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PAINTELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. I 'TYPE Outlet, Appliance QTY. TYPE: Service Repair TY. 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 MECHANICAL TYPE Minimum Fee QTY. TYPE Condensate Drain QTY. 1 'I VI'I; Generator Q'I'Y. TYPE 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 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 PLUMBING TYPE A/C Condensate QTY. TYPE Drains, Roof QT1'. TYPE Miscellaneous Fixture QTY. TYI'E 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) in the space provided below. RECEIVED AND REVIEWED BY: DATE: SECTION BY DA E Zonin • �� A /O A Electrical Mechanical Plumbing Fire Public Works Structural Building Official Page 4 OFFICE USE ONLY CH ECKLIST ® OWNER - BUILDER FORM (Attach) U FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ® 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 $ m PROOF OF OWNERSHIP (Attach) HRS / DERM APPROVAL (Septic / Sewer) IMPACT FEE (New Construction) m OTHER (Specify & Attach) PERMIT FEES $ (sq.ft. = x/1000 x0.60) (¢.005 /sq.ft.) (¢.01 /sq.ft.) U CONDO ASSOCIATION APPROVAL (Attach) ® BPR APPROVAL (Restaurants) to CONTRACTOR REGISTRATION (On File) REVIEWED AND PREPARED BY: PERMIT APPLICATION DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2"D AVE., MIAMI SHORES, FL c (305) 795 -2207 o FAX (305) 756 -8972 o http : / /www.miamishoresvillage.com 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 FLORIDA, COUNTY OF MIAMI -DADE "c> Signature ofOwner A L Print Name /� Print Name Sw. o • nd subscribed before me this) day , Sworn to and subscribed before me this day of ature o N . . ry Public (C•8l l ' da : - CIAL NOTARY Signature of Notary Public - State of Florida � 2 >4, ,-,T - ,a ANGELA M BECK SEAL: / y C C SSON NUMBER SEAL: B O O 15 6697 pF F' G R MY C0 �p/t ON EXPIRES 200 STATE OF FLORIDA, COUNTY OF MIAMI -DADE Signature of Contractor / Qualifier Personally known OR, Produced Identification C- Personally known OR, Produced Identification Type of Identification Produced: fro� ASS °° Sa'1 / O Type of Identification Produced: PERMIT APPLICATION PI OPEI "TY OWNER Name RI A - Av S (?le t. OA f id' Address 12,86 IU r ° l e i tin s $ • c—,c kl��e 5 Z - C R Home Telephone 3 6. - - C 7 - E` C .\ 1 Business Telephone S • Os , _ 'dam -' I. L- 7 Fax TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'l Attachment Other Add'l Detachment Other INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. 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 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. Address Apt. I 3 2 60 9 CIs Lot P-4 (Q Vr Block ). Subdivision G "rau�i nSI7aV PB 43i8PG Current Use of Property S Proposed Use of Property S A ∎ 1L `�t,�,, f ,, Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Master Permit No. Subsidiary Permit NB.SO City Description of Work -� Zoning S quare Feet y� Value of Work "7 ( C/f Tax Assessed/Appraised Value Flood Zone PERMIT APPLICATION State Zip Linear Feet Units Floors Bldg Value I I ) 8 114 1 19c(9 — �t5 t4c Base Floor Elev. ENGINEE Name License No. Address Telephone Fax CONTRACTOR Name License No. Address Telephone Fax Qualifier Name MIAMI SNORES VILLAGE Paint Color Approval and Agreement DATE: / /S /Q/ OWNER'S NAME: 4!am ADDRESS: *********************************** ** *** * * **** * * * * * * * * * * * **** ADDRESS OF SITE: / 2—C' � y %%/- CONTRACTOR & LICENSE (if applicable) COMPANY NAME: ************************ kcxxcxx xxx * * *.k * * * * * * * * * * �cxxxxr All Elements on the site must be listed and indicate the color to be painted. Walls 13ec e Fascia eJfrl� Drip Cap/Drip Edge ►„U1. r' Soffit Gt.) 10 Roof Flower Bins GLi IAA Shutters Greer Awnings Chimney Doors and door jams -Fro r - do - 51\C e-r1 Garage Doors w k' Railings r`e,e-vA Fences 0(6 Decorative Metal C9 rec./1 All brick (simulated or regular) Stucco Banding Any other stucco features Accessory Buildings Other 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 Signature of Owner 'Date Signature of Contractor Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED: WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION / v// O( Building Official Date rS /o / PHONE: PHONE: xx * * 8234M Daplin 0 4/23/01 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date Job Address / 2 tv Tax Folio Legal Description Historically Designated: Yes No Owner/Lessee / Tenant ahiA, D . S Master Permit # Owner's Address / M 8 6 / 1 / e 99 $ ' Contracting Co. (S /O, i 2; 7 pr y 4, 0/7 Address 36 23e cr/ ,,? C.ic/e e eo. Qualifier a4 _yv, Phone gal-- 66 S� - P263 State # Municipal # J :3J O7 /O/ Competency # c"1.500325 Ins. Co. Architect/Engineer Address Bonding Company _ Address Mortgagor — Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN / H� (t/(. -/e 7fv,`/►- WORK DESCRIPTION Square Ft. esZ Estimated Cost (value) Phone 7S7 - SS0' 3 dtiB '/O52/.5 rao ' #is 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 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. OWNERS 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 the work stated. Signature of owner and/or Condo President Date Notary as to Owner and/or Condo President My Commission Expires: APPROVED: Zoning Building Mechanical Date Signature of Contractor or Owner- Builder Notary as to Contractor or Owne My Commission Expires: ?jl FEES: PERMIT 4/ 0 RADON C.C.F. b NOTARY S Electrical .\p.12Y P&6 OFFICIAL NOTARY SEAL !l, BARBARA ANN FUCAZZI • p .< coMCI v NUMBER aa-q" ,). e� MY COMMISSION EXP. OF F\-CD &AR. 291998 BOND TOTAL DUE 4 7 1 6_ Date / 0 75176 Date Plumbing Engineering • ° PERMIT APPLICATION FOR MUNICIPALITIES (OWNER TO RETAIN COPY) Date3 Job Address ag5 Q-C,, G1O\ Legal Description , c t / , / Qualifier Square Ft. ° SCC-3 Signature of owner and /or Condo President Date: SS# Lessee / Tenant c) Owner's Address \ �.� -E 1 Contracting Co. 0 w 5•• Municipal # Competency # Ins.Co. OF DADE COUNTY Tax Folio // 3a OS it ®".-a if Master Permit # i .�9aT Phone Address Phone State # Architect /Engineer Address Bonding Company Address Mortgagor — Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION a, Estimated Cost(value) c am, v 0 WARNING TO OWNER: YOU MUST R ECORD 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 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 constructio thermore, I authorize the above -named contractor to do the work st INVIr Signature o Date: ID take an oath, or . NOT take an oath, -/i{ Notary as to Owner and /or Condo President ot- y as to Gestesotes.,APOwntir - Builder Commission ExpRY POBUC. STATE OF FLORIDA My Commission Expires: My ** * * * * * * * * * * FEES: PERMIT 1 4 0 515 RADON C.C.F. .56 NOTARY 1 5' TOTAL DUE 0( 1 APPROVED: Fire Zoning Building • J ) J q 7t- Electrical Mechanical Plumbing Engineering MY COMMISS4ON EXPIRES APRIL 16, 1992 BONDED DIN STEMBLER.ADAMS & SWEET * * * * * ** Other