685 NE 97 St (4)CONTRACTOR
Name Naomi Wome 101 ,� `_ c.44./
�j
License No. / O /y /.3/ / / ''
Address / y7( ,, / _ 0 if
Telephoner6r) & pf - /� /� Fax 74: — 412 � �'
, Naame
Qualifier - 2j� , /J A it--__
PROPERTY OWNER
Name & // ' �1
t.
Address ails ,e /f
S'
Mien, /, ,e- 334
Home Telephone � ,5.1 7f - 72.52—
l
Business Telephone � .•%�
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'l Detachment
Other
!INSTRUCTIONS - The following must be taken to obta a permit from the Miami Shores Village:
Step 1.
Gui.66 ,ye - //y
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.
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
) ( J o b Address: c t f /Ve 9750'
Address
Apt.
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
Folio Number
Lot
Subdivision PB PG
Current Use of Property
Proposed Use of Property
Tenant Information
Block
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
Flood Zone
Master Permit No.
Subsidiary Permit No.
p7,0,4„_ria,e-t
City
Description of Work e
State
Zoning
Square Feet ,�
Value of Work 2 / 4 7v Bldg Value
Tax Assessed/Appraised Value
Units
PERMIT APPLICATION
{�• 33/3e
Zip
Linear Feet
Floors
Base Floor Elev.
ENGINEER
Name
License No.
Address
Telephone
Fax
Page 2
1 . 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 QF 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
Signature of Owner
1/C1;/ / 11 h o n
Print Name
,ZOO—
Signature of No
SEAL:
Personally known
ORIDA, COUNTY OF MIAMI -DADE STATE OF FLORIDA, CO
ry
(6ez -
Kock
C day of "lc
Nog
Sworn to and subscribed before me this
MICHAEL IWASKEWYCZ
MY COMMISSION 9 CC 721000
.�, EXPIRES: April 10, 2002
N' F :,,,' Bondad Put Notary Public Umderve/ tors
OR, Produced Identification
Type of Identification Produced:
J/ Signature of Co actor / Qualifier
Print Name
Swo .: i d subscribed before me this
ature of N, ry
• PERMIT APPLICATION
Y OF MIAMI -DADE
day of /4 ,
Public State of Florida
SEAL: �Fia'ai. ,i � �a "�� Et;
.............i."
- "�` pA a BE CK
PUBS : (uc : 140i mos: fi o c r ::::: s
SPa;'+EL ��'`iCC0.its ,. 13, cow
s` Personally known ` . • ° , Pr�
Type of Identification Produced:
ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPE
Dryer
QTY.
TYPE
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
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
-
Dishwasher
Low -volt, Television
Service, Number of Amps
Water Heater New
MECHANICAL
T1'PE QTY.
Minimum Fee
'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
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
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:
SECTION
BY
DATE
•nin�
/- i �
3 J' cU_
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
y 7i .
W . 3 r
Page 4
OFFICE USE ONLY
ID OWNER - BUILDER FORM
(Attach)
U FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
U CONCURRENCY
(New Construction)
01 OTHER
(Specify & Attach)
$3.00 per page (Scanning Fee)
Miami Shores Village
Bond
Metropolitan Dade County (C.C.F.) $
Inspector State Educational Fund $
State (Radon) $
Code Enforcement Fine
Zoning Review
ID PROOF OF OWNERSHIP
(Attach)
HRS / DERM APPROVAL
(Septic / Sewer)
LI IMPACT FEE
(New Construction)
Di OTHER
(Specify & Attach)
`PERMIT FEES
( sq.ft. = x/1000
x ¢.60)
(¢.005 / sq.ft.)
(¢.01 /sq.ft.)
O CONDO ASSOCIATION APPROVAL
(Attach)
• BPR APPROVAL (Restaurants)
ID CONTRACTOR REGISTRATION
(On File)
TOTAL
REVIEWED AND PREPARED BY:
PERMIT APPLICATION
4, 3
DATE:
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL c (305) 795 -2207 c FAX (305) 756 -8972 o http : / /www.miamishoresvillage.com
Phone: 305 - 795 -2204
Printed: 3/25/2002
Applicant: KATHLEEN
(>- Owner: KOCH
PAY TO THE
ORDER OF
MEMO
Miami Shores Village
10050 NE 2nd Avenue
Contractor
Local Phone:
Building Permit
Permit Number: BP2002 -614
Address:
Cellular:
KOCH
KATHLEEN
Page 1 of 1
Parcel # 1132060171920 Legal Description: MIAMI SHORES SEC 4 AMD PB 15 -14 LOTS 21 & 22
Job Address: 685 NE 97 ST
Fees:
FEE2002 -1732
FEE2002 -1733
FEE2002 -1734
Permit Status: Approved
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.
COMPLETE HOME PAINTING
BY MICHAEL
1476 NE 130TH ST. PH. 305 - 895 -1368
NORTH MIAMI, FL 33161
Washington Mutual
Washington Mutual Bank, FA
North Miami/125th Street Financial Center 1728
900 NE. 12556 Street 1- 800.788.7000
North Miami, FL 33161
20 hour customer Service
.1: 26 ?OBI, L3 Lr.83 Lu14835 L LIN 30 336?
< <—S
Description Amount
Building Permit Application Fe$60.00
CCF
Notary Fee
Total Fees:
Permit Expiration: 9/18/2002 Construction Value:
DATE
$1.80
$5.00
$66.80
63- 8413/2670 3 3 6 7
8314835113
$J9? N
DOLLARS LSl ms "'°'.; u
BY:
$2,475.00
Total Fees: $66.80
Total Receipts: $0.00
BLK 101 LOT SIZE
' "
he 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 withbut
:tor or builder named above assumes the responsibility for a thorough knowledge of the
lgs or in the statements or specifications and that he assumes responsibility for work done
n compliance with all ordinances and regulations pertaining thereto and in strict conformity
•es Village. In accepting this permit I assume responisibility for all work done by either
BY:
MIAMI SHORES VILLAGE
Paint Color>Approval and Agreement
DATE:
OWNER'S NA E: f PHONE: 7,5'� -7e—
ADDRESS: t N 97 ,SY"
*************:********************* * * * * * * * * *. * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE.:
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME: PHONE:
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted.
Walls He-- //y
Fascia Dom- 4'
Drip Cap/Drip Edge
Soffit d c ref'
Roof iv ,�
Flower Bins
Shutters
Awnings
Chimney
Doors and door jams
Garage Doors
Railings
Fences
Decorative Metal
All brick (simulated or regular)
Stucco Banding l#
Any other stucco features
Accessory Buildings
Other
APPROVED:
Building Official
oc
-6c-- -'( y
Dc-' ( 'y
All"
3/)-
Date
El
0
n
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.
Signature of Owner Date Signatur'of Contract Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
4/23/01
HC -116
misty air