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. Include dimensions of sections and levels, clearly
identify dimensions of elevated presiure zones and location of pars • ets.
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Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 10/23/2002
Applicant: MIAMI SHORES
Owner:
jp JOB ADDRESS: 602
Contractor JOHN BUSTA
Local Phone: 305 - 219 -9699
Parcel # 1132060141410
Sign
Fees:
FEE2002 -5935
FEE2002 -5937
Permit Status: Approved
Work: ROOF TILE REPAIRS
limed;
NE 96
Legal Description:
Description
Building Permit Application Fee
CCF
Total Fees:
Permit Expiration: 4/16/2003
Building Permit
Permit Number: BP2002 -1784
PREBYSTERIAN
ST
Contractor's Address: 300 NE 91 ST
(Contractnr nr Ri iilriprl
Page 1 of 1
MIAMI SHORES SEC 2 PB 10 - 37 LOTS 1 TO 10 INC BLK 61 LOT SIZE
Amount
$60.00
$1.80
$61.80
Construction Value:
DV.
$2,250.00
Total Fees: $61.80
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.
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.
`� )