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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.