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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 3 it -o Wig e DATE 1291 63- 643/670 BRANCH 00666 $ 3 L � y J B.wrlrY �/ •i /s FeeNne DOLLARS t a ��• e• PERK Basic IV 511111— '11111111M M.111111124.1■11 OM Ur IIM1150 0 IIL:1 C431111111Ple As cl =5 Iltilralf0 Al ism • _z MI Orrin= MI 11/ en �WNm !� Ivi 113Ro • NE 0111 ST 4'NS L rAr? J 5K STL+ - � 30 JNIS P)Pr-_ ilp► g ed 0'3' rot? role i P e. sT 0 M sl N 4.4 0.111.71: 1111 • N,S W I cc -4 • �t „ovu.0 ao,s 'his st • T■ =, ST t 9QTN...ti., ST s) ?IN ' ST WWTN ; , ST STM ; ST T 91. sy `30 .st FGJ PIP N'T F VNi i PE Sc,LV4AL.. M I _ 97 S7 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.