PAINTPage 2
STATE
ay; arm 3o 07v7"
SEAL:
ature If Owner
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INIPORTANT NOTICES
1. DO NOT BEGIN ANY WORK WITHOUT KAVING RECEIVE) OOR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant
the right to begin construction. HOURS OF C6NSTIZUCTION a 're Iitfited 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 WIN IVED IN A CLEAN, EAT AND SANITARY CONDITION free from construction debris.
3. STREETS AND NEIGHBORING PROPERTIES SNIALL BE•KBP :FRE1 FROM I.IIRT AND DEBRIS.
4. SWALES MUST BE PROTECTED FROM BEING DAMIAGBD BY 6Q4IIT 4EAPf OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is
required for work in or near the street/sidewalk. • • • • .1 : °°° •' : ; '
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 Village Hall on Construction Lien Law and
Choosing a Contractor.
IAMI -DADE
Print Name
Sworn to and subscribed before me this '7 day of / P74 C
Zak
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ignature of Nota IS ;i c .`j�'� ', � D�1
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Atlantic Bonding 04 lfix'
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PERMIT APPLICATION
STATE OF FLOR
Si
Print Name
SEAL:
•
Swim to and subscribed before me this
L2..
t y taM ,,
Expires ove tig '
Y OF MIAMI -DADE
006
Personally known OR, Produced Identification Personally known OR, Produced Identification
Type of Identification Produced: Type of Identification Produced:
CONTRACTOR
/ /�
Name e auf/ / _ t 6 i. - G ¢/
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License No. 0 /5p /iv
Address 1 y 6 - ® St
Telephone r9j f36 Fax( j if ,e v0 ore)
Qualifier Name --(..--/, )/-
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PROPERTY OWNER
Name a- L A I '1 -Bo oiv f
Address
Home Telephone Q5. � 2 . G(, l
l [ t ! I
Business Telephone 305 ,l
(70 , go C 7
CJ L
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Fax
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'' Attachment
Other
Add'' Detachment
Other
Step 1.
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1, • • • • • 000.0*
PERMIT APPLICATION
... Master•Pernwt Ne, •
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INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Complete the attached permit application which must be sitRed:by the prop:rt»owner awd qualifier. Both signatures must be notarized. Please
print or type to allow for a more accurate processing of yd11c 4111ka4on: 1F joofing wor)< will be done, a roofing application must be submit-
ted 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
ob Address: U 058 K.1 E. 48 TH 3 - r2.F -'r IY1 l ►qm[ S lnr'.: , .5 Vi-
City City State
Folio Number Description of Work /' , PJu e /I c / r 6, 1
Lot Block L pe -,
Subdivision PB PG
Zoning
Current Use of Property Square Feet Units Floors
Proposed Use of Property Value of Work Z - /g - - 5-27 Bldg Value
Tenant Information Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
Address Apt.
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
33 3
Zip
Linear Feet
ENGINEER
Name
License No.
Address
Telephone
Fax
MIAMI SHORES VILLAGE
Paint Color App��v91410 Af reement
DATE: 3/7 �O
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OWNER'S NA E: /�
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OWNER'S NA E: /7�// /Sbni �H01% • 3 S} 762 -
t7 R 9f ,'V S /mil o
ADDRESS: / 144/ ; t 33/
********************** * * * * * * * * * * * * * ** * * * * * * * * * * * * * **
ADDRESS OF SITE /PO %`9::
6/y/3 :...
COMPANY NAME: fP
Cam/ —1 PHONE: ot T/
****** * * * * * * * * * * * * * * * * * * * * * * * *� * * * ** * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted.
CONTRACTOR & LICENSE (if appticfbte)• '
Walls /a — �G
Fascia d`e _
Drip Cap/Drip Edge 9 76'
Soffit /-/e - 96
Roof
Flower Bins g 7t
Shutters q Ter
Awnings
Chimney /t
Doors and door jams q7e'
Garage Doors 9 ?et--
Railings N /4
Fences /74'
Decorative Metal ti /,
All brick (simulated or regular) Gv /If
Stucco Banding , Alf
Any other stucco features
Accessory Buildings
Other
Belding Official Date
96-OH
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8/Z
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
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do t ork stated. Furthermore , the paint colors will be as per the attached
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Signature of Owner Date Signature of Contract Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
• A ,PROVED: WHEN PAINTING IS FINISHED,
• CALL FOR FINAL INSPECTION
?AZ)
4/23/01
EMO
r
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 3/12/2003
Applicant: FERNANDO
Owner:
JOB ADDRESS: 1058
Contractor
Local Phone:
Parcel # 1132050180330
NE 98
Permit Status: APPROVED Permit Expiration:
- Work:
exterior painting as per agreement
COMPLETE HOME PAINTING BY MICHAEL
MICHAEL IWASKEWYCZ
1476 NE 130TH ST. PH. 305 - 895 -1368
/
NORTH MIAMI, FL 33161
.Y TO THE / ,�v 9( stO
:DER OF / //
S �r wit
Was ' gton Mutual
Wa shington Mutual Bank, FA
North MiamV125th Street Financial Center 1728
900 NE 125th Street
1.800.788.7000
North Miami, FL 33181 24 hour Customer Sannea
/Zt
'e1 � i
:26 311: 83L48351L3 3693
Building Permit
Permit Number: BP2003 -396
FERNANDO
ST
Contractor's Address:
Legal Description: REV PL MIAMI SHORES SEC 8
Fees:
FEE2003 -1474
FEE2003 -1475
FEE2003 -1476
Description
Building Permit Application Fee
CCF
Notary Fee
Total Fees:
Amount
$60.00
$1.80
$5.00
$66.80
Total Fees: $66.80
Total Receipts: $0.00
63 -8413 -2670
DATE
9/8/2003
Construction Value: $2,250.00
If there is no permit package accessible on the 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.
3693
.3 /jZ�o3
/�� Q d
4-1/4 i,'_1 $6sr
DOLLARS
Drab war.
BY:
BY:
PB 43 -69 LOT 16
BLK 180 LOT
he equipment or device described in the application herefor in strict compliance with all
with any plans, drawings, statements or specifications that may have been submitted to
not done in compliance with such ordinances or if the plans are changed without
;tor or builder named above assumes the responsibility for a thorough knowledge of the
gs or in the statements or specifications and that he assumes responsibility for work done
compliance with all ordinances and regulations pertaining thereto and in strict conformity
s Village. In accepting this permit I assume responisibility for all work done by either
ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPE
Dryer
QTY.
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'1'1'1 ":
r OutleVAvliints • • • •
r •
Q'1'V
7'V'1'I{
Service Repair
Q'I'V.
A/C Central 1 -3 Ton
Fan
r•
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, Conunercial
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
QTV'.
T1"1'E
Condensate Drain
QTY.
TYPE
Generator
Q "I'V".
7'1"1'1?
Refrigeration, Tons
Q7'1.
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
7'1'PE
A/C Condensate
QT1'.
TV"PI',
Drains, Roof
QTV".
'I' PE.
Miscellaneous Fixture
QTV'.
7'V'I'I:
Soakage Pit
()Ty.
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
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PERMIT APPLICATION
INSTRUCTIONS: Please indicate the type of work beilig perfcSrrdea and q tibOes) in the space provided below.
RECEIVED AND REVIEWED BY: DATE:
Page 4
OFFICE USE ONLY
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
❑ CONCURRENCY
(New Construction)
LI OTHER
(Specify & Attach)
$3.00 per page (Scanning Fee)
Miami Shores Village
Bond
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CHECKLIST
❑ PROOF OF OWNERSHIP
(Attach)
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• ❑ t> ROVAL
• • • •('Septic / Sewer) • • •
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
PERMIT FEES
$ 0
Metropolitan Dade County (C.C.F.) $ fp F O (sq.ft. = x/1000
x ¢.60)
Inspector State Educational Fund $ (¢.005 / sq.ft.)
State DCA (Radon) $ (¢.01 /sq.ft.)
Code Enforcement Fine $
Zoning Review $
Notary $ 5_
ISSUING OFFICIAL
REVIEWED AND PREPARED BY: DATE:
SECTION
Zoning
Electrical
Fire
Mechanical
Plumbing
Public Works
Structural
Building Official
BY
DATE
7VelN
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PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ fO t7 0 3 0
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