ALARMMIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date 2 - Time
` �rl
Type Insp'n
Permit No. 1-200 3
Name
Address \ I S n . CM
Company
P _ al
JU f��/U 7
Phone#
For Inspector: /2491/0A
Approved
Correction
Re- Insp'n Fee
z
c
PAY
TO THE
ORDER OF
FOR
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 10 /24/2002
Applicant: CARMEN TERESA
Owner: ELWIN
JOB ADDRESS: 245 NE 99
Contractor BRINKS HOME SECURITY INC Contractor's Address: 5765 NW 158 ST
Local Phone: 305 - 558 -6625
Parcel # 1132060134550
Fees: Description Amount
FEE2002 -6035 Building Permit Application Fee $60.00
FEE2002 -6036 CCF $0.60
$60.60
Total Fees:
Total Fees: $60.60
Total Receipts: $0.00
\/ Permit Status: APPROVED Permit Expiration: 4/22/2003 Construction Value: $199.00
Work: BURGLAR ALARM 1 MASTER 6 DEVICES
If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection
BRINK'S HOME SECURITY
5765 N.W. 158TH STREET
MIAMI LAKES, FL 33014
Customer Connection
— 1 , Z 7" ate
Bank ofAmerica���
Electrical Permit
Permit Number: EL2002 -347
u m e n t. see back for del as
ELWIN
CARMEN TERESA
ST
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 17 & E1/2 OF LOT 16 BLK 33 LOT SIZE
DATE (D * 17' O)
11'00 39 2611' 1: L L L0000 L 21: L59 5 6 L 48 L
,O d
3926
32 -t /1110 TX
0
DOLLARS 8
Page 1 of 1
ication herefor in strict compliance with all
:ifications that may have been submitted to
:s or if the plans are changed without
ponsibility for a thorough knowledge of the
that he assumes responsibility for work done
ons pertaining thereto and in strict conformity
responisibility for all work done by either
CONTRACTOR
Name/ , ' Q� ,f ,
c�� E�
License No. E _, .7 / %'
Address i 766 _ / a , gt • /72
Telephone .Fax
Qualifier Name I/1 rem
PROPERT OWNER
Name A Q/ / 5
/ iv
Address .2 , Ne 3
Home Telephone
Business Telephone
Fax
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Add'I Attachment
Foundation Only
Other
Add'l Detachment
Other
SNoae ` ..
._..�
4.4-
a
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:
Lot
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.
c9416 - OE
Address
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
Block
Apt.
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
Master Permit No.
Subsidiary Permit No.
City
Folio Number �� 3�t' 0/ • ' $ Description of Work
tate
Subdivision PB PG Zoning Linear Feet
Current Use of Property Square Feet
Proposed Use of Property W/ ikihr' Value of Work 199 °%
Tenant Information
Tax Assessed/Appraised Value
Units Floors
Bldg Value
PERMIT APPLICATION
Zip
Flood Zone Base Floor Elev.
ENGINEER
Name
License No.
Address
Telephone
Fax
Page 2
1y1I Ot(I;NT N01'lc'IS
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.
s � ROBLES
"�' it my COI:".MTSSI0N B CC 921872
4 1 EXPIRES: June 4 2004
@ended Tlao t a uy Pub c Bar dui;
STATE O ' ORIDA, C
Signature of
Print Name
Sworn to and subscribed before
Signat
SEAL:
Personally known
a
OR, Produced Identification
I - DADE
Type of Identification Produced:
STATE OF FLORIDA [ O A1 Y OF MIAMI -DADE
Signature of C
/A* . '
T I•
subscribed before me this ° day of el:
Signatur
SEAL:
tary Pub
,� ;�••• JUDO ROBLES
`�`'
:, s MY COMMISSION # CC 921872
t " EXPIRES: June 4, 2004 _
••4,4f4:11%., C Bonded Thu Notary . .
PERMIT APPLICATION
Personally known OR, Produced Identification
Type of Identification Produced:
ELECTRICAL
TYPE,
Minimum Fee
A/C Central 1 -3 Ton
QTY. TYPE
� _= „-z ;.
�i',�`�
QTY. TYPE
Outlet, Appliance
-: utlet, Wall
QTV.
TYP1:
Service Repair
Service, Temporary
QTY.
A/C Central 4 -7 Ton
Fire ' p
; ji tlet, Switch
Cooling Tower
Signs
A/C Central 8 -15 Ton
Fixture - Fluorescent A
-ri ven
Space Heater (kw)
Paint Booth
A/C Central 16-20 Ton
F I!II i al
0 'Fig Lot Lights
Air Handler, Tons
Spas/Hot Tubs
Ductwork, Cost of
A/C Central 20+ Ton
Flood Lights
v Plugmold/Strip
Subfeeds, No. of Amps
A/C Window
FPL - Load Central
Posts
Swim Pool, Commercial
Bath Fan - Vented, #
Air Conditioners
? ��
Range/Range Top
Swim Pool, Residential
Chiller
:.. ..;,.,. _ Sri /074.
y/' Receptacles
Switchboards
Clear Violations
Heat Recovery
Refrigerator, Comm. (p/PH)
Temp Serv., Construction
Compactor
` _ . -volt Bur _ - iiiill
Refrigerator, Domestic
Temp for Test - 30 days
Deep Freezer
Low -volt, Fire
Renew - Temp Service
Gas Piping
Demolition
Low -volt, Intercom/Teleph.
Repair Circuits
Dental Chair
•Dir f jia li rAllra Low -volt, Television
Service, Number of Amps
Pump, Sprinkler
Pump, Sump
Utility - Sewer
Utility - Water
MECHANICAL
'LY
Minimum Fee
QTY
TYPE
Condensate Drain
Q . I . vpi:
Generator
Q
.LYPI:
Refrigeration, Tons
QTY.
A/C Central, Tons
Drains, Roof
Cooling Tower
- Heating Strips, each
Vent Hood, Cost
A/C Wall/Win. Tons
Dryer Vents, Number of
Paint Booth
Miscellaneous Repairs
Ventilation, Cost
Solar Water Heater
Air Handler, Tons
Bidet
Ductwork, Cost of
Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
Process/Pressure Piping
Fountain
Pump and Abandon
Bath Fan - Vented, #
Sprinkler System
Fireplaces, Number of
Pressure Vessel
Gas - Appliance
PLUMBING
LYPI, QTY
. Lvi , i:
OTY
'FI.l,l:
Q.I'v
.I.Yi,i,; QTY.
A/C Condensate
Drains, Roof
Miscellaneous Fixture
Soakage Pit
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
Pump, Sump
Utility - Sewer
Utility - Water
Discharge Well
Ice Maker
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:
Page 4
OFFICE USE ONLY
CIIECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi - family)
• CONCURRENCY
(New Construction)
O OTHER
(Specify & Attach)
Inspector State Educational Fund
State DCA (Radon)
Code Enforcement Fine
Zoning Review
REVIEWED AND PREPARED BY:
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
$3.00 per page (Scanning Fee) $
Miami Shores Village
Bond
Metropolitan Dade County (C.C.F.) $
$ �o
( sq.ft. = x/I000
x ¢.60)
$ (4.005 /sq.ft.)
$ (0.01 /sq.ft.)
SECTION
Zoning
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
BY
DATE
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
PERMIT FEES
TOTAL $ L9, b
ISSUING OFFICIAL_
CONDITION OF APPROVAL
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
Date S /3 ,4 3 -- Job Address o? y5 /1/ 79 . 7.ee'f'rax Folio
Legal Description His orically Designated: Yes No
Owner/Lessee / Tenant 4 J /we /- ''' 7 d 9 , Master Permit # 3 77, 9'
Owner's Address Phone
Contracting Co. gAFr f)Ati A Soc/N/) A /,1i`-1
Qualifier fI ice' 1� V D C SS# 2 3 8 9
State # lT o Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL LUMBING MECHANICAL ROOFING PAVIN FENCE SIGN
4- I rf' kk L- -3- 1 Q/ c S
Address
Square Ft. Estimated Cost (value)
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.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate an that all work will be d
laws regulating construction and zoning. Furthermore, I authorize the above -named ontractor to do the w
My onkiagtioopprfam. NOTARY SEAL
0 ei SANDRA M MONTIEL
* COMMISSION NUMBER
Q CC401201
(* MY COMMISSION .EXP. g
of c\P AUG. 17 1998
Date
5 3 -9S
compliance with all applicable
Y
Signature of Contrac or or Owner- Builder Date
Signature of owner and/or Condo President
isiotary as to Owner and/or Condo President Date Notary as to Contractor or Owner - Builder Date
My Commission Expires:
6 ;'1
FEES: PERMIT 3 9 e ) RADON C.C.F. �. NOTARY � TOTAL DUE
APPROVED:
Zoning Building Electric / X
Mechanical Plumbing Engineering