1218 NE 98 St (16)MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Da e • • 3 Time
Type Insp'n
Permit No.
Name
Address
Company
Phone #
For Inspector 3 /I b3 D,
Approved
Correction
Re- Insp'n Fee
)
Name & Date
Contractor's Address
City n,yvA
Qualifier
Owner's Name (Fee Simple Titleholder)
Contractor's Company Name
Number of: Bays Stories
Qitut 30
RECEIVED
J►UL 1 8 2003
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Build Electrical Plumbing Mechanical Roofing ce \\ -5i> _gG3 _ G 1 c
c"'; 0_._.� kksZ x1 Qi N-1v-, Phone # 'Clc J5(0 - \ I LI-
Owner's Address 12_ \Q, iv -- .
City \i ayvv; S ,\No e 5 State V._ Zip 3' \ -- S �
Tenant/Lessee Name Phone #
Job Address (where the work is being done)
City Miami Shores Village
Is Building Historically Designated YES
Miami Shores Village
Building Department
i t fknc E 1,11.J 6
Q
Architect/Engineer's Name (if applicable)
Architect/Engineer's Address
City State Zip Zip
( b00 \ L
$ Value of Work For this Permit << Square Footage Of Work: `� C
Type of Work: ❑Addition ['Alteration ❑New ❑ Repair/Replace ❑ Demolition
Describe Work: 4 P P I L / cil .LvUS7 -fi C__ //J ,24 C A-n/( Si-/T.i 7T? 7c 7
(AuA/Do 04C 5 tZ3 77f1Z-430C e ci 7' i--t C 7 z/J .
t
County Miami -Dade
NO X
State L
Phone #
Zip
7 ,31 3�
Families Bedrooms Baths
RE C EIVED
JUN 2 6 2!03
10050 N.E.
is S
�3S — c,
(«
Ph .31
Tel: (305) 95.2204
Fax: (305) 756.8972
Permit No. b7 .9w3- /QS
Master Permit No.
* * * * * * * * * * * * * * * * * * * * * * * * * ** *Fee Calculation -Misc Permits * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
County Escrow Fee $ Permit Fee $ (p0 / Notary $,
EducationlTraining Fee $ Tech $ Scanning $ Radon $
Code Enforcement $ Bond $ Struct. $
Minus Plans Check Fee $ 3 0 , 0 0 Fee Totals $ 6 '1 to (Continued on opposite side)
iok C -k30_ 00 cA4 j ,
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.
Owner or Agent
The foregoing instrument was acknowledged before me this c ;1
day of jt,KQ , 20 ., by 1 *4I' /mil 4, t * )
who is personally known to a or who has produced j/ J)L
04 t tifica{4on agd who did take an oath.
Signature(
NOTARY
Sign:
Print:
uk i
J! A 1Y. SEAL
Y .1V ::lt'A
NUM 1) -1 -1
^1 +icrxs • My Commission Expires!,, , . ; :; °N EXPIRES
1 2r,a
APPLICATION APPROVED BY:
Chc6/18/03
\ Signature
Contractor
The foregoing instrument was acknowledged before me this
, day of , 20 _, by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency,No.
JUL 15 2003
Plans Examiner
Zoning
OWNER BUILDER DISCLOSURE STATEMENT
I (, ► Ja. k Q_A1 SOY\ being the legal property owner, for the prop erty
Located at: 1 l� l� � 5 1 t CLa^'" -
'� V
Legally described as ct. 'th
Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the
State of Florida, F.S. 489.103(7),.gnd I have read and understand the following disclosure
Statement, which entitles me to work as my own contractor, I further understand that I as the owner
must appear in person to complete all applications.
State law requires construction to be done by licensed contractors. You have applied for a permit under an
exemption to that law. The exemption allows you, as the owner of your property, to act as your own contractor
even though you do not have a license. You must supervise the construction yourself. You may build or
improve a one - family or two - family residence or a farm out - building. You may also build or improve a
commercial building at a cost of $25,000.00 or less. The building must be for your own use and occupancy. It
may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the
construction is completed, the law will presume that you built it for sale or lease, which is a violation of this
exemption. You may not hire an unlicensed person as your contractor. It is your responsibility to make sure
that people employed by you have licenses required by state law and by county or municipal licensing
ordinances. Any person working on your building who is not licensed must work under your supervision
and must be employed by you, which means that you must deduct F.I.C.A. and with- holding tax and
provide workers' compensation for that employee, all as prescribed by law. Your construction must comply
with all applicable laws, ordinances, building codes and zoning regulations.
Proof of ownership provided ( ) initial of reviewing clerk. The foregoing instrument
Was acknowledged before me this 5 day of \()I , 20 03
BY � a retCG Y1CIQ r5On . who is personally known to me or who has
Producedp (UIGQ GT !Q 't' 1 / as identification and who did take an oath.
R 5%-��. ( -84O o el(
ner
Owner
VILLAGE OF MIAMI SHORES
BUILDING DEPARTMENT
DISCLOSURE STATEMENT
1 p` Y " Angela M Becker
My Commission DD150048
'�0, o Expires November 15, 2006
• t).(11) P-(0. H- 1-1-i bre-cau
p.i y 11G qs7Sf
- 14A'A %Lt. -
G 600e
MIAMI•DADE
BUILDING CODE COMPLIANCE OFFICE (BCCO)
PRODUCT CONTROL DIVISION
NOTICE OF ACCEP'T'ANCE (NOA)
Nladdcn Manufacturing Co.
1889 N. W. 22" Street
Pompano Beach, FL 33069
SCOPE:
1IIAMI -DADE COUNTY, FLORIDA
iv1N I -OADF FLACI.IiI 111111.1)ING
140 WEST FLAGLER STREET, SUITE IG0J
MIAMI, FLORIDA 33130 -1563
(3115) 375_2901 FAX (305)375-290S
This NOA is being issued under the applicable rules and regulations governing the use of construction materials.
The documentation submitted has been reviewed by jvlian►i -Dade County Product Control Division and accepted
by the Board of Rules and Appeals (BORA) to be used in Miami Dade County and other areas \where allowed by
the Authority Having Jurisdiction (A1 -IJ).
This NOA shall not be valid alter the expiration date stated below. The Miami-Dade County Product Control
Division (In Miami Dade County) and/or the AHJ (in areas other than i\liami Dade County) reserve the right to
have this product or material tested for quality assurance purposes. If this product or material fails to perform in
the accepted manner, the manufacturer will incur the expense of such testing and the AHJ may immediately
revoke, modify, or suspend the use of such product or material w ithin their jurisdiction. BORA reserves the right
to revoke this acceptance, if it is determined by Miami -Dade County Product Control Division that this product or
material fails to meet the requirements of the applicable building code.
This product is approved as described herein, and has been designed to comply \yitl► the High Velocity Hurricane
Zone of the Florida Building Code.
1)ESCRIPTION: /0-.050" Aluminum Storm Panels Shutter
A PPROVAL DOCUMENT: Drawing No. 00 -380, titled "0.030" Aluminum Storm Panels ", sheets 1 through 10
of 10, prepared by Knczcvich Associates, Inc., dated March 6, 200 last revision g2 dated February 19, 2002,
bearing the Miami -Dade County Product Control Approval stamp with the Notice of Acceptance number and
approval date by the Miami -Dade County Product Control Division.
MISSILE IMPACT RATING: Large and Small Missile Impact
LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and
following statement: "Miami-Dade County Product Control Approved ", unless otherwise noted herein.
RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no
change in the applicable building code negatively affecting the performance of this product.
TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in the
materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of any
product, for sales, advertising or any other purposes shall automatically terminate this NOA. Failure to comply
with any section of this NOA shall be cause for termination and removal or NOA.
ADVERTISEMENT: The NOA number preceded by the words Miami -Dade County, Florida, and followed by
the expiration date may be displayed in advertising literature. finny portion of the NOA is displayed, then it shall
be done in its entirety.
ItNSI'EC' ION: A\ copy of this entire NOA shall be provided to the user by the manufacturer or its distributors
and shall be available for inspection at the job site. at the request of the Building Official.
This NOA revises and renews NOA # 98-1110 and consists of this page 1 as \yell as approval document
mentioned above.
The submitted documentation was reviewed lips I leln►y A. ►sIakar,
NOA No 01- 0313.21)
Expiration Date: 03 /13/2008 .1
Approval Date: 03/21/21)02
Page 1
-
• 1. II
r
MIAMIDADE
1/111111 -
BUILDING CODE.COMPLIANCE OFFICE pcco)
pRoDucT. CONTROL DIVISION
NOTICE OF ACCEPTANCE (NOA)
Sias, Inc.
1121 S. W. 122 Avenue ( #307)
iliami, Florida 33184
AIIAiv l)ANF: c'oIJNTV, I:L uRIU:\
\'IE'CR AUE FLAGLER BUILDING
'W FL '.- ER STREET, St1TTE 1603
4AMI, FLORIDA 33130-156.1
• (305) 3 _901 FAX ( 305) 3 75 . 2 90s
SCOPE:
This NOA is being issued under the applicable rules and regulations governing the use of construction materials.
The documentation submitted has been reviewed by Miami -Dade County Product Control Division and accepted
by the Board of Rules and Appeals (BORA) to be used in Miami Dade County and other areas where allowed by
the Authority Having Jurisdiction (AHJ).
This NOA shall not be valid after the expiration date stated below. The Miami -Dade County Product Control
Division (In Miami Dade County) and/or the AHJ (in areas other than Miami Dade County) reserve the right to
have this product or material tested for quality assurance purposes. If this product or material fails to perform in
the accepted manner, the manufacturer will incur the expense of such testing and the AHJ may immediately
revoke, modify, or suspend the use of slrch product or material within their jurisdiction. BORA reserves the right
to revoke this acceptance, if it is determined by Miami -Dade County Product Control Division that this product or
material fails to meet the requirements of the applicable building code.
This product is approved as described herein, and has been designed to comply with the High Velocity Hurricane
Zone of the Florida Building Code.
DESCRIPTION: "HT -100" / Aluminum Accordion Shutter
APPROVAL DOCUMENT: Drawing No. 00 -849, titled " HT100 Accordion Shutter ", sheets 1 through 6 of 6,
prepared by Knezevich & Associates, Inc., dated July 23, 1996, last revision #8 dated May 10, 2002, bearing the
Miami -Dade County Product Control Approval stamp the Notice of Acceptance number and approval date by
the Miami -Dade County Product Control Division.
VIISSILE IMPACT RATING: Large and Small Missile Impact
LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and the
following statement: "Miami -Dade County Product Control Approved ", unless otherwise noted herein.
RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no
change in the applicable building code negatively affecting the performance of this product.
TERiVIINATION of this NOA will occur after the expiration date or if there has been a revision or change in the
materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of any
product, for sales, advertising or any other purposes shall automatically terminate this NOA. Failure to comply
with any section of this NOA shall be cause for termination and removal of NOA.
ADVERTISEMENT: The NOA number preceded by the words Miami -Dade County, Florida, and followed by
the expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, then it shall
be done in its entirety.
INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors
and shall be available for inspection at the job site at the request of the Building Official.
This NOA revises & renews NOA #00 0628.16 and consists of this page 1 & approval document mentioned above
The submitted documentation was reviewed by Helmy A. Makar, P.E.
NOA No 02- 0611.06
Expiration Date: 06/17/2007 -
Approval Date: 06/17/2002
Page 1
Citizens Property Insurance Corporation
WINDSTORM PROTECTIVE DEVICES - (HURRICANE /ORDINARY)
PROOF OF COMPLIANCE -- RESIDENTIAL FORM WIND ONLY POLICY
The intent of this form is solely for the application of shutter discounts. This form is not for use in conjunction with any other mitigation
features or discounts. ^ _ '
APPLIr,ArvroRO sNaIUE: � Fx . { CRgaie1 A- 4i4DERY��APPUC.ATIONIPOLXYNO. 516 210 - 3-e
39 PROPERrYADDRESS: 12 ► g 14' F . °I OAS LQ✓1 I Aim Sl}tit 5 D AT E COACE (S) INSTAL �Lt IAA 3(}; 264.3
AGENT/APPLICANT: The property address shown above must match the property address on the Application for Coverage to which this
document pertains.
Shutter Requirements:
A. All exterior wall and roof openings, such as doors (exterior
and garage), windows, sky - lights and vents, of the insured
building or unit, if a condominium unit, as described in the
Declarations, is fully protected with STORM SHUTTERS of
any style and material, or alternative as noted in Section B,
designed and properly installed to meet one or more of the
criteria requirements listed below.
All shutters and /or alternative to shutters at the location
shown above are designed to meet one of more of the
following:
1. Withstand wind pressure that at a minimum meets the
American Society of Civil Engineers, July 1988
standards (ASCE 7/88) and impact from wind -bome
debris, adopted by Dade County, Florida in September
1994 or any local code that meets, at a minimum,
September 1994 Dade County requirements for wind
pressure and impact from wind -bome debris or
complies with SSTD -12 standards for wind pressure
and impact from wind -borne debris.
2. Withstand wind pressure that, at a minimum, meets the
standards set forth in the South Florida Building Code,
adopted in Dade County, Florida in August 1988.
NOTE: Roof ridge vents, soffit vents, and breakaway walls
as defined and required by the National Flood Insurance
Program (NFIP), and other non shutter openings as
required by the Dade County building code, do not have to
be protected by shutters.
B. As an altemative to Storm Shutter(s):
1. The garage door(s) meets or is RETROFITTED to meet
the wind pressure and debris impact requirements
noted in A1.
2. The exterior door meets both the wind pressure and
debris impact requirements described in Al.
3. Window or other wall, and roof opening(s) are covered
by permanently installed glazing material that, along
with respective window or other wall and roof opening
structural components, meet both the wind pressure
and debris impact requirements noted in Al.
C.
As the Insured, I certify the following:
1. I will close and secure my shutters in event of a tropical
storm or hurricane affecting my premise(s); and
2. I have made arrangements to close and secure all
shutters in my building or unit (if in a multi -unit building)
when I am away from the premise.
3. The devices certified below are properly installed in
compliance with the manufacturer's installation
recommendation and aforementioned building codes.
4. "While your failure to comply with the above conditions
will not result in denial of a claim for loss caused by the
peril of Hurricane, Other Windstorm or Hail, we reserve
the right to discontinue the benefits of this endorsement,
including any related premium credit, in the event of
such failure ", and as stated in the policy conditions, "we
may cancel immediately if there has been a material
misstatement or misrepresentation or failure to comply
with underwriting requirements established by us."
Signature of Applicant Date
D. A signature of either a Registered Architect, a Qualifier for a
Manufacturing Company, Engineer, or Building Code
Compliance Official is required to verify section A and /or B.
Notary Public to affirm. NOTE: A Qualifier for a manufacturer
is a representative duly qualified and authorized on behalf of
such manufacturer to certify compliance with design,
structural, engineering and /or other specifications with
national, state, and local codes and regulations.
(Continued on Page 2)
WPD -1 R (7/02)
Page 1 of 2
This Affidavit and the information set forth in it are provided solely for the purpose of verifying that certain structural or physical
characteristics exist at the Location Address listed above and for the purpose of permitting the Named Insured to receive a property
insurance premium discount on insurance provided by the Citizens Property Insurance Corporation and for no other purpose. The
undersigned does not make a health or safety certification or warranty, express or implied, of any kind, and nothing in this Affidavit
shall be construed to impose on the undersigned or on any entity to which the undersigned is affiliated any liability or obligation of
any nature to the Named Insured or to any other person or entity.
1. I hereby certify that I am a State of Florida registered Architect, or an Engineer, proficient in structural design, or a duly
designated Regulations and Code "Qualifier" for a Manufacturing Company, or a Building code Official (who is duly
authorized by the State of Florida or its county's municipalities, to verify building code compliance): and
2. In my professional opinion, based on my knowledge, information and belief, I hereby certify that shutters, or altematives to
shutters, on the building or unit at the address indicated above comply with one or more of the stipulations set forth in
section A. and where applicable section B. of the Proof of Compliance Document:
(Check only one)
A.1 (Hurricane) A.2 (Ordinary)
State of FF rida
County bf
With respect to the above.
above named signatory has ,wom
document is accurate and true.
ignatur: o Nota
to and subscribed before me this
(Where applicable, check all that apply)
B.1(Hurr,ane) B.2( rricane) B.3 (Hurricane)
Signature of Registered Architect, Engineer or Date Signa ure o Building Code Complia a Official Da e
Qualifier (Circle one) (Notarize below) (Notarize below)
Print Name: Print Name:
Title
Address Department
Dept. Address
City, State, ZIP
Registration No. City, State, ZIP
Phone Number
Citizens Property Insurance Corporation
(type of identification) for identification.
Print, Type or Stamp Name of Notary
day o AD, 20a3 by
(name of person making the statement) that the ( informati contained within this
personally know the above signatory G inn �A^ or produced
E. Hardship Acceptance when signature in Section D. above cannot be procured:
1 have attached documentation proving that shutters, other devices, and doors without shutters meet the wind pressure and debris
impact requirements stated in the rule and the devices are properly installed in compliance with the manufacturer's installation
recommendation and aforementioned building codes. Such documentation must come from a Building Code and Compliance
Official, the Regulation and Code "Qualifier" for the Manufacturing Company, a Florida Registered Architect, or Engineer proficient in
s • ral d sign uch documentation may be waived if said individuals complete Section D. of this document.
- /
Date
nt
ignature of Appli
Citizens Property Insurance Corporation reserves the right to confirm all information contained in this form via a survey of
the risk.
"Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an
application containing any false, incomplete, or misleading information is guilty of a felony of the third degree.
WPD -1R (7/02)
Page 2 of 2
3
Miami Shores Village
10050 NE 2nd Avenue
Miami Shores, FL 33138
Inspection Record
Inspection #: INSP2003 -3148
Address: 1218 98 ST NE Reference #: BP2003 -1052
Applicant: REX HENDERSON
Directions To Parcel:
Inspection Type: SHUTTERS
Inspector: Curtis Craig
Passed?
Required Steps:
Comments: OK
Inspection Checklist:
[� FINAL
Page: 1
Printed: 8/6/2003
Date: 7/31/2003
Status: APPROVED