PAINTMIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Dat- > Time
Type Insp'n
Permit No.
Name
Addr
Compan ,\
Phone # 6— 77 v
For Inspector2 /(/ 03 Name & D
Correction
Re- Insp'n Fee ❑
Page 2
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PERMIT APPLICATION
IMPORTANT NOTICES
I. DO NOT BEGIN ANY WORK WITI•ipU2' htkVING REGEIYED Y01312 VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant
the right to begin construction. HOl?RS OFtONS1'kttTIaN are limited to: IVIonday 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 MIX BE MAINt1INV IIY A NEAT AND SANITARY CONDITION free from construction debris.
3. STREETS AND NEIGHBORING PROPERTIES SFI2111L HE KEPT t'REF FROM DIRT AND DEBRIS.
4. SWALES MUST BE PROTECTED FROM BEING D►4MAGEDVI+EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is
required for work in or near the street/sidewal16. : ; : • • • • • • •
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 $2,500 or intend to obtain financing, you may wish to consult with
your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at:
22 N.W. 1st Street, 1°` Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in
accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and
Choosing a Contractor.
ST TE OF FLORA, COUN OF MIAMI -DADE
1 c yy
�,py■1
S u re of Owner
rrint Name
Sworn to and subscribed before me this day of _L J
2002—
gnature o
SANDIZUCKERMAN
tiff MY COMMISSION # DD 131902
for fo EXPIRES: October 7, 2006
14600.1.NOTARY FL Notify Semen 8 Bending, Inc
SEAL:
Personally known OR, Produced Identification
Type of Identification Produced:
Print Name
SEAL:
Personally known
Sigh; o tractor / Qpalifier
Signa • re o otary ' blic - State of Florida
S�srn to . d ribed before this i day of
LISA CARSON
e + . , A MY COMMISSION # CC 866680
d. °�= EXPIRES: August 26, 2003
l: moll,
y� -, i ` ott Public Underwdler
liemolo . . .._...... — _
Type of Identification Produced:
CONTRACTOR
Name Q d1 av & , e k
License No. q 8 5 -400 ' P 3 b
"/ "J
Address
CIS ME' Rah
' )7S�..o'
Telephort�� /)
9/ Fax
Qualifier ame p ' 4 0 , K
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'l Attachment
Other
Add'I Detachment
Other
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
Address
License No.
Telephone
Fax
PROPERTY OWNER
Name
Address
Home Telephone
Business Telephone
Fax
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Master Permit No.
': SUbLSidi$ry.Pt✓r114 tic:
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PERMIT APPLICATION
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 i opertyownet and.i .Iifies..Both signatures must be notarized. Please
print or type to allow for a more accurate processing of your applie atioui s :f pooh; : crk:will a 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.
A PPLICATION
Job Address: 1 12a N. E. 1 6� MI turv■I S ho re s PL, 3313`
Address Apt. City 1 State Zip
Folio Number Description of Work nk I Zr∎ or ho (kse ki nI* 1 fl3_
Lot Block
Subdivision PB PG Zoning Linear Feet
Current Use of Property Square Feet ^^ Units Floors
Proposed Use of Property Value of Wo44 00 Bldg Value
Tenant Information Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
ENGINEER
Name
Address
•
License No.
Telephone
Fax
ELECTRICAL
TYPE,
Minimum Fee
QTY.
TYPE.
Dryer
QTY.
TYPI.
Olathe, • ppliange • • ;
QTY.
TYPE
Service Repair
Q'l Y.
A/C Central 1 -3 Ton
Fan
Outlet, vValr - . " ' " . •
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.
'HYPE
Generator
QTY.
TYPE
Refrigeration, Tons
()Ty.
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.
Tvi
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
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INSTRUCTIONS: Please indicate the type of work beingaperf8rmedsr¢I Qnantitt(its).iin the space provided below.
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PERMIT APPLICATION
RECEIVED AND REVIEWED BY: DATE:
SECTION
BY
DAT
Zoning
a"�?pi¢ -r
/�
r
Electrical
ff
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
71 5
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OFFICE USE ONLY
•
❑ 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.) $ 1
Inspector State Educational Fund
State DCA (Radon)
Code Enforcement Fine
Zoning Review
Notary
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CHECKLIST
• • • Cr PROOF OF t? 'IVASHIP
(Attach)
•• ••• •• • • • ••
•• •p• • • / r PROVAL
• • • • • : (Seyl'h /;S�w�r�l
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
PERMIT FEES
$ (¢.005 /sq.ft.)
$ (¢.01/sq.ft.)
4
(X .ft. = X/1000
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ ' ( `� e 0
ISSUING OFFICIAL
REVIEWED AND PREPARED BY: DATE:
CONDITION OF
Revised July 2001
10050 N.E. 2"° AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 12 /5/2002
Applicant: BRIAN BARBICK
Owner: BARBICK BRIAN
JOB ADDRESS: 1122 NE 98 ST
Contractor KAWALEK PAUL
Local Phone: 786 262 - 1457
Parcel # 1132050180370
ermit Status: Approved Permit Expiration: 6/2/2003
,Iiiiiiii
ork: EXTERIOR PAINTING AS PER AGREEMENT
PAUL R. KAWALEK ROOFING & PAINTING
485 N.E. 92ND STREET PH. 305- 754 -0191
MIAMI SHORES, FL 33138 -2566
1:063 L00 2771: 00366060 1.9 L411' 30 L
D.,. 1.1190,2
order of ` ey v; rho rs v; � 14,(3€ I $ 61- r�
order of n
s X — c V
Bank of America.
41- 4 ?;/e" IN+ 1
ACH FVr 083100277 /yy��
Fort 1 11 `r' _ l%
Building Permit
Permit Number: BP2002 -2088
Contractor's Address: 485 NE 92 ST
Legal Description: REV PL MIAMI SHORES SEC 8
Fees: Description Amount
FEE2002 -6912 Building Permit Application Fee $60.00
FEE2002 -6913 CCF $1.20
Total Fees: $61.20
Total Fees: $61.20
Total Receipts: $0.00
Dollars
Construction Value: $1,500.00
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 befnrP rattinn fnr - • ion.
3011
63- 27/631 FL
810
EMMY WM..
t equipment or device described in the application herefor in strict compliance with all
th any plans, drawings, statements or specifications that may have been submitted to
lot done in compliance with such ordinances or if the plans are changed without
br or builder named above assumes the responsibility for a thorough knowledge of the
or in the statements or specifications and that he assumes responsibility for work done
ompliance with all ordinances and regulations pertaining thereto and in strict conformity
Village. In accepting this permit I assume responisibility for all work done by either
3Y:
BY:
Page 1 of 1
PB 43-69 LOT 20
BLK 180 LOT
APPROVED:
MIAMI SHORES VILLAGE
Paint Color Appro41. anid ::40CHient
DATE: � I \ol.
OWNER'S NAME:
ADDRESS: laa n/
N/
Flower Bins 01
Shutters
w
Couh'Fr'7/ oG -']6
N /tk
•••
Awnings
Chimney
Doors and door jams 0 la Lo c& .r y/ OC_ '76
Garage Doors O Id_ Co GLh4 r O C-7 6
-2 4 ) /07-
Building Official D ate
•
• PI-IOI�IE:
• ••• • •••
* * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE: Ill WE c‘ch t:: : : :. •.
CONTRACTOR &'LICENSE (if a licable)' : fj:p"01�.
COMPANY NAME: } Wtt )e ? �j
�.1 �4 i n . PHONE: p 3 S �sv ei
l
******************************* * * * * * * * * * * * * * * * * * * * * * * *c * * * **
All Elements on the site must be li t d and indicate the coloro be painted.
Walls �'; lit J::;. i ►: %— . Q V(� O IAA I IC .
Fascia C•ehl C In Ve p cf
Drip Cap/Drip Edge r?"''• Scenic- Drive bQ r7 -
Soffit O Id c°GVl Y)/ OL ri 6
Roof
Railings N��l
Fences n'j A-
Decorative Metal IVA
All brick (simulated or re ular) DI d Coca y/ 0 C-`?
Stucco Banding PRA
l
Any other stucco features /V/
Accessory VU/
Other
0
0 0
nn
V C
01
- L) b
_,5 ntie ,S' /
OWNER'S AFFIDAVIT: I certify that all the foregoing informati
and that all work will be done in compliance with all applicable la
construction and zoning. I authorize the above -named contractor, if applicable, to
do the work stat . Furtherer e , the paint colors will be as per the attached
s • ples. E *J PmQ �' q J5 I Dz
ignature o Owner Date Signature of Contractor Date
g g
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
4/23/01
b
Owner's Name and Address
/A- --h2 /G A Mc./ {/
Location and legal description of lot to be built on:
Zone cubage required
Distance to next nearest building
Maximum live load to be borne by each floor
I hereby submit all plans and specifications for said buildint
1/A
Building Inspector
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT 4 €,, 7 0 93
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building 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.
Registered Architect and,or Engineer
Name and address of licensed contractor V �/�/ E
// //a 2 / ' E ry _S�r e �t
Lot / 8 ote Block / Subdivision �il✓ 6 & & / 1 Ge/v / /� 31#6 �1 0057e9
Street and Number where work is to be done 1 /0 2 ^/. �• 74e. e L°
State work to be done and purpose of building (by floors). state exterior colors (submit samples)
�/ and for no other purpose.
New Building Remodeling Y Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
PA4/4/ /1y y ? 00
Estimated Total cost ofe,,p�uoements S �J 5 V
The undersigned applicant for this building permit does hereby certify that he understands and acc
Compensation Act. being Section 5966, Compiled General Laws of Florida. Permanent Supplemen
compliance from all contractors or sub - contractors employed by him in the work to be performe
on the site of the work such public notice or notices as are required by the Act. The undersigne
under this permit. as are licensed by Miami Shores Village.
Date
Remarks (Signed)
Amount of Permit S ,3 2.
093
/ se Ca- // w ke_ rid y
it/ ,7c- - P6e /
OF, /c e
Date / � ' — b — c ?7 19
No. Street
of
ding and its construction may be sent to
is his obligatons as an employer of Labor under the Florida Workmen's
d has complied with the .rovisions thereof. and will require similar
u der this permit: and wi post . cause to be posted for inspection
ees to
r ploy only su 1 sub - o ractors. on work to be performed
STATE OF FLORIDA
COUNTY OF DADE. } ss.
Before me. the undersigned authority. a notary public, duly authorized to administer oaths and take acknowledgments. personally appeared
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. e2 -/ (p e / Date /c /a'/ Read. Sworn to and Subscribed before me.
Disapproved
(Signed)
Notary Public. State of Florida
My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved 1 ate Disapproved Date
NOTE: A charge of S25.00 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 S25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and or workmanship.