DRIVEWAYMIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date
Type Insp'ner Gtr/ / AS,Ltdt-
Permit No. bP aoda • I
Name LC/r e14;(_J
Address•.
Company
Phone #
For Ins. ctor:
Correction
Re- Insp'n Fee
41 fL Name & Date
Time
Application is hereby made for the approval of the detailed statement us Inge ptans and specifications herewith submitted for the build •
in or other structure hcrcirs described. This application Is made in compliance and conformity with the Building Ordinance of /sham(
Shores Village. Florida. and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and iil rules and
regulations of the hull. ling Divisinn 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. 9
Date 3 / 7
°v.-ne 's Name and Address .._ 2I S... f4 / ZA,¢ 2T1,/ • lM / 4 / /i No. J
Registered Architect and /or Engineer............_.._...._. .._._...,._. —
Name and address of licensed contractor n P ie L C LII /f - C 3 7 VC /1 /6 ' •[,8ht a.�eini.,L 3 Y3 r/
Location and legal description of lot to be built on: // � "s' / 6 23s Q
Lot_ l a Block A. Subdivision Li ( `S ACV ee-j s /f: c t
Street and Number where work is to be donee !J aid hi" -:r •
State work to be done and purpose of building (by floors) p1SS' L A' 1 c-C.f' �-
_i.&. o a r .Lt' tad' � �..r c�._..._ 1 � .,7 e a A �r1 #..LT � 41) us /1-4-
L019F
and for no other purpose.
New Building.. »__...._ ........... Remodeling..._. ...._.. Addition_.,_,.. _ Aepairi...._. No. of Stories...... » � •�
To be constructed of . »sass ......... ...._... Kind of foundation— _. .». ...,_- _sass._. Roof Covering.. ....L -A.
)
Estimated Total cost of improvements = »_?...a-` , ° v ° Amount of Permit 8 t
Zone cubage required Plan Cubage g 02 ' r 7
Distance .to next nearest building......... ..... ...__._ _..Size of Building Lot. -
Mfaxitnunt live load to be borne by each floor
1 hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to.. 37 W.....�� r / . L �. 1 #1z-c- .T...
Tr..e undersigned applicant fur this building permit dots hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida %Vorkinen's Compensation Act. being Section 5966, Compiled pal La Florida, Pernnanrnt Supplement,
anti has complied with the provisions thereof. and will require lar compliance from co.tracto s or sub - contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for nspecti'on on the ' e •f the work such public notice
or noticcs as are required by the Act. The undersigned agrees to employ only such nnracto s, • • k t performed undo this
pcnnit, as are licensed by Miami Shores Village.
Remarks (Signed)
STATE OF FLORIDA,
COUNTY OF DADE. Its.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
L to me well known,
n ei , r
d that he did sign the same, and that all facts
peered
APPLICATION FOR BUILDING PERMIT
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 applica
therein by him stated are true..
Permit No..---s:1-2,..7............ Dated/ o1 / Read worn • and Subscribed bef e • e.
Disapproved ».. ». . r pate. _ __._ sass,
(Signed) ..._..._._._,.. -
MIAMI SHORES ViLLAGE
BUILDING INSPECTION DEPARTMENT
Notary ublic, State of F ride
Building Inspector ommission Expires
Coalman Member
Member - .._, Member
Member sass. _. ._ Member
Council Approved —. .._ _.._ _Date Disapproved
Nntary Pithlir State of Florida
My Commission Expires Dec. 28, 1990
PLANNING BOARD. _. _ r
.------DATE 9ondod Thru Troy Fain - Insurance Inc.
Date
NU: E: A charge of $1.00 will be made for making corrections or changes to this application after approval has horn obtained folio
the I'Ltnnir.;t Ilu.rd.
A rc•tn.tw•t tiun fce of 31.00 will be charged when such re inspection is made necessary by improper notice foe inspection or faulty
materials anu /or workmanship.
Page 2
1NIPORTANT 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, 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.
STATE OF FLORIDA, COUNTY OF MIAMI -DADE
Signature of Owner
r .ah G{ -(O(i1
Print Name n
Sworn and subscribed before me this ) / day of / G'/t/�
`.J
• Ignaturq
k / / 4
! A ■ _ 1 ' 1 Ir7rI.w!`►1"1 , tri►...4. ......�
� f Notary ' bl , tate o� �rApCELA M BECKER
OOMMItMON NUMBER
Q V C0786697
71.0p 0
4t MY t�lssis 15,2002
SEAL:
Personally known OR, Produced Identification
STATE
Signa
Si
SEAL:
ctor / Qualifier
WFo 1.T tale
Personally known
Type of Identification Produced`Vj ...J i" ' 4/ � O � `1 � ) U J3 j 1 Type of Identification Produced:
PERMIT APPLICATION
RIDA, COUNTY OF MIAMI -DADE
Print
A • .∎
me
nd subscribed before me thi
e of Nota
day of
p �PR Y PUr AN GELA M B
R L
�ii * O OMMISiION NUMBER
v, i ; Q CC786697
7- • MY COMMISSION EXPIRES
OF FtO NOV. 15,2002
OR, Produced Identification 1
PROPERTY OWNER
Name `
J
i,..4 � �� `2 e)-e , o n
Address /a 9
/4,
Q' E 9 G Si--
S
Alteration Exterior
) 1 33
Home Telepl�oAr 0 1 �
) &7c4„) 7 ..
Y s
30
s Tes lle
as
Business
Fax
Relocation of Structure
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 Mianii 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
Job Address:
Folio Number /13a0:5 • 0 ` . u3.57 Description of Work A
Lot Block
Subdivision PB PG Zoning
Current Use of Property Square Feet
Proposed Use of Property Value of Work
Tenant Information
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
/0 9 F ' ) f ' 0. ,W: k
Address Apt. Cit
ARCHITECT
Name
License No.
Address
Telephone
Fax
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
Master Permit No.
Subsidiary Permit No. 6 Y ' aoo /(
ENGINEER
Name
License No.
Address
Telephone
Fax
CONTRACTOR
Name
License No.
Address
State
Zip
(
CGO c) OI
1CABS 14sr14I
• IA
Tele hone "
^
p 3 B 21 12
Qualifier Name- FRpV-4ci�
PERMIT APPLICATION
33J3
Linear Feet
pp��
Units Floors
00 Bldg Value