1183 NE 99 StDate
Type Insp'n
Permit No. _
Name
Address
Company
Phone # . �� )c3
For Inspector:
Correction
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Re- Insp'n Fee ❑
Time
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. TYPE
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.
TYPE
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) m the space provided below 1
RECEIVED AND REVIEWED BY: DATE:
Page 4
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
O 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
REVIEWED AND PREPARED BY:
▪ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROV
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
$
SECTION
Zoning
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
BY
DATE
(sq.ft. — x/1000
x ¢.60
(0.005 sq.ft.)
(¢.01/ q.ft.)
PERMIT APPLICATION
•
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
PERMIT FEES
TOTAL $
ISSUING OFFICIAL
DATE:
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2"° AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com
Page 2
IMPORTANT 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 OUN Y -OF —.M AMI -DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE
1
Signature of Owner
Print Name
,,
Swo .I to and subscribed before me thi
f..
da, of
Signature of NI .t rry PuYic State of Ion .: Signature of Notary Public - State of Florida
P O
1 r a A ' r �., _ ,r SEAL:
4 y
• C I
Personally known OR, Produced Identification Personally known OR, Produced Identification
SEAL:
Type of Identification Produce
Signature of Contractor / Qualifier
Print Name
Sworn to and subscribed before me this day of
PERMIT APPLICATION
'type of Identification Produced:
7ROPERTY OWNER
/ Naeiw
NeW Construction
m 7�-�
t /LLI �'� 7) , �n --,v,J y
Enclosure
Address
gg3 /tie 99 1 57
mfi/9 soa6"5 icL- 33/
3,
1
Home Telephone 3Os_ ^ ?sY " 3 2 st 7
Repair
Business Telephon e
Alt Interior
Fax 303 7j 9 '-- tOr / c/ Q'
Demolish
TYPE OF MANAGEMENT (✓ )
NeW Construction
Enclosure
Alteration Exterior
Repair
Alt Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'l Attachment
Other
Add'1 Detachment
Other
Step 1.
Step 2.
ob Address: 1/93 /U e, 92
�
Address
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
Apt.
Subdivision PB PG Zoning
Current Use of Property
Proposed Use of Property
Tenant Information
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
ST/are Feet
slue of Work
Tax Assessed/App laised Value
Flood Zone Base Floor Elev.
Linear Feet
PERMIT APPLICATION
Master Permit No.
Subsidiary Permit No. / 1 3
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Complete the attached permit application which trust be signed by the propery 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.
Submit the completed application with all necessary documents to the Buildng, Planning and Zoning Department for processing. During the
processing of your application, you may be asked to submit additional infortpation.
A PPLICATION
Alblrf sifoieEs , FL. ?3/3 g
City
State Zip
Folio Number VDescription of Wor / 9, 'L E Gtl/9L4,kCh/i47 01/E/.
Lot Block G0/0 C4 € kvi9 Zi•AiliilEP WAY 7 Fizo/V'T boob ,
Units Floors
5 ODD, a') Bldg Value
ENGINEER
Name
License No.
Address
Telephone
Fax
CONTRACTOR
Mime
License No.
Address
T elephone
Fax
Qualifier Name
Miami Shores Village
10050 NE 2nd Avenue
Building Permit
Phone: 305- 795 -2204 Permit Number: BP2002 -813
Printed: 4/29/2002
Applicant: NORA TENNEY
Owner: TENNEY NORA
JOB ADDRESS: 1183 NE 99 ST
Contractor
Local Phone:
Parcel # 1132050180090
Contractor's Address:
Legal Description: REV PL MIAMI SHORES SEC 8
Permit Status: Approved Permit Expiration: 10/21/2002 Construction Value: $5,000.00
Work: MARBLE WALWAY OVER CONCRETE WALK WAY TO FRONT DOOR
Page 1 of 1
PB 43-69 LOT 20
Fees: Description Amount
FEE2002 -2344 Building Permit Application Fee $60.00
FEE2002 -2408 Notary Fee $5.00
FEE2002 -2407 CCF $3.00
Total Fees: $68.00
Total Fees: $68.00
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 o1 rawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees.
Signed: (INSPECTOR) BY:
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 responlsibility for all work done by either myself, my agent,
servants or employes.
Signed: (Contractor or Builder) BY:
BLK 178
,.
Disapproved
(Signed)
Application is hereby usnde for the approval of the detailed statement or the plans and specifications herewith submitted for the build
ing or other structure herein described. This application is madc 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.
`'� Pry Date.. .T. 1_ , I
Owner's Name and Address...U.�.Q t ,.... 1.,X� g.,ti_2l/ . _ ._ No.� /_ i Street -1) ,7 r_
Registered Architect and /or Engineer ,,.•••...•....„...,...•.•.,. „.,t..
Name and address of licensed contractor 'Q 0•1 .....
Location and lcgal'dcscription of lot to be built on:
Lot Block Subdivision _ _ ._.......�.___
Street and Number where. work is to be done. ...�J ._ 7`)... 7 . _ 's ....,i14 l
State work to be done and purpose of Wilding_ by floors) %.Ter.
UP\ �G•2 t G... 1 Y ..ka`
APPLICATION FOR BUILDING PERMIT
_..__ and for no other purpose.
New Building Remodeling r Addition Repairs; No. of Stories _
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $..'5'c 6 Amount of Permit Ss. � t
Zone cubage required .Plan Cubage
Distance to next nearest building. Size of Building Lot
\faxiunum 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 permit 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 Sup element,
and has complied ssith the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by hips
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 arc required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this
pcnnit, as are licensed by Miami Shores Village.
Remuks (Signed) T1 �L.
Building Inspector
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
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 ar e.
y p
Permit No. ._L" _ 0 Date q') Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Chairman 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 I'Lrnnir.4 hoard.
A re-inspection fee of 31.00 will be charged when such re- inspection is made necessary by Improper notice for inspection or faulty
materials and /or workmanship.