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853 NE 96 St (6)PROPERTY OWNER Name L-cU s 4.n /A✓l/o a. Address .?-33 i /' 96 3r 7 /4?(A..�'I ( 51-10,&) -61 S //,' Home Telephone 5%,7 5 7 5 V' TeP/ Business Telephone 3 e6 5 9--5y 6, )11 Fax 3 (1 rsv v'7-7 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. 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: Folio Number PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other 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. Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Master Permit No. Subsidiary Permit No. � , S 0 City Pr State Description of Work ((, / FOPIKi_ PERMIT APPLICATION Zip Lot 'N a\t Bloc1-71 `1 Subdivisiof PB 0 P(1 Zoning Linear Feet Current Use of Property Square Feet Units Floors Proposed Use of Property PS/ 06'7"C Value of Work /( COO / / Value Tenant Information Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT CHANGE (✓ ) ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. Address Telephone Fax Qualifier Name Page 2 II\IPORTANT 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, P' 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. i ST - TE •1 FLORIDA . • .� • :II • -DADE 40 ‘fir .401 g ature o Owner 41 % bo. O Print Name A t • rid subscribed before me this day of n�`-� Sworn to and subscribed before me this day of J �. L �' phi ��� � L Print Name • Signature o otary Pub 'c - State o Florida SEAL: STATE OF FLORIDA, COUNTY OF MIAMI -DADE Signature of Contractor / Qualifier Signature of Notary Public - State of Florida SEAL: PERMIT APPLICATION Personally known OR, Produced 15Ient ifieatioft / cc - • - personally known OR, Produced Identification Type of Identification Produced'LJ) Z , J v1 S3 pe of Identification Produced: JOB ADDRESS \PPLICANT 'HONE tT APPUCATION • SHEET OF' MISCELLANEOUS DATE t 0 1 7 01 ?(5f Fiv OL FE ) c 6 ZONING . ,a CRITIQUE SHEET COMMENTS Axlro 0.51 'Is G9 6cks ►'-t Lts7 b c S se 1 - c e1asC,A/f S Aa t,J e(eu dyon (h de t ti 3 -01 e_ e \ •- Y•>or +Nit (no,' /.t s', S�(f c.( - fe46 S IOC-K-01)6- wts L act PERMIT NO. ADDRESS: MIAMI SHORES VILLAGE BUILDING / ZONING DEPARTMENT' SECTION DATE ZONING ELECTRICAL MECHANICAL PLUMBING FIRE PUBLIC WORKS STRUCTURAL BUILDING OFFICIAL BY 2 1. Subjact to cocnptlaum with eft Federal, State. Comty,WWlaae rides tad mutations. Yittage USX= no responstbllIty for eccurecy otter resutts from these plans. 2. ThIs copy of plans moat be `Ya1ItSt• oa botching site or no Inspection Mil be conducted. INITIALS " orna $te v f j-( 6e9 515-3 jU. e . ` �( 5 JOB ADDRESS APPLICANT ' I ,N 2. PHONE # APPUCATION DATE DU.NI.N% . CRITIQUE SHEET SHEET OF • MISCELLANEOUS COMMENTS V-11 ax I twit IAE _ e 0 . 5 1 - 5 1 6 0A-es t‘-t t.A.ser b ch s PERMIT NO. ADDRESS: MIAMI SHORES VILLAGE BUILDING / ZONING DEPARTMENT SECTION BY D ATE ZONING ELECTRICAL • MECHANICAL PLUMBING FIRE PUBLIC WORKS STRUCTURAL BUILDING OFFICIAL 1. Subject to compliance with alt Federal, State. Co ady,Yitlage rules end regulations. Winge assumes no responstbIlIty for accuracy otlor resutts front these flans. 2. This copy of plans oust be ' on budding site or no tnspectlon 'Mil be conducted. INITIALS " o rn g stei>k I 19-( 6e� se(-c IBstfictV �1f Stto tAi e (e v'dion C h c dei 4A1 ccSt farm e . 54 [r1L f"ea r • e - r`e' si ( M uni Sizoreo AFFIDAVIT STATE OF FLORIDA) COUNTY OF DARE) The undersigned Affiant, 5 41A/A1/ i does hereby attest that the (property owner) attached survey, performed by 4/06t)4 S1-(7/-0 o' (name of surveyor's comp ny) performed on ©a f / C ?' , is an accurate representation of the existing conditions and (date of survey) 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 p 4 is ffiant/Pro. Further, Affiant sayeth naught. • �l w;JtS��a itb •l C 41.1 )‘ Witness(sign and print) Witness(sign and print) SWORN TO AND SUBSCRIBED before me this day of a-. v Affiant is personally known to me, oduced � P 4 4 'SS'y _�La� identification. Sunshine State 6 5 0 4 4 824 v oopez M 011-02-62 M 640 A6 ag og t OZ� sxre Oyes best toques by taw. A,Y I " i s NW. 'TM 611 suas 'V uti.tAi. FlefluDA 04111g IfitottotIr: (300) 22%3171 Fla ( te" ID: Nona purtittpro LAND SURVEYORS SKETCH OF SURVEY Scale I" JUN 05'98 f:1■10.!0C ?,1.1• 11, I. • • • • • . • • • • • . • ••• • • • • • • •• 9(.7 6.09 • • arIET RP • 2 • • ••• ••• sows, wo • • ••• ec .°' : : . . 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V -.? 1 1 — • . n a I X ' >�S Woc.!) _ Top r ►t (1 ►.1 e IJ 1 ? • • • • • • ••• • • • • • • • • • • • • • • • • • • • • • •• • • • • • • • • • • • • • • • • • • • • • • ••• • • • . • ••• ,it‘C..•.'- 1 t „11 ■ • • • ••• • • •• • • •• • • • •• • • • • • • • • • • ••• ••• •• • • ••• d•• lb• I. •• ••• •• (9 • • • • •• • 1-10:141:0 • • • • • • •• • • • • • ••• •• D' 2� d • ( 2 4.X to fl<<cn "1 `elf n 41)!..1 5'-O" MAX 2' -0" Owner's Side 4 — l' -O"— WOOD FENCES " X 4" Wood post 2" X 4" Wood kad I" X6" or I" X8" Wood Pickets Concrete d ° °I1- =III III= 1 =111 ° ° 111= 11 =1 3' -0I 2915 Fences Wood Posts 4' -0" High or Less = 6' -0" O.C. 5' -0" High or Less = 5' -0" O.C. 2915.1 Wood fences, so located on a property that by zoning regulations they cannot be used as a wall of a building, shall be constructed to meet the following minimum specifications. (a) Fences not exceeding 5 feet in height shell be constructed to meet the following minimum requirements: from nominal 4 inch by 4 inch by 8 feet -0 inch long posts sp&ced 5 fee -0 inches on centers, having a fiber stress of 1200 p.s.i. in bending, and shall be embedded 2 feet -0 inches into a concrete footing 1 fcot -0 inches in diameter and 3 feet -0 inches deep. Other components shall be designed to comply with the provisions of this Chapter and Chapter 23. (b) Fences not exceeding 5 feet and 4 feet in height respectively shall be constructed as provided in paragraph 2915.1 (a). herein, except that the spacing of posts may be increased to 5 feet -0 inches and 6 feet -0 inches on centers for these heights. ELECTRICAL 'I'YI'. Minimum Fee QTY' TYPE Dryer QTY T'Y'PE 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/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 Supply, AC Well Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Temporary Toilet PLUMBING TYPE A/C Condensate QTY. TYPE Drains, Roof QTY. 'l'YI'E 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 er..(e6. DATE /.2Ac /cy Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official �1 /2- Z/- Page 4 OFFICE USE ONLY CIIECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) 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 ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) $ 4 a 7 S oa ISSUING OFFICIAL REVIEWED AND PREPARED BY: (sq.ft. = x/1000 x ¢.60) (¢.005 /sq.ft.) (¢.01 /sq.ft.) PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) 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