BP-03-25PROPERTY OWNER
6
N d „ , : , 7 ,,,,,,,,,
Home Telephone.
Business Telephone
Fax ;
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
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 submitted
along with this permit application.
Step 2. Submit the comple appli cation 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.
Step 1.
Job Address: ' C ' C 42 ' 7 , #9 )2/‘ o S 0 ro c
a Address Apt City State Zip
Folio -3a0 Number i ! ‘ --O 1 q t q `V Descripfio of Work �NS ' .t �. �'L a 0 N
Lot ) . � / a Block 4 ( p ®dI ,� �` 1' C6 d 4 U. )b.Q
,_
Subdivision a S 0A& PB 10 73',1°G
Current Use of Property C O ir► PT I
Proposed Use of Property ,S4 r
Tenant Information
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
1
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
Zoning Linear Feet
Square Feet 'e E' 0 Units L Floors /
Value of Work 1 ? S 0 O Bldg Value
Tax Assessed/App Value
Flood Zone
ARCHITECT
Name
License No.
Address
Telephone
Master Permit No
Subsidiary Permit No.
ENGINEER
Name
License No.
Address
Telephone
Fax
CONTRACTOR
Name
License
Qnatifier ltame v
Address r e2 ® .1 ( 3
J
Base Floor Elev.
PERMIT APPLICATION
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, 1a 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 Co i c u • n Lien Law and
Choosing a Contractor.
SEAL:
Personally known
Print Name
Sworn to and subscribed before me this/ 7 day of
.
.
Signa •r otary Public - State of Florida
ro 4 7 - '1_ AA M. MCLEOD
SSION # DD 012023
EXPIRAp1144:005
or F∎ e Bonded Thru Budget Netat11§
Type of Identification Produced:
OR, Produced Identification
STATE F FIR D , •
Print _ _
Sworn to and subscribed before me this
0' .
•
Signature of Notary Public - State of Florida
SEAL: �o tn �, ° NINANL M(+ZOD
MY COMMISSION # DD 012023
EXPIRES: April 4,2005
r nder.Thruauc ?st<rn
Personally known - OR, Produced I. r r cation
Type of Identification Produced:
PERMIT APPLICATION
) day of
-DADE
wo 1/ .
• ./1-y14
Convection
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305 - 795 -2204
Building Inspection Request
Date Time
Type Insp'n D 00 )
Permit No
Name I f' "FL
Address 20 IN
Compan
Phone #
For Inspector. Name & D to
Approved,
Re- Insp'n Fee ❑
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305 - 795 -2204
Building Inspection Request
Date Time
i
Type Insp'
^ Permit No.
Name
Address
Company
Phone # ( /
For Inspector: 0 0 Name &
L�J
Re- Insp'n Fee ❑
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date 1 D Time
Type InsP'
Permit No.
Nam -
Addre
Company ` I
Phone# � S`l ^ � / - 7 L3
For InspectorR/ 221 3 Name & Date
Approved
Correction
Re- Insp'n Fee
J°L
Dat
Type Insp'
Permit No.
Name
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Address_ - 0 4K
Company o� f�
Phone # 1 111
For Inspecto 13103 j3
Approved
Correction
Re- Insp'n Fee
Time
Name & Date
G-aG ei. -
//b s us
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 1/7 /2003
Applicant:
Owner:
JOB ADDRESS: 602 NE 96
Contractor J & K ROOFING INC
Local Phone: 954 - 961 -7663
Parcel # 1132060141410
Permit Status: Approved Per cvniration: 7/6/2003
Work: INSTALL ROOF ON MC
If there is no permit package
fee is $50.00, which must be pa'
This Permit is granted to the contracto, 3
ordinances pertaining thereto and with th'
and approved by the proper municipal a g
authorization. A further condition upon v °
ordinances and regulations pertaining tc
by his agents, servants or employees. a
Signed:
In consideration of the issuance to 1
with the plans. drawings. statements
myself. my agent servants or empbj
Signed:
PAY
TO ORDER OF
S[
1
Building Permit
Permit Number: BP2003 -25
ST
Contractor's Address: 2013 LEE STREET
Legal Description: MIAMI SHORES SEC 2 PB 10 -37 LOTS 1 TO 10 INC BLK 61 LOT SIZE
Fees:
FEE2003 -121
FEE2003 -122
FEE2003 -123
Description
Building Fee
Buildier's Bond
CCF
Total Fees:
Amount
$300.00
$300.00
$9.00
$609.00
Total Fees: $609.00
Total Receipts: $0.00
Construction Value: $14,500.00
J AND K ROOFING LEE ST G INC.
PHONE 954 - 961 - 9879410
i
#49A4Ac?---,,,,~46/ .........
v 2000 14 28 ' -.
Page 1 of 1
ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPE
Dryer
QTY.
TYPE,
Outlet, Appliance
QTY.
TYPE
Service Repair
QTY.
A/C Central 1 -3 Ton
Fan
Outlet, Wall
Service, Temporary
A/C Central 4-7 Ton
Fire Pump
Outlet, Switch
Signs
A/C Central 8-15 Ton
Fixture - Fluorescent
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
QTY.
TYPE
Generator
QTY.
TYPE
Refrigeration, Tons
QTY.
A/C Central, Tons
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
Supply, AC Well
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
.
PLUMBING
TYPE
A/C Condensate
QTY.
TYPE
Drains, Roof
QTY.
1'YPE
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:
Page 4
OFFICE USE ONLY
CI- IECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
❑ PROOF OF OWNERSHIP
(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
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
PERMIT FEES
3oc»-
c L )
SECTION
Zoning
Electrical --
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
BY
DATE
(sq.ft. = x/1000
x ¢.60)
(¢.005 /sq.ft.)
(¢.01 /sq.ft.)
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL
REVIEWED AND PREPARED BY:
PERMIT APPLICATION
o
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