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BP-02-1784Date Type Insp'n Permit No. Name Address Company Phone # For Inspector: MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305 - 795 -2204 Building Inspection Request Correction Re- Insp'n Fee '2 / L I)Oam&Dt e o TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior — Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'l Attachment Other Add'l Detachment Other INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. 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 Job Address: egOZ 4 .1 City State Zip er Description of Work meek 77 / Address Folio N Lot Block Subdivision PB PG Zoning Linear Feet Current Use of Prope Square Feet MS Units Floors Proposed Use of Property Value of Work a Bldg Value Tenant Information Tax Assessed/Appraised Value Flood Zone PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other v PERMIT CRINGE Chg. Contractor Renewal Revision Extension Supplement Reinspection Apt. ( ✓) ARCHITECT #/A License No. Address Telephone Fax PROPERTY OWNER Name ,t IO2) a 7e S RAS 7w ealie : 9 Address /E:94 ,f Whet l r( Home Telephone Business Telephone Fax Master Permit No. Subsidiary Permit No. PERMIT APPLICATION Base Floor Elev. ENGINEER Name A JA License No. Address Telephone Fax CONTRACTOR Name .1 401 lezer i k — nwtl' License No. eee axe ygp Address Telephon ° 2/9, V Fax X7 ' of Qualifier Nam i� , g Page 2 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 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. STA OF . O s. I_�� . C UNTY OF MIAMI -DADE Si ature of Owner ' ef t Ekevss Print Name orn to and subscribed before me this ,l day of O i wrg, Signature o Ng SEAL: Personally kn Public - State of Florida way oN IguoAnN L8 papuo9 90L601. ( t uoissimwo3 900Z'9l uaiptgwwooAra Bppou . Jo AM ON - MIcind ON H� (13)I 38IvT8 1 entificafon Type of Identification Produced: Signature of Contractor / Qualifier Print Name � Sworn to and subscribed before me this Z day of s) ck , • _ • 9 i h LORRAINE KELLER % Notary Public - State of Florida y • MyCommisakin Expires Apr16,200(1 Commission * DD 109725 Bon, ::, By National Notary Assn. Si SE Per on.' y :..o•• Type of Identification Produced: PERMIT APPLICATION cation Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) PERMIT FEES $3.00 per page (Scanning Fee) Miami Shores Village Bond $ $ 0 Metropolitan Dade County (C.C.F.) $ / i 0 Inspector State Educational Fund $ State DCA (Radon) $ Code Enforcement Fine Zoning Review ❑ OTHER (Specify & Attach) $ (sq.ft. = x/1000 x ¢.60) (¢.005 / sq.ft.) (¢.O1 /sq.ft.) REVIEWED AND PREPARED BY: SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ e l v ISSUING OFFICIAL DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. TYPE Outlet, Appliance QTY. TYPE Service Repair QTY. A/C Central 1 -3 Ton Heating Strips, each Fan Outlet, Wall Service, Temporary - Paint Booth A/C Central 4-7 Ton Fire Pump Outlet, Switch Piping, Flammable Liquid Signs A/C Central 8 -15 Ton Fixture - Fluorescent - Process/Pressure Piping Oven Space Heater (kw) A/C Central 16-20 Ton - Pressure Vessel 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 QTY. TYPE Generator QTY. TYPE Refrigeration, Tons QTY. A/C Central, Tons QTY. Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Wm. Tons Dryer Vents, Number of - Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System - Process/Pressure Piping Pump and Abandon Bath Fan - Vented, # Fireplaces, Number of - Pressure Vessel Gas - Appliance 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: °If ISecurit enhanced document. See back or details. El PAY TO THE ORDER OF ACH Ra 083100277 JOHN BUSTA ROOFING INC. 305-757-2728 300 N.E. 91 STREET MIAMI SHORES, FL 33138 08-00 OAP" ,s0‘...ri.:740 Bankof America. •°7' FOR 11 20" 406 3 L00 2 ? 71: 00 3 7 30 23 280 211 DATE / -* **** 7 "e ), Z 1 eT' DOLLARS el 1720 83-27/831 FL 988 500.491.111re■ 1VP High Velocity Hurricane pone Uniform Permit Application Form 1 Section A (General Information) Master Permit No. Contractor's Name \109/1/19/1-.V4 Job Address (O/ 9h S ROOF CATEGORY ❑ Low Slope ❑ Mechanically Fastened Tile 1 Mortar /Adhesive Set Tile ❑ Asphaltic ❑ Metal Panel/Shingles ❑, Wood Shingles/Shakes Shingles ❑ Prescriptive SUR -RAS 150 ROOF TYPE ❑ New Roof ❑ ' Roofing ❑ Recovering > Repair ❑ Maintenance g 9 p r �. ROOF SYSTEM INFORMATION Low Slope Roof Area (SF) Steep Sloped Roof Area (SF) Total (SF) otte /ZS 1' rs Process No. Section B (Roof Plan) Sketch Roof Plan: Illustrate all Ievs and sections, roof drains, scuppers, overflow scuppers and overflow drains. 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Re- inspection fee is $50.00, which must be paid in advance before calling for another inspection. 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 herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that 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 without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether 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. BY: In consideration $f the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity �._.._, _.swings; 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 myself, my a ants or employes. `� )