DRIVEWAYRegistered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Disapproved
)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
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 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.
Date c , 19
Owners Name and Address I Q �' No / Street
Street and Number where work is to be done
State work to be done and purpose of building (by floors)
ali - c am L — — --
/ (7, /
Notary Public, State of Florida
Lot Block Subdivision
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $__ 42.0 Amount of Permit $
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 the 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 pennit 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 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 wor to be perform d under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed) -,'
STATE OF FLORIDA,
COUNTY OF DADE. ss.
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.
Permit No 1 Z r Date
Read, Sworn to and Subscribed before me.
Building spector My Commission Expires
PLANNING BOARD DATE
Chainnan 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 Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
Approved
Correction
Re-Insp'n Fee
MIAMI SHORES VILLA
BUILDING DEPARTME
305- 795 -2204
Building Inspection Request
Dat
Type Insp'n
Permit No.
Name
Phone #30 c-, 3-zS }
For Inspector: )' I ).\ Name & Date
Dat
Correction
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Time
Type Insp'n
Permit No.
Name
Address
Company
Phone # 7 Z DS " 3 1 / 4t/ 1
For InspectorM/23 J3 Name & D
Re- Insp'n Fee ❑
10050 N.E. 2nd Avenue ■•. Mjami Shores, Florida 3313 L.. . . ; , : —1—
4 101 apt: 305 456 -$972
Date Job Address J Z S'/96 - , %k 5-1- Tax Folio
7 /"' 4C1 A\ ,v k
c (�'. r, �. `
/ ' � i ►�' I is
Legal Description 'V €10 7 f = � Historical _y Designated: ��' � . Z
Owner /Lessee/Tenet SM t/L� � e7J6 Master Permit # Imi• - ---- j
// /
Owner's Address /� Z.5 X-- aT n & - , ST . sfrtO/ted Phone ° 73/ 7(1
Contracting Co)[ 74401.- -- (2)(X7 t pill Address g < gee/see /3.3A/0 - Lj'/4-44
� 4 .
Qualifier /60 &- L 4 , GO2 ss# —Phon s 2gr s
State # Municipal # Competency # I l Co. 71 -
Permit Type (circle one): BUILDING
WORK DESCRIPTION: /5 t e; 4,
..5) j L e 60/1Ar r
Square Ft.
Signature of owner and/or Condo President
FEES: PERMIT
APPROVED:
RADON C.C.F
Zoning WC�CX s /i7 " Building
Mechanical Plumbing
PERMIT APPLICATION FOR MIAM4 SNORES VILLAGE
ELECTRIC
'a\
Notary as to Owner and/or Condo Presidvtt Date ; ary as to ontra
My Corrunission Expi
PLUMBING
Estimated Cost (value)
/2d0
NOTARY
MECHANICAL
.^i
IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VEFY,
THERE WILL BE NO INSPECTION. RE- INSPECTION FEE IS 550.00 AND MUST BE PAID IN ADVICE
BEFORE CALLING FOR ANOTHER INSPECTION.
ROOFING
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 ANY 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. understand that separate permits are required
for all disciplines.
OWNERS 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.
ontra
■
1
. _:.‘,......._ _..,.......,,,,,„,
Date igriatu r 1 for or Owner Bu rder
Ail 4!
4,,r, � -
w �.*
My Commission Ex•
But • e6D0s10s4
t1 MY COMMISSION EXPIRES
OF .\9 MAR. 1,2006
5
at
-a3 $.3
Date
Aro•-Th BOND
TOTAL DUE / (J& for
Electrical
Structural Engineer
Legal Description:
I of D,'of KINNEY PARK, according to the plat thereof as
recorded in Plat Book 67, at Page 78, of the Public Records
of Miami -Dade County, Florida.
15.00 ALLEY
80.00' S8950'00 "E
N.E
98 th
Certified To:
SALOMON AND MYRIAM PUENTES, GREE
PIOTRKOWSKI, P.A., ATTORNEYS' TrILE
FUND, INC., WASHINGTON MUTUAL BAT
SUCCESSORS AND /OR ASSIGNS.
STREET
W
0
J
h
n
EDGE OF PAV
NORTH
SCALE: 1,20
r1
Contractor STAR ISLAND CONCRETE
Local Phone: 305 - 391 -8817
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: BP2003 -735
Printed: 5/8/2003
Applicant: CHRISTINE CANTON
Owner: CANTON CHRISTINE
JOB ADDRESS: 1025 NE 98 ST
Parcel # 1132050320040
Building Permit
Contractor's Address: 13820 SW 112 ST #207
Page 1 of 1
Legal Description: 5 53 42 KINNEY PARK ' PB 67 -78 LOT D LOT SIZE 80.000 X 104 OR
Fees:
FEE2003 -2757
FEE2003 -2760
FEE2003 -2761
FEE2003 -2762
Description Amount
Builders Bond $300.00
Building Fee $100.00
CCF $3.00
Inpector State Educational Fund $3.93
$406.93
Total Fees:
Total Fees: $406.93
Total Receipts: $0.00
Permit Status: Approved Permit Expiration: 11/4/2003 Construction Value: $6,075.00
Work: STAMP CONCRETE
Signed:
In consideration of the iss
conformity with the plans,
done by either myself, my
Signed:
PAY
TO THE
ORDER OF
Starr Isla
Concrete Design Corp.
13081 S.W. 133 COURT
MIAMI, FLORIDA 33186
SUNTRUST
SUNTRUST BANK, MIAMI, NA
MIAMI, FL (305) 591 -6000
/.,/�)l
FOR /. J / `i/ -- 73 a 7s 7
�, O$) 253 -LS7s7
L UC
DATE
mss" 3
vim" y - 0
11'0048 20H° 1:066000604 L80 148 51
4820
63-60/660
gob-73
D S 8 PA ...
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
WHEREASS 4 ji4 t / e , hereinafter referred to as the Owner of the
(owner)
following described property:
Legal description/folio#:
Lot � Block Subdivision
Tax Folio #:
/1 - OS e'o ctV
requests permission to install:
[ ] Asphalt, concrete, brick pavers
[ ] Landscaping
[ ] Other
SIGNED. SEALED AND DELIVERED in the presence of:
3iiores
10050 N.E. SECOND AVE.
MIAMI SHORES. FLORIDA 33138 -2382
Telephone: (305) 795 - 2207
Fax: (305)-756 -8972
-KA;kiirac ki
Ivan M Lopez •
• My Commission 00042074
( Expires July 15, 2005
uK
APP"left
within the public road right of way of /&3S ,O L - q4 iks4 . 5h ,I,/4 3 3 /,
(address)
IN CONSIDERATION of the approval of this permit by the Village, the Owner agrees as follows:
1. To maintain and repair, when necessary, the above - mentioned item(s) installed within the dedicated right
of way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said
items within public right of way including restoration of street by reason of the Owner's failure to do so,
such expense shall be paid by the Owner or shall constitute a. lien against the above described property
until paid.
2. The owner does hereby agree to indemnify and hold Miami Shores Village or dade County harmless from
any and all liability, which may rise by virtue of permitting the installation of these items within the public
right of way.
3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days
notice by the Village to do so. Failure to comply with this notice will result in the Village causing the
item(s) to be removed and a lien being placed on the property and/or assessed against the Owner for all
costs incurred in the removal and disposal of the item(s).
4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and
shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such
time as this obligation has been canceled by an affidavit filed in the Public records of Dade County, Florida
by the Village Manager of Miami Shores Village (or his • authorized representative).
SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on
o e ._ -V
X
'STATE OF FLORIDA)
COUNTY OF DADE)
The undersigned Affi
(property owner)
attached survey, performed by �I-- 61 S SC)/Z UT7/ '6-
(name of surveyor's company)
performed on O s /� 02 is an accurate representation of the existing conditions and
(. . to • 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 • rmits..
t sayeth naught.
fr i�►
sign and print) Witness(sign and print
Affiant is personally known t
lGLY12G Shore�
SWORN TO AND SUBSCRIBED before me this
roduced as identification.
otaiy
oes hereby attest that the
y of
pi Expires July 15, 2005
Ivan M Lopez
Legal Description:
Lot D, of KINNEY PARK, according to the plat thereof as
recorded, in Plat,Book 67, at Page 78, of the Public Records
of Miami -Dade County, Florida.
ONE STORY
RESIDENCE
#1025
Certified To:
SALOMON AND MYRIAM PUENTES, .GREET
�
PIO�T�R�KOWSKI, P.A., ATTORNEYS' TITLE I
t UNtic INC., WASHINGTON MUTUAL BANI
SUCCESSORS AND /OR ASSIGNS.
& Panel Number: 0093
CE Suffix: J ,
/ „
p �1 �sp ' ��� 4. D 179 ' MIA 'SHORES SEC.6 45.69 i
TS Data of Firm Index: 3/2/94 ' Aply __ _ ,
Flood Zone: AE �- -� �; _ • 3
Base Flood Eleva pn.8 ' r - - .- - - - - -,
1 ^ I 1 - o . loo Iro13 I , S r lao'
Date of Com Teti 05/10/2002 ' ' "O7 A °6 THIS • PLAT . g � 1 1
p L $ 9 REVISE!) PLAT OF 6 MIAMI SSLWORES d $ 3 I i g 2 61
IT*
Sc{.I, )N ;E ({13'49)
15 I6 j Il l0 19 4i a° �� ` al
NOT A MILT a THIS PLAT I 1,8'
Property Address:
1025 N.E. 98 STREET
MIAMI SHORES, FL 33138
Survey: M8817
SIGNED
•
9LK. 100
GENERAL NOTES:
MIAMI SHORES SEC. O. REVISED 45-GD
1) LEGAL DESCRIPTION PROVIDED BY OTHERS.
2) THE LANDS SHOWN HEREON WERE NOT ABSTRACTED FOR EASEMENT OR OTHER
RECORDED ENCUMBERANCES NOT SHOW /4 ON THE PLAT.
3) UNDERGROUND PORTIONS OF FOOTINGS, FOUNDATIONS OR OTHER
IMPROVEMENTS WERE NOT LOCATED.
4) ONLY VISIBLE ENCROACHMENTS LOCATED.
5) WALL TIES ARE TO THE FACE OF THE WALL.
6) BEARINGS REFERENCED TO LINE NOTED AS B.R.
7) NO IDENTIFICATION FOUND ON PROPERTY CORRNERS UNLESS NOTED.
8) NOT VALID UNLESS SEALED WITH THE SIG ING SURVEYORS EMBOSSED SEAL.
9) DIMENSIONS SHOW ARE PLAT AND MEAS e • D UNLESS OTHERWISE SHOWN.
10) ELEVATIONS IF SHOWN ARE BASED •O, 'N.G.V.D. 1929 UNLESS OTHERWISE
NOTED.
11) THIS IS A BOUNDARY SURVEY UNLo ' S ITHERWISE OTED.
I HEREBY CERTIFY T THIS BOUND . URVE S : ' UE CORRECT
REPRESENTATION OF SUR EY PREP ;I UN R Y DIRECTION.
S.M. ' O.5101
S 1 ATE OF FLO
FOR THE FIRM
THIS SUR EY IS INTENDED F• ' MORTGAGE OR • 1 ANCE PURPOSE ONLY,
EXCLUS LY FOR THIS USE : Y THOSE TO WHOM IT IS CER'111•IhD. THIS SURVEY IS NOT
TO BE USED FOR CONSTRUCTION, PERMITING, DESIGN OR ANY OTHER USE WITHOUT
WRITTEN CONSENT OF MIGUEL ESPINOSA.
MIGUEL ESPINOSA
LAND SURVEYING, INC.
6494 S.W. 24 STREET
MIAMI, FLORIDA 33155
PHONE: (305) 740 -3319
LB # 6463
CONTRACTOR
New Construction
Name
r Z — / ._ clec-4
-f /�O !
Home Telephone 7 s / - 7 ?z. o
License No.
_ / GGO
G
7
Repair
Address /
Q 4/2/ /� C ,
a) 3
Telephone
5/C / Fax e5 3 5/
7/
Qualifier Name
./.‘, 1 4i,
PROPERTY OWNER
New Construction
Name S L 0/1,4// / V FA7 Ee
Address /0 2 S .C,e, `9k C 7
«'Si, e J 33 iae
Home Telephone 7 s / - 7 ?z. o
Alteration Exterior
Business Telephone
Repair
Fax
Alteration Interior
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
Step 1.
Job Address:
Address
Folio Nu ber
Lot j) Block
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
Apt.
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
Description of Wo
Master Permit No.
Subsidiary Permit No
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 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
/0 Z5 /W ..sx 7" "Mi.
City
78.5
State
Subdivision PB 6 7 PG 78 Zoning
/ ems
Current Use of Property �f !C1 / L. Square Feet
Proposed Use of Property / de L Value of Work 0 7S' Bldg Value
Tenant Information Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
Linear Feet
Units 7
ENGINEER
Name
License No.
Address
Telephone
Fax
Zip
ATION
Floors
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.
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 Hall on Construction Lien Law and
Choosing a •ntractor.
int Name • nt Name
orn to and subscribed before me this2..11/ day of di
•
r P.s " 3 2 - S 0-3V-- 33 ? -- 0
Signature of Notary Public - State of Florida
SEAL:
Type of Identification Produced:
Ivan M Lopez
g My Commission 0D04
oo dR Expires July 15, 200
Personally known OR, Produced Identificatio
— 1
SE
Personally known
ribed before me this day of
Public - State of Florida
PERMIT APPLICATION
''"° Ivan M Lopez
• MY Commission 00042074
Expires July 15.2005
OR Produced Identification
— 3Y 1 1 - 0 Type of Identification Produced:
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
Condensate Drain
QTY. TITE
Generator
QTY. TYPE. 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
PLUMBING
TYPE
A/C Condensate
QTY
TY
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
DAT
Zoning
al / ounT9
54 .03
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
•
./W. I.
Building Official
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
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
PERMIT FEES
$ 3,
ISSUING OFFICIAL
REVIEWED AND PREPARED BY:
(sq.ft. = x/1000
x ¢.60)
(¢.005 /sq.ft.)
(¢.01 /sq.ft.)
10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com
PERMIT APPLICATION
m CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ \t O 6 ..13
•
DATE:
CONDITION OF APPROVAL
Revised July 2001