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770 NE 97 St (10)PRO T O NER New Construction Name 'DA vv. . Q -IMALU Enclosure Address 770 N r C —) Cl Alteration Exterior Home Telephone .k) S 7 . 2 0� 7 7 Business Telephone Z(.5 S: Of po 7 41 3 Alteration Interior Fax Z O c t e t 2 -2 E 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: 7 '70 "V1. Address PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other 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 Apt. Folio Number Lot Block Subdivision PB PG Current Use of Property Proposed Use of Property Tenant Information PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Master Permit No. Subsidiary Permit No. 1V of City .r:/ i if State escription of Work Ct. t A) f e 01 PERMIT APPLICATION Linear Feet Z2/3f Zip Zoning Square Feet ue of Work O Bldg Value ax Assessed/Appraised Value Flood Zone Base Floor Elev. Units Floors ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. Address Telephone Fax Qualifier Name 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. Owner 'N- OLtM{r /V\.2 NiAlr[2,f >lPrint Name w. . and subscribed before me this day otary Publi S . e :f orida Signature of Notary Public - State of Florida OFFIGtAL t,017—z- 'O i - . - . V .—' t. d ,1/4.01Y P 0 9 ANGELA B �'+ SEAL: O� l � ^ irr � /0 C p.gs,.pq.umrL , Personally known OF fx OR, Produced Identification Personally known OR, Produced Identification SEAL: OF FLORID a • UNTY OF MIAMI -DADE Print Name Sworn to and subscribed before me this day of Signature of Contractor / Qualifier PERMIT APPLICATION STATE OF FLORIDA, COUNTY OF MIAMI -DADE Type of Identification Produced: I�,l /1� a � Type of Identification Produced: ELECTRICAL TypE Minimum Fee ()Ty. TYPE Dryer Q,I'V. TYPE Outlet, Appliance QTN. T1 PE Service Repair ()Ty. 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 TYPE. Minimum Fee QTY. TYPE Condensate Drain Q1'V. TYPE Generator QTY. 'Fyn: Refrigeration, Tons ()Ty. 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 TVPE A/C Condensate QTY. TYPE Drains, Roof QTY. 'fY Miscellaneous Fixture Q'I'V. mg.: 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 D ' TE Zonin _ #.'4 wrY4 Electrical i Mechanical Plumbing Fire Public Works ...itra Structural Building Official _ t_ Page 4 OFFICE USE ONLY CHECKLIST CI OWNER - BUILDER FORM (Attach) CI FIRE DEPARTMENT APPROVAL (Commercial / multi - family) CONCURRENCY (New Construction) OTHER (Specify & Attach) $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 CI PROOF OF OWNERSHIP (Attach) ® HRS / DERM APPROVAL (Septic / Sewer) LI IMPACT FEE (New Construction) LI OTHER (Specify & Attach) $ $ 0 a (s ¢ . x/1000 x (¢.005 /sq.ft.) (¢.01 /sq.ft.) PERMIT APPLICATION LI CONDO ASSOCIATION APPROVAL (Attach) U BPR APPROVAL (Restaurants) LI CONTRACTOR REGISTRATION (On File) PERNIIT FEES TOTAL $ ISSUING OFFICIAL REVIEWED AND PREPARED BY: DATE: t._._ _ RO''AL COND17`lON OFAPP Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL o (305) 795 -2207 o FAX (305) 756 -8972 o http : / /www.miamishoresvillage.com MIAMI SHORES VILLAGE Paint Color Approval and Agreement DATE: ('D 2 OWNER'S NAME: ma c , it/Le,,./ A ) ea PHONE:Ws 7?S 7 3 ,? 0 - w ADDRESS: `7 N °I 7 R't 2 oS- ?S — �f ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ADDRESS OF SITE: 770 N 6-97 CONTRACTOR & LICENSE (if applicable) COMPANY NAME: PHONE:. ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All Elements on the site must be listed and indicate the color to be painted, Walls c I .e.1lmA) Fascia Lu Drip Cap/Drip Edge U3 kl e ° Soffit w Roof Flower Bins b Shutters tl En Awnings Chimney x Doors and door jams w k- %ca ro. aa g c t e ou w...r o , c Garage Doors v-AA ; +s,._. Railings cz Fences Decorative Metal All brick (simulated or regular) Stucco Banding , Any other stucco features Accessory'Buildings Other APPROVED: W,// Building Official g /44 Date OWNER'S AFFIDAVIT: I certify that all the foregoing ii. and that all work will be done in compliance with all applicac. construction and zoning. I authorize the above - named contract do the work stated. Furthermore , the paint colors will be as per ti mples. WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION 4/23/01 :0 Signature of Owner Date Signature of Contractor Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** MIAMI SHORES VILLAGE Paint Color ApprovaTand Agreement DATE: / - ( ' O s7- OWNER'S NAME: Zc,avv G�/1•:6iilae�' PHONE: �cDf- 7f'22 4 ii - ADDRESS: '770 Tic- Q ? S--f- ********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ADDRESS OF SITE: CONTRACTOR & LICENSE (if applicable) COMPANY NAME: PHONE::;.::. ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All Elements on the site must be listed and indicate th' ^ ^: ^ * " 1 Walls S cv r t7 nb Fascia ) (n',. -e Drip Cap/Drip Edge Soffit (A/ Roof Flower Bins Shutters Awnings Chimney Doors and door jams u jk-i-c ( c - c�o�rc�c C7j Garage Doors Railings Fences Decorative Metal All brick (simulated or regular Stucco Banding Any other stucco features ►� Accessory'Buildings Other tk.)4:62L OWNER'S AFFIDAVIT: I certify that all the foregoing informatiion.is,accurate and that all work will be done in compliance with all applicable laws r-egitfating 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 s pies. �--� — `0 �/ 0 • z Sign ure of Owner Date Signature of Contractor Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED: Building Official Date WHEN PAINTING IS FINISHED CALL FOR FINAL INSPECTION t0 b (11k Ots 0' 4/23/01