1135 NE 99 St (12)MIAMI ,SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date 7 12 Time
Final ?oinlinc
Type Insp'n
Permit Noc�,�[�
Name 0Cirt
Address 113s te_ c q S+
Company RI\ C lCtI)I1S
Phone # � yi � 9 10 — S 1 /
7/29 Name & Date
Approved
Correction
Re- Insp'n Fee
BP X003
For Inspector:
MIAMI SHORES VILLA
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Dat� i • ±3 Time
Type Insp . Mk • k
Permit No.
Name
Address 1 t 35_1)
Company
Phone # /
For Inspector( 1 / 4 -3 Name & Date
Approved
Correction
Re- Insp'n Fee
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle):
Miami Shores Village
Building Department
Eieectrieal Plumbing Meeharncal Roofing
Owner's Name (Fee Simple Titleholder
State iq •S .38
Permit No.
Master Permit No.
Owner's Address
City
Tenant/Lessee Name Phone
Job Address (where the work is being done) • //3,3 '• 1 / C;✓
City Miami Shores Village County Miami -Dade Zip c 3Z ee
Is Building Historically Designated YES NO
Contractor's Company Name 4 649/4S j, `• / AS Phone 0 " 1 4;'• SkY /
Contractor's Address / i. / 4 0 r
City hev v-e ate (1 • zip c.F3A 9
Qualifier
Architect/Engineer's Name (if applicable) - Phone #
Architect/Engineer's Address
City
"JO /) ( 1 4X W1
State
$ Value of Work For this Permit 102000 • ( Square Footage Of Work:
Number of: Bays Stories 1 Families Bedrooms
Type of Work: DAddition °Aiteration drew 0 Repai
Describe Work:
County Escrow Fee $ l t fi Permit Fee
0
Education/Training Fee $ Tech $
Code Enforcement $ Bond $
Minus Plans Check Fee $ Total Fee Now Due $
;oa cctsh 3Q ,GAO
Notary $
8
10050 NE and • venue
Miami Shores, Flor 8
Tel: (305) 204
Fax: (305) 972
Zip
Radon $
(Continued on opposite side)
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
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.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
Chc7/7 /03
APPLICATION APPROVED BY:
Signature / C
Plans Examiner
2 4 2003
Engineer
Zoning
NOT
Sign Sign.
Print: Print: d Lif C
'*C t . t *- MY COMMISSION # CC921790 EXPIRES *;
My Commission Expires;;.,r`
' a
April e, 2004 My Commission Expires: AP riI 8, 2004
- 4. �F��h
;•IA `� BONDEDTHRUTROYFAININSURANCEINC u BONDED THRU TROY FAIN INSURANCE, INC
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
G 4 !
.,./
Owner or Agent Contractor
The foregoin: instrument was acknowledged before me this,? ...?4-a The foregoing instrument was acknowledged before me this,
day o . -- • /3 . ii-L0 S It Ii : , day • 20 , by (e& ei i
who is • rs ona y known to me o ho has produced i
_ P who ' rsona y known to me o who has produced
4 As identificati. ' and who did take an oath.
• A ' LICE NOTARY P
as identification an o did take an oath.
XPIRES
Miami Shores Village
Paint Color Approval and Agreement
'Date )
Owner's Name ie_ i / /°� . , J Phone #
Owner's Address // , t ,4/. 8 ,/ S/
City f �I/f`1 ,.�G�l g,thinp State / • Zip 43/V
Job Address (where the work is being done) /�J �Y / ,4/
City Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES NO
' man Name (if applicable) 1- /4 Ti fJ Phone # a .6 9/
Contractor's Company y ( PP ) f�/' � - s OS.
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Aelements on the site must be listed and indicate the color to be painted
/ A
W alls
Fascia
Drip Cap/drip Ed
Soffit �,vy
Roof
Flower bins
Shutters
Awnings
Chimney
Doors and door jams
doors /n]
Railings
Fences / T y�
Decorative metal /U .
All brick (simulated or regular)
Stucco banding
Signature
APPLICATION APPROVED BY:
Any other stucco features
Accessory Buildings
Other
P& Z Official
.33/3
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
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.
V ' J 4z4L
Owner • _:.;ent
Date
Date
(V �
Chc6 /1803
Village of Miami Shores
10050 NE 2nd Avenue
Miami Shores, FL 33138
Phone: 305 - 795 -2204
Printed: 1/25/2002
Applicant: LUCILLE
Owner: SUSMAN
Contractor
Local Phone:
Parcel # 1132050180060
Job Address: 1135 NE 99 ST
Fees:
FEE2002 -441
FEE2002 -442
FEE2002 -443
Permit Status: Approved
CCF
Notary Fee
Total Fees:
Building Permit
Permit Number: BP2002 -149
Address:
Cellular:
SUSMAN
LUCILLE
Legal Description: REV PL MIAMI SHORES SEC 8
Description Amount
Building Permit Application Fe$60.00
$0.60
$5.00
$65.60
Permit Expiration: 7/24/2002 Construction Value: $500.00
Work: EXTERIOR PAINTING AS PER AGREEMENT (OWNER BUILDER PERMIT)
Page 1 of 1
Total Fees: $65.60
Total Receipts: $0.00
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.
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: (INSPECTOR) BY:
PB 43 -69 LOT 17 BLK 178 LOT
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: (Contractor or Builder) BY:
MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
DATE: I N S -
OWNERS NAME: l/Z / / /z 5 4HONE(o3) 75 - 6 337
ADDRESS: /n/ /g e 4'c s IL 33 a /°7
********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE: //3j 4/ / _5 /fl , '/}M I S go/e t iS
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME: PHONE:
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted.
Walls
Fascia
Drip CaO/Drip Edge
Soffit
Roof
Flower Bins
Shutters
Awnings
Chimney
Doors and door jams
Garage Doors
Railings
Fences ,f 6i fZ /�- >f) C-'5 7U � aC 412 i ,)7 /1) /
Decorative Metal
All brick (simulated or regular) N
Stucco Banding /
Any other stucco features k/G9" K / e
Accesso Buildings
ry g
Other
APPROVED:
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
do the work stated. Furthermore , the paint colors will be as per the attached
sa ples / /1)
Sig ature of Owner Date Signature of Contractor Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
Building Official Date 4/23/01
PROPERTY OWNER
- r
Nam 12 c /f/ - se/ .5
Address
Home Telephone
Business Telephone
Fax
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'1 Attachment
Other
Add'l Detachment
Other
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 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 l 1 3 of > 5 t) bescription of Work
Lot Block
Subdivision PB PG Zoning
Current Use of Property Square Feet
Proposed Use of Property ' of Work 5e2
Tenant Information
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fen
Other
rx
//3S /1) 99 sr
Address Apt.
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
Master Permit No.
Subsidiary Permit No.
City
<V,W4' /2.
State
PERMIT APPLICATION
Zip
L_r 04
Linear Feet
Units Floors
Bldg Value
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
PERMIT CHANGE (✓ )
ENGINEER
Name
License No.
Address
Telephone
Fax
CONTRACTOR
Name
License No.
Address
Telephone Fax
Qualifier Name
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.
1.
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 FLO PA, COUNT /SF MIAMI -DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE
ature of Owner
Print Name
Sworn to and subscribed before me this °.-S day of
Signature of Contractor / Qualifier
Print Name
' PERMIT APPLICATION
Sworn to and subscribed before me this day of
ature o . ry Public - ,. e of Fl.rida Signature of Notary Public - State of Florida
♦P PU B ANGELA NOTARY SEAL
SEAL: 20 l4" # �, 0 OOMMISIRON NUMBER j SEAL:
u; r P.+ . r CC786697
- 9 l MY COMMISSION EXPIRES
` OF f■ NOV. 15,2002
Personally known - '/ ) ' o )) uce enu icatior Personally known OR, Produced Identification
Type of Identification ProduceTfl , AO�o� ` 71)b
Type of Identification Produced:
ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPE
Dryer
Q . LY .
.I.vI,I.
Outlet, Appliance
QTY.
'mg.:
Service Repair
Q.LY.
A/C Central 1 -3 Ton
Fan
Dryer Vents, Number of
Outlet, Wall
Ventilation, Cost
Service, Temporary
Air Handler, Tons
A/C Central 4 -7 Ton
Piping, Flammable Liquid
Fire Pump
Outlet, Switch
Fire Sprinkler System
Signs
A/C Central 8 -15 Ton
Bath Fan - Vented, #
Fixture - Fluorescent
Pressure Vessel
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
TV'PF:
Minimum Fee
QTY. TYPE
Condensate Drain
QTY. TYPE
Generator
QTV. TV'I'F
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
Solar Water Heater
Air Handler, Tons
Ductwork, Cost of
Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
Process/Pressure Piping
Cap - Fixture
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
Pump and Abandon
PLUMBING
TVPF:
A/C Condensate
QTY.
TYPE
Drains, Roof
QTY.
TY'PF.
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
I 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
Zonin:
M 0?
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
1 ---2
Building Official
P
'I. S
Page 4
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
PERMIT FEES
$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)
D HRS / DERM APPROVAL
(Septic / Sewer)
O IMPACT FEE
(New Construction)
0 OTHER
(Specify & Attach)
S, o
(sq.ft. = x/1000
x 0.60)
(¢.005 /sq.ft.)
(¢.01 /sq.ft.)
REVIEWED AND PREPARED BY:
'PER IT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ , v
ISSUING OFFICIAL
DATE:
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
PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER e TO / RETAIN COPY)
(ffi 9.r.A� Tax Folio //
gjie' 15 Permit #
Job Address
Legal Description (�! / 7g
Owner // Lessee / Tenant
Owner's Address
Contracting Co.
Qualifier
State#
Architect /Engineer
Bonding Company
Mortgagor
Geo. -e
/0 5 A1
Compet
Permit Type (circle one): UILDIN
WORK DESCRIPTION \ \�
Square Ft. E5I I Ov
9q
Signat of Owner and /or
Date: • 9rn../ r
/
N ary /as to Owner and /or Condo President
My Commission Expires: y / /G / j
* * * * �1
ident
Master
5. /rodate_.Q y
qq 54-
Address
PERMIT FEE: APPROVED:
Zoning
Mechanical Plumbing Engineering
Fire Other
phone
is /- goy
ria phone
Ins. Co.
Address
Address
ELECTRICAL PLUMBING MECHANICAL PAVING
04.4-19
sv4 -vt Q a 1104.4 s.e_
Estimated Cost
it
,QOi®O
FENCE SIGN
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 AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT).
Application is hereby made to obtain a permit to do work and installation as indicated. I 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, SIGNS,
POOLS, ROOFING, and MECHANICAL work.
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.
Furthermore, I authorize the above -named contractor to do the work stated.
Signature of Contractor or Owner - Builder
Date:
Notary as to Contractor or Owner - Builder
My Commission Expires:
* * * * * *
Electrical
* * *