PAINTPROPERTY OWNER
Name - fhro id 0 CJI bL
Address a0% N • - n\C s
Home Telephone C 3 o5) —.1.56 _ C 3 `(
Business Telephone 0 i ( 2 q 7 _ 573 Z 7 sO
Fax 0 1 l 2-/ 7- S 87 53 5?
CONTRACTOR
/J / / - /
Name A/er e. lTrz 1 Z P /Q 1 1 (. ,64..radt c
License No. ✓ U
Address 5295" AIL,. ((4—
MiCk. w i C I- 3 30 l Li
Telephone O Fa f 6
Qualifier Name I orq .G /pn ,1;2
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'I Attachment
Other
Add'I Detachment
Other
INSTIZ t CT IONS - The folI) inlg steps nui.t he taken to obtain a hermit from the \Iiaini Shore',
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 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.
kI'1'1.1(• VI ION
Job Address:
taw N.E. cc St. M;(a■; SiN3ces Ft . 33V38
Address
Apt. City
Folio Number Description of Work Y.kett- i be Pa, r1ki 1J q _
Lot Block
Subdivision Its PB PG Zoning Linear Feet
Current Use of Property l 4 c ,e_. Square Feet 0005/ Units Floors Z
Proposed Use of Property X 5 1 &o no.- Value of Work
I oo•00
Tenant Information Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roof
Fence
Other
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
N M
Telephone
Fax
19p7 /c 2fia A-e-- 3
JUN 1 8 200
Master Perm
_- -Subsidiary- PSrrrrit-
r
PERMIT APPLICATION
p? x,413- qv/
0.
State Zip
Bldg Value
ENGINEER
Name
License No.
Address
Telephone
Fax
Page 2
1\lI'tllt'I \ \'I' \(►'fl('i:
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 m 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.
\ \\ 1I - Please read carcfulli.
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 FLORID 2, IAMI -DADS STATE 0 FLORIDA, COUNTY OF MIAMI -DADE
/id rot/
Signature of C , : ctor / Qualifier
Signature of Owner
Print Name r� ' J ('
Sworn to and subscribed before me this 1 I day of A t4 t ,
a oo3.
Signature of Notary Public - State of Florida
SEAL:
Personally Imo
CHRISM NAVARRO
NOTARY
UC STATE OF FLORIDA
ION NO. DDI15600
ti
Type of Identification Produced:
totiq Pcf110.∎
Print Name 00
Sworn to and subscribed before me this ‘—‘ day of 3%-
a OD3
Signature of Notary Public - State of Florida
SEAL:
PERMIT APPLICATION
CHRISTIE NAVARRO
NOTARY PUBUC STATE OF FLORIDA
CO I. ION NO. DD115600
MY SS
Personally known
Type of Identification Produced:
6 /7 1/43
DATE:
OWNER'S NAME: Horn 1c ()At A1ne2
ADDRESS: t cZ p% N • e.. cl q ` " •
Miami Shores Village
10050 Northeast Second Avenue
Miami Shores, Florida 33138 -2382
Telephone: (305) 795 -2207
Fax: (305) 756 -8972
www.miamishoresvillage.com
Paint Color Approval and Agreement
ADDRESS OF SITE: 1 N • E. G1 q •
CONTRACTOR & LICENSE (If applicable)
COMPANY NAME:
All Elements on the site must be listed and Indicate the color to be painted.
do q - 0 &- Pa
Walls: \.1 \tAI2--
Fascia:
Drip Cap /Drip dge: WhA-
Soffit: \ r ' %
Roof: vA\ 1.
Flower Bins: • P I L 7 ? ? ►� s 5 i o k
Shutters: NM
Awnings: iv/
Chimney: iv /
Doors and door jams: W �✓
Garage Doors: l.•- Al-(e_
Railings: /1 /i4
Fences: Ar lt9
Decorative Metal: /v /4
All brick (simulated or g lar): /3 141• 77 / 14 s SapeN0
Stucco Banding: lo i-
Any other stucco features: A//fl
Accessory/Buildings: NM
Other:
OWNER'S AFFIDAVIT: 1 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, tt a paint colors will be as per the attached samples.
Signature of Owner
APPROVED:
l et
1/d 3
Building Official Date
PHONE: 011 -;q 1-,rjS3 -f750
PHONE: 305 (oQ (0 1 O
aS 6(14}
Signatur f,f Contractor
61 /1 /43
te
WHEN PAINTING IS FINISHED, CALL FOR FINAL
INSPECTION
ELF( i RR .\I.
I\I'I.
Minimum Fee
1)11.
11I'1
Dryer
1)11.
111'1
Outlet, Appliance
I)I1.
I11'I
Service Repair
1111.
A/C Central 1 -3 Ton
Fan
Outlet, Wall
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
\IF('11.\ \I('.\I.
11 VI .
Minimum Fee
I ) 1 1 .
1 1 I ' I
Condensate Drain
1 ) 1 1 .
1 1 I ' 1
Generator
Q11.
1 1 I ' I
Refrigeration, Tons
O 1 1.
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
P1 t N1B1 \(;
I 1 I'F.
A/C Condensate
) ! 1.
I 1 I'I
Drains, Roof
Q11.
1 1 1'I
Miscellaneous Fixture
Q11.
l 1 1'1
Soakage Pit
Q11.
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
Draintield, 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) in the space provided below. I
RECEIVED AND REVIEWED BY: DATE:
SECTION
BY
DATE
Zoning
7
'(i1 L__147
e, /i 7/ r 9
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
- f %'A1tre'' r
Page 4
OFFICE USE ONLY
( 1 1 1tj 'IN 1.1 i
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi - family)
❑ CONCURRENCY
(New Construction)
O OTHER
(Specify & Attach)
I'i :I2 \11'I 1'11:S
$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
Notary
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
O OTHER
(Specify & Attach)
$
(sq.ft. = x /1000
x ¢.60)
(¢.005 /sq.ft.)
(¢.01 /sq.ft.)
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ ‘/
(
ItiS( I \(; OFI I('1 \I.
REVIEWED AND PREPARED BY: DATE:
('U \I)I 11U\ \I.
•
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 MIAMI SHORES VILLAGE
2t:S
Date A M ■ I. –98Job Address ( Z 01 1/ E.. q i ST M (n t Tax Folio
J Historical) Designated: Yes No
Legal Description ./ W C_.LL- ( Al C Historically � J
/ Tenant .4(A A 0 L D O J () A C / Master Permit # `.- 2 7 c 7
Owner's Address I ZO I A/C- g q S 7
Contracting Co. t/ 17GI / I Art/ / /I i l? Address 7 so() /V" - (p 9 4 //6
Qualifier d:7-'7'1-15 - 7OVCphone (3v- C NN "'MO
State # Municipal # Competency # 6 (3 SG 00 Ins. Co. 6 rc Oa COS �` in S _
Architect/Engineer
Bonding Company
Mortgagor
799
Permit Type (circle one): BUILDING ELECTRICAL PLUMBL . _ _ .— _ _ _ PING PAVING FENCE SIGN
WORK DESCRIPTION Pre�6' /-e c 4 247 1 A C At aSZ 0/7/ 7/7 ,i?. /
`1 yf I- re T ki t re_ { �rvl-,q5
Y�o j ` N` 4 0_00ir a� r� toy o o c e m ootn c.�I ►r `rtriM 6( _
Square Ft. 2 0 0 C� S - F f , ,./ ,,,,k Estimated Cost (value) / 6 00 .0
I
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 above, and on the attached addendum (if applicable). I
5ertify 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.
My
Zoning
Mechanical
OWNER'S AFFIDAVIT: I certify that all the for
laws regulating co ' truction • i zoning. ' urth
Signature of o er an
or Condo President 1D
Notary as to Owner and/or Condo President Date
Y C R I AL NOTARY SEAL
P SANDRA M ME�►MBER
� M COMMISSION •EXP.
OF FA O AUQ. 17 S98
FEES: PERMIT RADON
oing ' ormation is accurate and that all work will be done in compliance with all applicable
I . uthorize the above -named contractor to do the work stated.
Building l I D
Plumbing
Contracto • Owner -Buil
Date
Signature
C.C.F. NOTARY 1/4-
Phone 3 0 6 -A •`i 3 1 1
• ..was to Contractor or Owner- Builder
y Commission Expires: :-.• „ :-. h
Electrical
er
9,
BOND
TOTAL DUE ys '
Engineering