pressure Piping
Sprinkler System
Bath Fan - Vented, #
Gas - Appliance
Fireplaces, Number of
Pressure Vessel
Supply, AC Well
PLUMBING
TYI'E , QTY.
A/C Condensate
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:
FOR
PAY
TO THE
ORDER OF
ACH Rif 063100277
Sern r el y It r d Jorn r Ser inr:dr:t
COOL BREEZE AIR CONDITIONING CORP
Bank of A ric
-<e-
305-226-2665
13120 S.W. 130TH TER
MIAMI, FL 33186-5895
11-01
DATE
NA.4.1c. (
11•00 L05130 I:063000047i: 00341-.8567652e
U=4.7.'-.11,111.11:411=.11‘110121,. LOZIOJCON.Z.,
/1-36/0
Is 7$
1058
63-4/630 FL
276
DOLLARS 8
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date
Company
Time
Type Insp' n
Permit No. `-' c OO4 • C
Name c?�G
Address
Phone # 50s - 97.0
For Inspector: / _yam
Approved 11
Correction ❑
Re- Insp'n Fee ❑
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date C Time
Type Insp'n i1Je /44 ) 610
Permit No.
Name
Address
Company
Phone #
For Inspector:
Approved
Correction
Re- Insp'n Fee
lac 2.®oz- /2)
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l6 /yam' 7 SD
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)
Pk4,1"e, 7A1
Name & Date /�
(e
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date f Q-02.. Time A
Type Insp'n / h /`0
Permit No. No 0 -/1
Name iiih `r ra, k v
Address 6 .,(5 J /� Z$r
Company ( 2/ 0 12ti
Phone # ,P0,5-' ,Z .. I'e 5.4
For Inspector:
Approved
Correction ❑
Re- Insp'n Fee ❑
Name & Date
, 16 . 6 ((.0'
e 47414 2ets-35(cac.IP