90 NE 96 St (3)Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
ing or other structure herein described. This application Is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
regulations of the iuilding 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
STATE OF FLORIDA,
COUNTY OF DADE. j ss.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Disapproved , __.. .4 Date
(Signed)
Building Inspector
- �.`- g'z
Nsid" ._ . Street- /64
Registered Architect and /or Engineer /0 ... ... ... ._- .. .. ...
Name and address of licensed contractor...0.1
Location and legal description of lot to be built on:
a
Lot...../ ub
Block ..r division /
�.. /d'/
.....—.._.._ _. --
Street and Number where work is to be done — -
State work to be done and purpose of building (by floors) �i� �.S...,tC _.. .__..._........_......_.._..___ _
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories....'..
�-'.� r/ �
To be constructed of. +
,��.�.:.. Kind of fou ndation ....a�'..��..4.Z?..�d,�l` Roof Covering �.....,rr�"'r�
..�.t_
Estimated Total cost of improvements $ � 47 °< 7 $ A of Permit . • OD _
Zone cubage required 0/600 _...._.._....Plan Cubage 3 �
Distance to next nearest building. Size of Building Lot ®6 . /.. v 0--
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to.,ld..r,7 7s2 ' 4f" ., ../ ' T. �., O 49 cz26
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen'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 employe by hint
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
pennit, as are licensed by Miami Shores Village. •
Remarks..._ (Signed).._- ..... 4 ?- - /XGi'e - 4)
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared _..
- _- 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. ) I
Permit No.- __ob.i Date '......
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member ...... Member ...._
Council Approved Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning
A re- inspection fce of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
Legal Description:
Lot: /
Comments:
APPLICATION FOR CERTIFICATE OF RE- OCCUPANCY
I r/ ' � ► n n 1rp
to re- occupy the single family residence known as : (address)
6 10 A/6 96 57' . , Miami Shores, Florida_
Block
I hereby certify that I understand that the zoning of the property is for single - family residential use
and that it is unlawful for more than one family to reside therein. I also understand that any
Certificate of Re- Occupancy that may be issued by Miami Shores Village, certifies only that the
referenced property is being used for single - family purposes and that such Certificate does not .
constitute any representation, warranty or certification as to the condition of the dwelling or other
structures on such property.
Applicant Date j1 - 2 F9
Print Name iri' ,G J / a r e
* * * * * * * * * * * * * * * * ** * s****************s********* * *** *s * * * * * * * * * * * * *s *== * * * * * * **
For purposes of conducting the inspection required by Section 902 of the Miami Shores Land
Development and Zoning Code, please contact:
Contact Name: C / rAtzLev
Buyer Seller Realtor \r • Company Nam
Application Fee (S50) pai Cash) ao• 6)6) Check No. _
Inspected by: F. wive of
/ 40,A
Wok 19M
, hereby apply for a :ertificate
PB &PG: /3/5 - 391q -
Telephoi<W6) �.. O 3C /0
tA/ tv�
Approved V Denied Date 1 ,2- R
?AGE . OF 2
CER111 1C ATE OF RE- OCCUPANCY
On behalf of Miami Shores Iiillage, Florida, the undersigned certifies that the property
described in the above application has bee inspected for purposes of re- occupancy pursuant to
Sections 901 and 902 of the Miami Shores Land Development and Zoning Code and that such
propery may be re- occupied by the above applicant for single- family residential purposes.
MIAMI SHORES VIT.T,AGE, FLORIDA
By
THIS CERIIF!CATE VERIFIES THAT THE REFERENCED
PROPERTY HAS BEEN INSPECTED BY MIAMI SHORES
VILLAGE AND HAS BEEN DETERMINED TO PRESENTLY
COMPLY WITH THE SCHEDULE OF REGULATIONS OF THE
MIAMI SHORES LAND AND DEVELOPMENT CODE
PERTAINING SOT.FLY TO THE REQUIREMENT THAT EACH
ONE- FAMILY DWELLING IS USED AND INTENDED TO BE
USED FOR A ONE - FAMILY DWFT ZING PURPOSE ONLY;
HOWEVER, THIS CER111k1CATE DOES NOT CONSTITUTE ANY
REPRESENTATION OR WARRANTY AS TO THE CONDITION
OF THE DWELLING OR OTHER STRUCTURES ON THE
PREMISES DESCRIBED HEREIN, OR ANY ASPECT OF SUCH
CONDITION, AND LN PERSONS ARE ADVISED AND
ENCOURAGED TO MAKE THEIR OWN INSPECTION OF THE
PREMISES IN ORDER TO DETERMINE THE CONDITION,
THEREOF.
PAGE 2 OF 2
Date of Certification: (,L - 2 -? 7
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: BP2003 -325
Printed: 2/26/2003
Applicant: ARI LYNN
Owner: TURNER
JOB ADDRESS: 90
Contractor
Local Phone:
Parcel # 1132060130600
Fees: Description Amount
FEE2003 -1212 Building Permit Application Fee $60.00
FEE2003 -1213 CCF $1.60
FEE2003 -1214 Notary Fee $5.00
Total Fees: $66.60
Total Fees: $66.60
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration:
Work: REPAIR OF TOW CRICKET AREAS
If there is no permit package accessible ort.2t3e 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.
Signed:
In consideration of 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
with the plans, drawings, 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 agent, servants or employes.
Signed:
t
1
NE 96
Building Permit
TURNER
ARI LYNN
ST
Contractor's Address:
Page 1 of 1
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 1 & 2 BLK 5 LOT SIZE 106.20 X 143.00
8/25/2003 Construction Value: $1,600.00
(INSPECTOR) BY:
(Contractor or Builder) BY:
REG COI 022603 1446 i9C #01 005129 DIRGE
$66.60
SECTION 1524
HIGH VELOCITY HURRICANE ZONES REQUIRED OWNERS NOTIFICATION FOR ROOFING
... • .COi\'$IRERATI ON S
•. .• • • • •. .• •
• 1524.1 As it pertains to thi3 sec ti44„it s,tke resportsjbility of the roofing contractor to provide the owner with
the required roofing permit, and to explain to the owner the content of this section.. The provisions of Chapter
15 of the Florida Building Code, Bui!din$ govern the minimum requirements and standards of the industry for
roofing system installations.'AAdditro4aty, tie AiloVng items should be addressed as part of the agreement
between the owner and the contractor. 7 ►d ow4e4s jnyial in the adjacent box indicates that the item has been
•
explained.
Aesthetics- �Voi'l�mair� rid �'111e� vIdrlary Mship provisions of Chapter 15 (High Velocity Hurricane
Zone) are for the purpose of F¢oyidir ikit Elie rooting system meets the wind resistance and water intrusion
performance standards. Aestheti8s ('ap atai ee) issues are not a consideration with respect to workmanship
provisions. Aesthetic issues such as color or architectural appearance, that are not part of a zoning code, should
be addressed as part of the agreement between the owner and the contractor.
X 2. Renailing Wood Decks: When replacing roofing, the existing wood roof deck may have to be
renailed in accordance with the current provisions of Chapter 16 (High Velocity Hurricane Zones) of the Florida
Building Code. (The roof deck is usually concealed prior to removing the existing roof system).
A 3. Common Roofs: Common roofs are those which have no visible delineation between neighboring
units (i.e. townhouses, condominiums, etc.). In buildings with common roofs, the roofing contractor and/or
owner should notify the occupants of adjacent units of roofing work to be performed.
b k 4. Exposed Ceilings: Exposed, open beam ceilings are where the underside of the roof decking can be
viewed from below. The owner may wish to maintain the architectural appearance, therefore, roofing nail
penetrations of the underside of the decking may not be acceptable. The Florida Building Code provides the
option of maintaining this appearance.
5. Ponding Water: The current roof system and/or deck of the building may not drain well and may
cause water to pond (accumulate) in low -lying areas of the roof. Ponding can be an indication of structural
distress and may require the review of a professional structural engineer. Ponding may shorten the life
expectancy and performance of the new roofing system. Ponding conditions may not be evident until the
original roofing system is removed. Ponding conditions should be corrected.
v Overflow scuppers (wall outlets): It is required that rainwater flow off so that the roof is not
overloaded from a build up of water. Perimeter /edge walls or other roof extensions may block this discharge if
overflow scuppers (wall outlets) are not provided. It may be necessary to install overflow scuppers in
accordance with the Florida Building Code, Plumbing.
■Islool■ . Ventilation: Most roof structures should have some ability to vent natural airflow through the
\ interior of the structural assembly (the building itself). The existing amount of attic ventilation shall not be
reduced. It may be beneficial to consider additional venting which can result in extending the service life of the
roof.
wner's /Agent's Signature
CADOCI51C•M eLOCALS•I∎Tme3ECTIOS 13:i.doc
O2. / Zc, / C�3
Date Contractor's Signature
OWNER BIJJLDE.R.UIS.CLOSURE STATEMENT
1• • • • • • ••• •••
K 1 4r, Lynn I u rn6r being the legal property owner, for the property
Located at: X acs N.E. 96 , PICtMI' Skew FL 33138 ,
Legally described as " � /( , 0 Ce , V
Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws f the
State of Florida, F.S. 489.103(7), and I have read and understand the following disclosure
Statement, which entitles me to work as my own contractor, I further understand that I as the owl ner
must appear in person to complete all applications.
State law requires construction to be done by licensed contractors. You have applied for a permit under an
exemption to that law. The exemption allows you, as the owner of your property, to act as your own contractor
even though you do not have a license. You must supervise the construction yourself. You may build or
improve a one - family or two - family residence or a farm out - building. You may also build or improve a
commercial building at a cost of $25,000.00 or less. The building must be for your own use and occupancy. It
may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the
construction is completed, the law will presume that you built it for sale or lease, which is a violation of this
exemption. You may not hire an unlicensed person as your contractor. It is your responsibility to make sure
that people employed by you have licenses required by state law and by county or municipal licensing
ordinances. Any person working on your building who is not licensed must work under your supervision
and must be employed by you, which means that you must deduct F.I.C.A. and with - holding tax and
provide workers' compensation for that employee, all as prescribed by law. Your construction must comply
with all applicable laws, ordinances, building codes and zoning regulations.
Proof of ownership provided ( ) initial of reviewing clerk. The foregoing instrument
Was acknowledged before me this2 r0 day of _, 200 3
By
Produced ' 2 Fa OP -474 ?? as identification and who did take an oath.
Owner
• • ••• • • • •••
: •� ' Q'F' MIAMI SHORES
• • • ••• • .
• • ••••••• ••••
• BUILWNQ IMPARTMENT
•• ••• •• • •
• • • • • • • • • • • • • •
• • • • •
• • • •• ••••
••• ••• • • •
• • •
DISCLOSURE STATEMENT
V who is personally known to me or who has
4. Angela M Becker
a My Commission 00150048
w a Expires November 16, 2000
' Sta e
•
•
ARI'LYNN TURNER
J kSURE �•�
BAY ' VG. FL 33141 - 1 T C50
.Alt 01 01010 SE. *10MI gj101[0005 1L000SEM[0R
09 -19 -67 F 5 -04 A
ICE0SE 1001MBEP nweD 08 -21-92
T656- 012 -67- 839- 0E.o4w 09 -19 -98
CLASS: E
SAFE DRIVER w1t' -00}00
p S1093 4591
_5
Master Permit No.
Contractor's Name
Job Address
❑ Low Slope
❑ Asphaltic
Shingles
• _ = .T ` .�' i ii
Florida Building Code Edition 2002
High Veloci ty Hurricane Zone Uniform Permit Application Form.
Sectior>,A (General Information
Process No.
E. 9 . S �-(,' ' FL 3
13,
ROOF CATEGORY
❑ Mechanically Fastened Tile
❑ Metal Panel /Shingles
CC Mortar /Adhesive Set Tile
❑ Wood Shingles /Shakes_
❑ Prescriptive BUR -RAS 150
ROOF TYPE •:
❑ New Roof
❑ Recovering Repair ❑ Maintenance
• ROOF SYSTEM INFORI(ATION
Low Slope Roof Area (SF) Steep Sloped Roof Area S
(F) Total (SF)
❑ Re- Roofing
Sketch Roof Plan: Illustrate al
scuppers and overflow drains
identify dimensions of elevated
Section B Roof Plan
1 levels and sections, roof drains, scuppers, overflow
. Include dimensions of sections and levels, clearly
pressure zones and location of parapet ='
. - - - . • _�_
• t • �• - *
• •'••. .••: i •!
t'.
•• • •••c ••• � i
• • '• •• •
•• ••• •• • • • ••
• • • • •• •••
• • • • • • • •.
• • • • • • •
• • • • •• • • •
• • • • • • • •
••• • •• • •
••• •
• •
• •
••• •
• • • •• •
• • • • •
• ••• • •
• • • ••
• • ••• •
•
•
•
•
Page 2
IMPORTANT NOTICES
• •
1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOU V D,4TED PE.M17' PE14.4IT CARD. Applying for a permit does not grant
the right to begin construction. HOURS OF CONSTRUCTION are limitedsto: Monday threugh'Ffiaay frdtrf ?: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 fletg.4 b i t e r 41trti t bR1 .: •
4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIVIENT i d$Oic1 t, AJe) 1\4Y 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.
ature of 0
ignature
trE
� JI
SEAL:
O. FLORID
L 1t ix net
Print Name
Sworn to and subscribed before me this day of /p ,
otary ' . blic S • 1 of Fl, 'da
�r v Angela M Becker
My Commission D0160048
V Expires November 18, 2006
• •• •• • •
• • • • • • • • • •
• • • ••• • • •
• • • • • • • • • • • • •
•••• • ••••••• •
Y OF MIAMI -DADE 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:
PERMIT APPLICATION
OR, Produced Identification Personally known OR, Produced Identification
Personally known II `�'/ / Q
Type of Identification Produced: "F-Lb b S,& O I "1 �v J f Identification Produced:
PROPERTY OWNER
New Construction E
'Ric Name t Lynn t lC nPl—
Enclosure
dre 7
ss
Go N .E .c(011 s-�.
Ilia t,i Shc eo
3313
,
Home Telephone (365 7S 8 n Z
O
Repair
Business Telephone
Alteration Interior D
Fax (3C.) 7s C9 ° 6952 0
Demolish
TYPE OF MANAGEMENT (✓ )
New Construction E
Enclosure
Alteration Exterior R
Repair
Alteration Interior D
Demolish
Relocation of Structure S
Shell Only
Foundation Only A
Add'l Attachment
Other A
Aad'I Detachment
Other •
• • .• •. •
• • • • • • • • • •
• • • ••• • • •
• • • • • • • • • • •
•
• ••••••• ••••
• • • • • Master Permit No. .1?' 6)/ •
• • ' • • • ' ' SLbsidiary Permit No.
• • • • • • • • • • •
• • •• ••.•
••• ••• • • •
INSTRUCTIONS - The following steps must be taken to obtain a permit from the NI
Step 1.
Step 2.
Address:
Complete the attached permit aeplic'atiop vigio ters4 bC Signedby the property owner and qualifier. Both signatures must be notarized. Please
print or type to allow for a molt cc3.14e 4ropstrg otyour application. If roofing work w.11 be done, a roofing application must be submit-
ted along with this permit appliidtiog. • • • • • • . • • • •
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.
Address
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
b .E. %
Apt.
Folio Number
Lot Block
Subdivision PB PG
Current Use of Property
Proposed Use of Property
Tenant Information
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
PERMIT APPLICATION
'ami Shores Village:
(.1 Shce0 S FL 3313 8
City / State Zip
escription of Work __ 1 Y.
eOrts 0' ) «X
Zoning Linear Feet
Square Feet t Units Floors
alue of Work + LOGO • L_e.J Bldg Value
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
ENGINEER
Name
License No.
Address
Telephone
Fax
CONTRACTOR
Name
License No.
Address
Telephone
Qualifier Name
Fax
ELECTRICAL
TY1'!
Minimum Fee
QTY.
TYPE
Dryer • •
QTY.
TYPI?
Outlet, Appliance
QTY.
'I YI'li
Service Repair
Q "1'
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
INIECHANICAL
TYPE
Minimum Fee
QTY.
TvPI:
Condensate Drain
QTY
TYPE:
Generator
QTY
Typr
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
TYI'F:
A/C Condensate
QTY.
TYPI:
Drains, Roof
QTY.
TVI'i :
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 tlie typ .ef vioilc tein$p and quantity(ies) in the space provided below.
•
RECEIVED AND REVIEWED BY: DATE:
Page 4
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi - family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & 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
Notary
• •
❑ PROOF OF OWNERSHIP •
(Attach)
•• ••• •• •
❑ HRS / DERM APPROVAL •.;
(Septic / Sewer) ..:
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
PERNIIT FEES
$ C
$
d ab
x ¢f t. 1000
$ (¢.005 / sq.ft.)
$ (¢.01 /sq.ft.)
$ 5 , OD
ISSUING OFFICIAL
REVIEWED AND PREPARED BY: DATE:
SECTION
Zoning
Electrical
Mechanical
Plumbing
Fire
Public Works
BY
DATE
• • • • • • • .. .
• • • • • • • • • •
• • • •• • • •
• • • • • • • • • • •
.... ••••••• •
•• •
Structural
Building Official
•
•
•
• • •❑ MIZIDO ASSOCIATION APPROVAL
• • • •
(Attach)
PERMIT APPLICATION
BP1bAPPROVAL (Restaurants)
• . • • •
• • •
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ 66.x
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com