790 NE 97 St (3)PROPERTY OWNER
Name Q,r 11
� �
Address
oiv t. 4 � Sr M;401.% Shoes pi
Home Telephone i Q5 - S' 7_�de
Business Telephone 5OC_ O r -) of `t i '
Fax3DS- -75-(7" 1,5-11
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
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Step I.
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.
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
PERMIT CHANGE (
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
City
Description of Work
Square Feet
Value of Work
Master Permit No.
Subsidiary Permit No.
Zoning Linear Feet
019 4
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
ENGINEER
Name
License No.
Address
Telephone
Fax
Name
License No.
Address
Telephone
Qualifier Name
CONTRACTOR
PE' MIT APPLICATION
5 3 /
State Zip
d eb/e--t.../ani/ t fl , h 0 c ( C
Units Floors
Bldg Value
Fax
Page 2
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.
1.
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 FLO DA, OUNTY OF MIAMI -DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE
Sian
iSe fl h/e�
J �` "`�
Print Name
worn to and subscribed before me this day of
SEAL:
Personally known
Signature of Contractor / Qualifier
PERMMIITSAPPLICATION
Print Name
Sworn to and subscribed before me this day of
otary P Ti taf� €, (fi �:'` Signature,of Notary Public - State of Florida
II ' UB ANGELA P9 EcC■:Sit
' l� %',.-.,' j, co::.- eco :: ruw cc7 � � SEAL:
'OF Fk2D 1. 15, 200?
OR, Produced Identification Personally known OR, Produced Identification
Type of Identification Produced: Type of Identification Produced:
'ELECTRICAL
TYPE
Minimum Fee
QTY
TYPE
Dryer
QTY.
TYPE
Outlet, Appliance
QTY.
TYPE
Service Repair
Q . h
A/C Central 1 -3 Ton
A/C Central, Tons
Fan
Cooling Tower
Outlet, Wall
Heating Strips, each
Service, Temporary
Vent Hood, Cost
A/C Central 4 -7 Ton
A/C Waln. Tons
Fire Pump
Dryer Vents, Number of
Outlet, Switch
Paint Booth
Signs
Ventilation, Cost
A/C Central 8 -15 Ton
Air Handler, Tons
Fixture - Fluorescent
Ductwork, Cost of
Oven
Piping, Flammable Liquid
Space Heater (kw)
Periodic Inspections
A/C Central 16-20 Ton
Barbecue
Fixture Light
Fire Sprinkler System
Parking Lot Lights
Process/Pressure Piping
Spas/Hot Tubs
A/C Central 20+ Ton
Bath Fan - Vented, #
Flood Lights
Fireplaces, Number of
Plugmold/Strip
Pressure Vessel
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
Disposal
Refrigerator, Domestic
Interceptor
Temp for Test - 30 days
Roof Inlet
Deep Freezer
Water Closet
Low -volt, Fire
Domestic Well
Renew - Temp Service
Laundry Tray
Septic Connection
Demolition
Water Heater
Low -volt, Intercom/Teleph.
Drainfield, 4" Tile/Res.
Repair Circuits
Lavatory
Septic Tank
Dishwasher
Water Heater New
Low -volt, Television
Drains, Area
Service, Number of Amps
Meter Set (Gas)
Sewer Connection
MECHANICAL
TYPE QTY. TYPE QTY. TYPE QTY. TYPE Q Y.
Minimum Fee
TYPE
Drains, Roof
Condensate Drain
TYPE
Miscellaneous Fixture
Generator
TYPE
Soakage Pit
Refrigeration, Tons
Bath Tub
A/C Central, Tons
Drinking Fountain
Cooling Tower
Miscellaneous Repairs
Heating Strips, each
Solar Water Heater
Vent Hood, Cost
Bidet
A/C Waln. Tons
Filter Replace
Dryer Vents, Number of
Pool Piping
Paint Booth
Sprinkler Repair
Ventilation, Cost
Cap - Fixture
Air Handler, Tons
Fountain
Ductwork, Cost of
Pump and Abandon
Piping, Flammable Liquid
Sprinkler System
Periodic Inspections
Cap - Water
Barbecue
Gas - Appliance
Fire Sprinkler System
Pump, Domestic
Process/Pressure Piping
Supply, AC Well
Cap - Sewer
Bath Fan - Vented, #
Gas - Natural
Fireplaces, Number of
Pump, Fire Stand
Pressure Vessel
Temporary Toilet
Catch Basin
PLUMBING
TYPE
A/C Condensate
TY.
TYPE
Drains, Roof
QTY.
TYPE
Miscellaneous Fixture
QTY.
TYPE
Soakage Pit
Q' •
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
Relay Repair
Utility - Water
Vacuum Pump
_
Dishwasher
Indirect Wastes
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
a • •••
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
Zoning
4( /&.V0
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
t�
jA Z.
Page 4
OFFICE USE ONLY
!CHECKLIST
❑ 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
Metropolitan Dade County (C.C.F.)
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)
PERMIT FEES
$
(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 $ , t
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
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: BP2002 -480
Printed: 3/8/2002
Applicant:
Tib
Owner: ANDREWS BRAIN
Contractor
-. Local Phone:
Address:
Cellular:
Parcel # 1132060142190 Legal Description: MIAMI SHORES SEC 3 PB 10 - 37 LOTS 1 & 2 BLK69 LOT SIZE SITE VALUE
It Job Address: 790 NE 97 ST
Fees: Description Amount
FEE2002 -1395 Buildier's Bond $300.00
FEE2002 -1396 CCF $0.60
FEE2002 -1397 Building Permit Application Fe$60.00
FEE2002 -1407 Notary Fee $5.00
Total Fees: $365.60
Permit Status:
Approved Permit Expiration: 9/2/2002
Work: INCREASE DRIVEWAY IN BACK
Building Permit
Construction Value: $1,000.00
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 anott��..�a °tea -� ^^
This Permit is granted to the contractor or builder named above to construct the h.'"
ordinances pertaining thereto and with the understanding that the work will be perfc
and approved by the proper municipal authorities. This Permit may be revoked at
authorization. A further condition upon which this permit is granted is the understai
ordinances and regulations pertaining to the work covered hereby whether shown c
by his agents, servants or employees.
Signed:
(1IgSPECTOR)
In consideration of the issuance to me of this permit, I agree to perform the work
with the plans, drawings, statements or specifications submitted to the proper auth
myself, my agent, servants or employes.
J. STEPHEN ALLEN
790 NE 97th St
Miami Shores, FL 33I38
Sao
/r-
PAY TO
THE ORDEROF
First Union National Bank
® flistunion.com
003 R/T 067004032
FORE T 1
Page 1 of 1
Total Fees: $365.60
Total Receipts: $365.60
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DATE
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WIRBOA
790 N.E. 97 STREET
MIAMI SHORES, FLORIDA 33130
- i 9• P AvF MrJ.r'f
plat thereof, as
to the P subject
LEGAL o1 an d Lot 2 ON MIA MI SHORES subdivision according to to thereof,
Lot 1 and Lot 2, book 69, a e 37, Public Records of
recorded in plat book 10, at P g rictions of record: "''�y "
to dedications, reservations, easements or rest
ro erty is true and
of the above described
correct y is true an
SURVEYOR'CERTI survey
I hereby to that this sketch of and belief as recently
knowledge Land
are Title
no
correct to the best of my 472.027 nd the Florida StatutES•
and c conforms to the to iSectionhnical Standards adopted by the Florida
Association, pursuant
encroachments except as shown.
CHRISTOPHER B. Cu`e
r /
Registered Land Surveyor #4229
State of Florida
15021 N. Saxon Circle
Ft. Lauderdale, Florida 33331
(954) 434 -2695
surveyors's seal.
Not valid unless sealed with an emb96sed
120652 3/2/94 X
Date of field work: December 26, 093 J
FLOOD ZONE INFORMATIONS Allen, Attorn' Insurance Fund,
Brian C. Andrews and John S.CAlien, Ats rneyseys' Title ors annInssu assigns CERTIFIED TO: Colletti, Mellon Mortg g
Inc., Joseph R.
their interests may appear.
JOB ADDRESS 7 p 0 to.
APPLICANT Sow J kut
PHONE nn
APPLICATION 'l kvitalfil
SHEET OF
MISCELLANEOUS
CRITIQUE SHEET
COMMENTS
SECTION .
ZONING
PERPAIT NO.
AODRESS:
MIAMI SHORES VILLAGE
BUILDING / ZONING DEPARTMENT'
ELECTRICAL
MECHANICAL
PLUMBING
FIRE
PUBLIC WORKS
STRUCTURAL
BUILDING OFFICIAL
DATE
1. Subiect to compliance with ail Federat Slate,
Coc. -,ty.V a silos cod regulations. Wine assn
no responsibility for accctrecy otter resutts trasa
C•.ese plans.
2. This copy of pions must be avtllttie on
batting site or no Inspection will be condc.:ted.
DATE ZONING
• .1- a.l .0.)_ Q 04- Q/NNvo - 4.1.5 6-20 1") 14
sue TxS 19 P (i 0
INITIALS
JOB ADDRESS
APPLICANT
SHEET OF
7o. fr 0 77 s
APPLICATION Doi
4/Q-- MI( 4q-
CRITIQUE SHEET
PHONE
MISCELLANEOUS
DATE LU•NIN( •
Dal ' cwcry /
2C 76 4e4c •/' rg7/? ( ° )
4 2
COMMENTS
PERMIT NO.
ADDRESS:
MIAMI SHORES VILLAGE
BUILDING / ZONING DEPARTMENT•
SECTION
ZONING
ELECTRICAL
MECHANICAL
PLUMBING
FIRE
PUBLIC WORKS
STRUCTURAL
BUILDING OFFICIAL
1. Sullied to cocnpilanci with att Federal, State.
Cos..-tty.Witlage cotes end regulations. Village ssscx=
no responslbillty for accurecy otloc results frosa
these plans.
2. Thls copy of plans must be available co
tlAding site or no Inspection will be conduc;ad.
UPiI L /may
h cAti cg.)/
DATE
INITIALS
Uhf e
� �
k Q`'" ` gQ � 2 l ��� W "" � ��
STATE OF FLORIDA)
COUNTY OF DADE)
attached survey, performed by
performed on
• ni SkoreJ i e
AFFIDAVIT
The undersigned Affiant, �
gn , does hereby attest that the
(p
chL__ operty owner)
Cvb /
of survey)
(name of surveyor's company)
b is an accurate representation of the existing conditions and
locations of all structures on the property as of this date.
The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the
property without first providing a survey less than six (6) months old. The Affiant, as property owner, further
agrees to remove or obtain permits for any structures which now may exist on the property which are not
permitted or which may violate zoning or building code regulations. The Affiant further understands that the
existence of any such structures may affect final inspections as applicable to this or other permits..
Further, Affiant sayeth naught.
Witness(sign and print)
known TO SUBSCRIBED before me this �'
ersonally
Affiant is own to me, produced
Witness(sigo and print)
,
cis- MY Ca^I^::1SSlO EXPIRES
OF
F�O NOV. 15,2002
e ANGELA :ECKER
` T commsriow NUMBER
, cc7asiiden�
i fication.