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853 NE 96 St (7)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE ‘e a/el',l �f 6 Job Address 2S3 NE 76 S- 1 ree j Tax Folio Legal Description Historically Designated: Yes No Owner/Lessee / Tenant 1„01,vre t farm f /IG1r /ro Master Permit # 5 q;- e 0 Owner's Address Pc /1/X 76 lira P Phone /751 � 7� (� r 7 ,1vl 31V" 3// Contracting Co. l/.-( / (6 `Z Address ((( Qualifier SS# Phone State # Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION / , 1 Cc/lr' /�t/`j17� ,4) - f Aon f/l/1J* .f n (JX;!P (Cri»e ( Square Ft. Estimated Cost (value) a 000 WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I 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, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAV . I certify that all the foregoing information is accurate and that all work will ,be done in compliance with all applicable laws regula ' • g cons , ction and :. Furthermore, I authorize the above -named contractor to do i work staff ature of . -' er and/or Condo President Date Sign y, •f Con , tor or Owner- Builder Date Notary as to Owner and/or Condo President Date My Commission Expires: FEES: PERMIT RADON Notary as to Contractor or Owner- Builder My Comm. Exp iresr :,tY '! ,, �r:S.::QE. :i ©?AFin ::r: L El Dania C.C.F. NOTARY TOTAL DUE stic Date APPROVED: Zoning Building ' / �n} N�k Electrical Mechanical Plumbing Engineering PERMIT APPLICATION FOR MIAMI SHORES VILL, Date I 2 Y Job Address ? ki 0 — 6 1 co sr Tax Folio Legal Description Historically Designated: Yes Owner/Lessee / Tenant --V1„ I �– {yry /!7 Z— Master Permit # 1 /3 l CIS Owner's Address � Phone Contracting Co. 61/1/1/12A) Address Qualifier SS# Phone State # Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION ea ✓1\1 ± 1 O 1 ) 6 -(-3 5 V }' - ��JY� 04-7 N+ { D L )\vi j P31 4c -/se rN i h '�' Square Ft. Estimated Cost (value) WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I 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, SIGNS, POOLS, ROOFING and MECHANICAL WORK. 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. Furthermore, I authorize the above -named contractor to do the work stated. Signatur otary as t My Commi OgitAZ STATE OF FLORA COMMISSION NO. CC714103 MY COMMISSION EXP. M R. I FEES: PERMIT 0 RADON 0 Date Date 0 6 a() f Signature of Contractor or Owner- Builder Date Notary as to Contractor or Owner - Builder Date My Commission Expires: C.C.F. . g NOTARY 5 — BOND TOTAL DUE /6 APPROVED: Zoning Building Electrical Mechanical Plumbing Engineering Page 2 IMPORTANT NOTICES 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. 1. 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. ATE Signature of • ner to 1 0 d subscribed before me thi� No Public - "my to o S \ Print Name , W ,. gnature SEAL: ORIDA, C 0 d PAY PUS <i 6P:C.'LA o 2 t l ,� rt COQ ^ . E . li C C 7 9 7 Personally knotivry _ "�C :-i eF FA Type of Identification Produced: TY OF MIAMI -D Florida PERMIT APPLICATION STATE OF FLORIDA, COUNTY OF MIAMI -DADE Signature of Contractor / Qualifier Print Name Sworn to and subscribed before me this day of Signature of Notary Public - State of Florida SEAL: 396 0. -ce ut ddcmiili anon Personally known OR, Produced Identification �. fi R S 2.537 , 3 Type of Identification Produced: PROPERTY OWNER ��� \ N ame 1 1445 1042',' vo z Address 8 i, 0_ 96 ST Home Telephone [ /// 3,0 5 f cF Business Telephone 2D .„ 2 2 j " zoo 7 a 1 � Fax 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 jS Job Address: PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other 2 NE J% 141/4-)-7; Sh s Apt. City Address Folio Number .- Description of Work Pl 411 .5 Lot Block Subdivision PB PG Zoning Current Use of Property Square Feet Proposed Use of Property Value of Work Tenant Information PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Flood Zone Master Permit No. Subsidiary Permit No. ?) , .20(2a. -7i9 50 Tax Assessed/Appraised Value PERMIT APPLICATION State Zip Linear Feet Units Floors Bldg Value Base Floor Elev. ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. Address Telephone Fax Qualifier Name PAY TO THE ORDER 0 .•1 Miami Shores Village 10050 NE 2nd Avenue Phone: 305 =795 -2204 Permit Number: BP2002 -789 Printed: 4 /18/2002 Applicant: LUIS & IRENE Owner: JOB ADDRESS: 853 NE 96 Contractor Local Phone: Parcel # 1132060142820 Permit atoll lc LUIS O. HERNANDEZ OR IRENE HERNANDEZ 853 NE 96TH STREET MIAMI SHORES, FL 33138 Building Permit HERNANDEZ ST Contractor's Address: Legal Description: 5 - 6 53 42 MIAMI SHORES SEC 3 PB 10-37 LOTS 23 -24 BLK 74 LOT SIZE Fees: Description Amount FEE2002 -2263 Building Permit Application Fee $60.00 FEE2002 -2264 CCF $1.80 FEE2002 -2265 Notary Fee $5.00 Total Fees: $66.80 Total Fees: $66.80 Total Receipts: $0.00 FIRST UNION NATIONAL BANK GAINESVILLE, FL 32601 -3337 63 -2/630 MEMO 11'00383911' 1:06300002LI: 998 2 240 2 2 21' 64/73/0?-- 1839 DOLLARS 8 It - inspection yr in strict compliance with all ordinances peen submitted to and approved by the ut authorization. A further condition upon - s and regulations pertaining to the work vants or employees. thereto and in strict conformity with the cork done by either myself, my agent, MIAMI SHORES VILLAGE Paint Color Approval and Agreement DATE: /�6 OWNER'S NAME: / l ?.'dvvDgr Z PHONE: 6 22-962da ADDRESS: # 5 3 A 1 - 7.6 j ?' ********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ADDRESS OF SITE: 053 Ne ?6 S r CONTRACTOR & LICENSE (if applicable) COMP ANY NAME: PHONE: ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All Elem on the site must be listed and indicate the color to be painted. Walls Fascia �1 Drip Cap/D • . Edge _61 C ELI /ice Soffit Roof �re,,ure e�a�1 Flower Bins Al Shutters Awnings Chimney Doors and door jams '•\ Garage Doors Railings Fences Decorative Metal All brick (simulated or regular) Stucco Banding %) / Any other stucco features J 1 ))- Accessory Buildings / )41, Other l/Vt 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. rthermore - - paint colors will be as per the attached k1 • mple� 7.1W„ E / ignature o i wner * * * * * * * * * * * * * * * * * * * * * ** APPROVED: Building Of cial Date crl H H e t f /i Q Signature of Contractor Date ********* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION 4/23/01 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/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. 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 D • TE Zonin: 4eirffiii /fiff 0 Electrical Mechanical Plumbing Fire Public Works Structural - 7.-- , ). Building Official qj 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) ❑ OTHER (Specify & Attach) PERMIT FEES $3.00 per page (Scanning Fee) Miami Shores Village Bond $ 60 Metropolitan Dade County (C.C.F.) $ Inspector State Educational Fund $ State DCA (Radon) $ Code Enforcement Fine $ Zoning Revie $ S r O � 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 $ /, e 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