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700 NE 96 St (8)E}te a of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein describ made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of ail ceufn aces of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with. whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. Owner's Name and Address /8p aF 2 - - I 10 % L E 2 Registered Architect and/or Engineer 1L Name and address of licensed contractor Location and legal description of lot to be built n: Lot � Block Subdivision y Street and Number where work is to be done MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT .ATION FOR BUILDING PERMIT 796 2' C fI J - Remarks (Signed)X Signed )X STATE OF FLORIDA COUNTY OF DADE. ss. Before me. the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments. personally appeared Date Date Notary Public, State of Florida 7 5 /- Q //a- No % e>o Street !/✓ r/ 91 State work to be done and purpose of building (by floors), state exterior colors (submit samples) 4 ✓1 X02 /✓) /p1/ 7 i "/ G CJy1 /S7/ MOnN6L w ) T and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering stimated Total cost of improvements S �c' - 6740 Amount of Permit S . --7,7Te Zone cubage required Plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all plans and specifications for said building. All notices with reference to the building and its construction may be sent to The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatons as an employer of Labor under the Florida ■Vorkmen's Compensation Act. being Section 5966, Compiled General Laws of Florida, Permanent Supplement. and has complied with the provisions thereof. and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit: and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors. on work to be performed under this permit, as are licensed by Miami Shores Village. to me well known. and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction. that he has carefully read the foregoing application, and that he did sign the same. and that all facts therein by him stated are true. Permit No. 743 f Date ' .1 i Read. Sworn to and Subscribed before me. Disapproved (Signed) Building Inspector My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approved Date Disapproved Date NOTE: A charge of $25.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re- inspection fee of $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and/or workmanship. 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 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. K Print Name A Print Name Sworn to and subscribed before me this ,F� 4 day of , Sworn to and subscribed before me this day of Signature of Nota SEAL: Personally known FLORIDA, COUNTY OF ,.��'�`p"% Stephen R C,urt - .Ul o`'^°% = cotnrttission * DD 01711 - _? ` ' ' Expirts Oct. 1, 20135 - �� •a BorIci I Thr o ',FOF s Atlantic Bonding Ca, Inc. OR, Pi Identification Type of Identification Produced: STATE OF FLORIDA, COUNTY OF MIAMI -DADE Signature of Contractor / Qualifier Signature of Notary Public - State of Florida SEAL: Personally known - Type odentificatiogProduced: PERMIT A# LICATION G o �\ Oft, Produced Identification PROPERTY OWNER /� Name X,(p ♦_ i eel: /e Address ?et% ,�l o N. A: 96 S of e e7 4 / I I tr <.�oot S .4 33/3 Home Telephone Business Telephone _ 4,15 _ , 34 -• / 7 ve Fax 3' - 7 57 -91177 TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'l Attachment Other Add'1 Detachment Other INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. X , Job Address: 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 applicatioq 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. A PPLICATION 7o o N. g. •6 r oee e 7 0,4* ' if /l oR es /7 Address Apt. City State Folio Number k Description of Work 49/All / N9 Lot Block Subdivision PB PG Zoning Linear Feet Current Use of Property Square Feet Units Floors Proposed Use of Property �( Value of Work 4 ,..S O V Bldg Value Tenant Information , \ Tax Assessed/Appraised Value Flood Zone Base Floor Elev. 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 PERMIT APPLICATION Master Permit No. Subsidiary Permit No. 33, 38° Zip ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. Address Telephone Fax Qualifier Name ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. TYPE Outlet, Appliance QTY. TYPE Service Repair QTY. A/C Central 1 -3 Ton Dryer Vents, Number of Fan Ventilation, Cost Outlet, Wall Ductwork, Cost of Service, Temporary Periodic Inspections A/C Central 4 -7 Ton Fire Sprinkler System Fire Pump Outlet, Switch Fireplaces, Number of 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 QTY. Minimum Fee 'TYPE i Condensate Drain QTY. T'YI'E Generator QTY. 'fYI'E QTY. Refrigeration, Tons A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Win. 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 Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel PLUMB'N TYPE A/C Condensate QTY. TYPE i 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: SECTION BY , eV/VC Zoning 1�'� Electrical Mechanical Plumbing Fire Public Works Structural Q Building Official l l Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) 0 FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) ❑ PROOF OF OWNERSHIP (Attach) O HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) PERMIT FEES $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 (sq.ft. = x/1000 x0.60) $ (¢.005 / sq.ft.) $ (¢.01 /sq.ft.) REVIEWED AND PREPARED BY: ISSUING OFFICIAL 2 TOTAL $ 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 Village of Miami Shores 10050 NE 2nd Avenue Miami Shores, FL 33138 Phone: 305 - 795 -2204 Printed: 2/14/2002 Applicant: LOIS Owner: BUTLER Contractor Local Phone: Parcel # 1132060142110 Job Address: 700 NE 96 ST Fees: FEE2002 -960 FEE2002 -961 Description Amount Building Permit Application F460.00 CCF $0.60 Total Fees: $60.60 Permit Status: Approved Permit Expiration: 8/13/2002 Building Permit Permit Number: BP2002 -329 Address: Cellular: BUTLER LOIS Legal Description: MIAMI SHORES SEC 3 PB 10 -37 LOT 9 Construction Value: Work: EXTERIOR PAINTING AS PER AGREEMENT (OWNER BUILDER PERMIT) If there is no permit package accessible on the job -si__ fee is $50.00, which must be paid in advance before cal This Permit is granted to the contractor or builder named above to con: ordinances pertaining thereto and with the understanding that the work w and approved by the proper municipal authorities. This Permit may be re authorization. A further condition upon which this permit i granted is the ordinances and regulations pertaining to the work c. » hereby wheth( o by his agents, servants or employe Signed: (INSPECT( • In consideration of the issuance to me of this permit, I agree to perfon with the plans, drawings, statements or specifications submitted to the I myself, my agent, servants or employes. $500.00 Page 1 of 1 DUDLEY R. WELLS LOIS H. WELLS 700 NE 96TH ST. 305 - 756 -5667 MIAMI SHORES, FL 33138 -2520 Y. Washington Mutual Washtn 0n Mutual Bank, FA Miami Shores flnanctal Center 1722 Miami S F 33 1.800.788 -7000 38 24 now Customer Serves Virr rrr PA t 1tr fyr. E Y e Zcsi 1 1: 2 6 7081113 1i:8 3 4th0685Oman' 0677 (Contractor or Builder) BY: Total Fees: $60.60 Total Receipts: $0.00 BLK 68 LOT SIZE SITE VALUE 6 3- 8413/2670 8340685178 t 1rE6�+� 1 r. nY l O ()-00.2, $ ( Go). �, 4 - ,t , 1liIIAMi SNORES VILLAGE Paint Color Approval and Agreement DATE: � r) 1 '4 i a-o c� 4._ OWNER'S NAME: t, e 1 s 34. '�� i--- a PHONE: 3 v s- 7 S c 5 7 ADDRESS: ?d Q N , Cr Sr 3� 5 - 9 S a�3 G * * * * * * * * * * * * * * * * * ** * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * >l< * * * * * * * **** ADDRESS OF SITE: CONTRACTOR & LICENSE (if applicable) COMPANY NAME: PHONE: ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All Elements on the site must be listed and indicate the color to be pain* Walls 1 1z) 1 1 - < << 5 ; koft p Fascia t 1-(D d \�\ Drip Cap/Drip Edge Soffit ( 43 q - � 1 •1 P r-p Roof Custard Flower Bins Shutters Awnings N a— I c ra_e- Chimney Doors and door jams Garage Doors , it - a- c ;i s -gyp Railings w ai '� t Fences Decorative Metal w All brick (simulated or regular) L Stucco Banding E(, C , � E'E<< c REAM VVN. 21 Any other stucco features Accessory Buildings ,_, t--t t,..} -e, -, s. r e- Other accurat OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. I authorize the above -named contractor, if applicable, to do the work stated. Furthermore , the paint colors will be as per the attached samples. 2( Signature of 4 Iwner Date Signature of Contractor Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED: /fad Building Offi 'a 1 Date - Z 1 f_cJ 'Z WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION 4/23/01 MIAMI SHORES VILLAGE Paint Color Approval and Agreement DATE: ':-= C- S41--v 121 OWNER'S NAME: Lois p, 0, rL re PHONE: 3 o S- 7 5‘- t> 7 ADDRESS: 76 0 fq et c„ kk--P r 61- /-r s a c� Fes• 3 i 3 p ********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ADDRESS OF SITE: CONTRACTOR & LICENSE (if applicable) COMPANY NAME: PHONE: * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All Elements on the site must be listed and Walls 6'0 c 7) Fascia PP o G 7 Drip Cap/Drip Edge Soffit Roof Flower Bins Shutters Awnings Q! Chimney Doors and door jams Garage Doors P PO Railings aa �a Fences Decorative Metal 4a) I All brick (simulated or regular) t Stucco Banding Any other stucco features Accessory Buildings � j-t r s Ai N Rot) s c' Other — i 1 -o 'a. icate the color to be painted. OWNER'S AFFIDAVIT: I certify that all the foregoing information is ... e and that all work will be done in compliance with all applicable laws regulating construction and zoning. I authorize the above -named contractor, if applicable, to do the work stated. Furthermore , the paint colors will be as per the attached j es i ce . Afilli . i • atu o f Owner Date Signature of Contractor Date * ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED: WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION Building Official Date 4/23/01