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755 NE 97 St (5)4 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Datet*/‹1 Job Address 5� % 7 Legal Description' f r I4} Owner / Lessee / Tenant l *4 AAst/ Master Permit # ✓ / 7! Owner's Address • 7 ,3 ,7-'9i . Phone 7,31- ,943 Contracting Co. OM44'i Qualifier SS# - - Phone State # Municipal # Competency # Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one):: BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN �l/`�,�` at...,-.1 WORK DESCRIPTION � ` and ., e dii q ) 5 23 A 0 Square Ft. Estimated Cost(value 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. 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. Furthermore, I authorize the above -named contractor to do the work stated. Signature of owne Date: Notary as to Owned 981Z''�S °el asnoqunnc_ My Commission Expires: ** * * * * * * * * * * * * APPROVED: Zonin Mechanical Tax Folio G , 1" /4 ot3 g `ctor or Owner- Builder Signature f Con Date:V. /9,1 'otar " as to My Commission FEES: PERMIT 7,.5 9 RADON C.C.F. 5 NOTARY S; -120 TOTAL DUE q.1 Plumbing ** Other Electrical Engineering PROPERTY OWNER New Construction Name p /4 01� tt h ,i,j©' / /� - 7 - e ; Address / ) 5 S 1\I 9') 6� Home Telephone Business Telephone Fax 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 Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi - family) LI CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) PERMIT FEES $3.00 per page (Scanning Fee) $ Miami Shores Village PAC_ Vie. $ ) cicD Bond Metropolitan Dade County (C.C.F.) Inspector State Educational Fund $ State DCA (Radon) $ Code Enforcement Fine Zoning Review Notary cot $ o 't (sq.ft. = x/1000 x 0.60) (¢.005 / sq.ft.) (¢.01 /sq.ft.) PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) rr ISSUING OFFICIAL TOTAL $ REVIEWED AND PREPARED BY: DATE: SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY D TE CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL 0 (305) 795 -2207 ® FAX (305) 756 -8972 o http : / /www.miamishoresvillage.com 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: Folio Number 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 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. Address s PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax PERMIT APPLICATION Master Permit No. Subsidiary Permit No. at00.■ Apt. City / State X Description of Work P/9-/ (/t /-1C a 5 • Zip Zoning Linear Feet �cVal Square Feet Units Floors of Work 5t.c Cr) Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. Address Telephone Fax Qualifier Name ELECTRICAL TYI'E Minimum Fee QTY TYPE Dryer QTY. TYPE Outlet, Appliance () . L1 PI.: Service Repair Q'fl 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 Water Heater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New MECHANICAL T 1'P}_ Minimum Fee ()Ty. T l'I'E Condensate Drain on'. 'FITE QTY. Generator I YPh 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 'nil: A/C Condensate QTY. '1'YI'F. Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. TN IT Soakage Pit ()Ty. 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 2 IMPORTA 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. L. 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 0 . DADE p� O � / f N 7 ii-sr) Signature of Owner Print Name Print Name worn to and subscribed before me this gnature of SEAL: otary Public Type of Identification Produced: tate o orida STATE OF FLORIDA, COUNTY OF MIAMI -DADE Signature of Contractor / Qualifier Sworn to and subscribed before me this day of Signature of Notary Public - State of Florida PERMIT APPLICATION ai .:u:...� SEAL: I, � C. Per - .LA AA BICI.. _ -.Y r ^ '86∎x97 Personally known OR, Produced Identification' Personally known OR, Produced Identification 6 -- 6pe of Identification Produced: 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: MARY C. JOHNSON ROLAND H. JOHNSON 755 N.E. 97 ST. MIAMI SHORES, FL 33138 Wir Dollars ankofAmerc Pay to the order of ACH R/T 083100277 For L. 1:0 3 1100 2 ? ?I: 0000 ?DO 569 2 larti Date 1271 63-27/631L 988 -r4 Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Applicant: / Owner: JOHNSON MARY JOB ADDRESS: 755 NE 97 ST Contractor Local Phone: Parcel # 1132060142320 it Status: Approved Permit Expiration: 11/ rk: EXTERIOR PAINTING AS PER AGREEMENT Signed: /F.,lyne win IaIJ ��� � ri J I�l f ( l �I i IIIa'ryI�I I i Ip�,Yr� IIINIIIIh ; II 'MwI! t IIf 1 ��bpr�� h d I IR 1111 li �: I @u;Iit Contractor's Address: ntractor or Builder) Construction Value: $500.00 Ydei3 BY: rJ,1n1U Y II Ia,Alt an ° rn Permit Number: B P 002 - 929 Prince ' /.,2 / 1).:„.--3>.1....„,, J�- Page 1 of 1 _ Legal Description: 5 -6 53 42 MIAMI SHORES SEC 3 PB 10 -37 LOT 4 & W4OFT LOT 5 IRK 70 LOT Fees: Description Amount FEE2002 -2775 Building Permit Application Fee $60.00 FEE2002 -2776 CCF $0.60 FEE2002 -2777 Notary Fee $5.00 Total Fees: $65.60 Total Fees: $65.60 Total Receipts: $0.00 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. PECTOR) BY: This Permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application hereto' in strict compliance with all ordinances pertaining thereto and with the tnderstanding that the work will be performed In compliance with any plans, drawings, statements or specifications ti.at may have been submitted to and approved by the proper municipal authorities This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed ..ithour authorization A `giber v dition usx'n which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility tor a thorough knowledge :;t the ordinances and Regulations pertaining to the ■Mork covered hereby eihelher shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations perlainina thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either n•Iyseif, my agent, servants or employes. MARY C. JOHNSON ROLAND H. JOHNSON 755 N.E. 97 ST. MIAMI SHORES, FL 33138 t Date Pay to a order of c . ankofAmedc AGM WT 063100277 For 1:063 L00 2 ? ?N: 000070056924e 1,2? CIj _L • ••••:..0 • • i DATE: OWNER'S ADDRESS: MIAMI SHORES VILLAGE Paint Color Approval and Agreement AME. A / PHONE: *************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ADDRESS OF SITE: -5A 1 1 CONTRACTOR & LICENSE (if applicable) COMPANY NAME: PHONE: *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * - * * * All Elements on the site must be listed and indicate the color to be painted. Walls ijc U) Fascia Drip Cap/D Soffit Roof Flower Bins Shutters Awnings Chimney Doors and door jams A Garage Doors Fences Decorative Metal All brick (simulated or regular Stucco Banding Any other stucco features Accessory'Buildings`r$l / /S j r) -7 D , D /oj2 ,Pcmk z4 & 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 7 ate Signature of Contractor Date * * * * * * * * * * * * * ****** ************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** e' APPROVED: 5 * ✓ * * * * * * * * * * * * * ** WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION Building Official v Date 4/23/01 txi