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PAINTDate Time Type Type Insp'n�� � aZ • Permit No. � P / � J Name v�G� Address aEq G5 Company -- Phone # For Inspector: Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request OS) ;.)— Nam 7 i ELECTRICAL TYPE Minimum Fee Q'I'V. TYPE Dryer QTV. TYPE Outlet, Appliance QTV. 'I'VPI.: Service Repair 1'r‘' . A/C Central 1 -3 Ton - Heating Strips, each Fan Outlet, Wall Service, Temporary Paint Booth A/C Central 4 -7 Ton Fire Pump Outlet, Switch Piping, Flammable Liquid Signs A/C Central 8 -15 Ton Fixture - Fluorescent Process/Pressure Piping Oven Space Heater (kw) A/C Central 16-20 Ton Pressure Vessel 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. TVPI? Generator QTV. TV Refrigeration, Tons QTV. A/C Central, Tons vv. 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 Pump and Abandon Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Gas - Appliance PLUMBING TYPE A/C Condensate QTY. TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. TYPE: Soakage Pit vv. 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: Page 4 OFFICE USE ONLY CHECKLIST `OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi - family) ❑ CONCURRENCY (New Construction) O 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 Notary ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) $ tab $ D tab (sq.ft. = x/1000 x 0.60) $ (0.005 / sq.ft.) $ (0.01 / sq.ft.) $ 5 -o0 RE v ;:: r,li AND PREPARED BY: 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 $ ISSUING OFFICIAL CONDITION Oh Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com MIAMI SHORES VILLAGE Paint.Color Approval and Agreement DATE: -' 2 2-(.)z- OWNER'S NAME: Ke rL- e rP Laid PHONE: 9 39 19 ADDRESS: Z(Q b rlc 9 Q, (YI _ ,S' ha►c.! R , 3 3 f 3cfr ********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ADDRESS OF SITE: CONTRACTOR & LICENSE (if applicable) COMPANY NAME: ************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All Elements on the site must be listed and indicate Walls 1 tq A- Kea Fascia W1/4- ,.Ve Drip Cap/Drip Edge ►t/ )- Soffit L Lk. Roof p j /a- Flower Bins N/A Shutters f A-. Awnings A// fy Chimney (,.5,t nm(fW'1 . T1J Doors and door jams m A 1 u and S — Garage Doors V1- Railings Fences Decorative Metal All brick (simulated or re _ular Stucco Bandin Any other stucco features Accessory Buildin_s Other ' ` APPROVED: w '21 2 2 -/ 0 2 Building Official Da e BENJAMIN 3 e-'( COLORPREV EW 2148 H H i1r1 0 0 P .'' v Ovy OWNER'S AFFIDAVIT: I certify that al t e foregoing information is accurate and that all work will be done in compliance with all appli,e'able laws regulating construction and zoning. I authorize the above -named contractor, if appli . do the w • . - .. Furthermore , the paint colors will be as per the attached sam dv 7. 2? gnature o Owner Date Signature of Contractor Date - ****************************************************************** WHEN PAINTING IS FINISHED, • CALL FOR FINAL INSPECTION BENJAMIN MOORE® COLORPREVIEW" 4/23/01 MIAMI SHORES VILLAGE Paint Color Approval and Agreement DATE: a ?roe - 6 ?- OWNER'S NAME: c r? N P PHONE: 3of- 75 f' -39' ADDRESS: **********************************. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ADDRESS OF SITE: .2.6o N 99. S / 3 13 8 CONTRACTOR & LICENSE (if applicable) - COMPANY NAME: PHON ******************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *4 All Elements on the site must be listed and indic Walls 5 .) Fascia Drip Cap/Drip Edge t, Soffit ./( (AZ, Roof Ni /g Flower Bins N / Shutters Awnings Chimney N APPROVED: crz . -2/4/}3 -So 7/ Building Offic' 1 Date 21V e_e 0-54 c ol t yc 3Y lu.l.ti•. Doors and door jams Garage Doors Railings Fences - Decorative Metal All brick (simulated or regu Stucco Banding Any other stucco features 1 -a Accessory Buildings E cJ Other .:. N /�� ,te OWNER'S AFFIDAVIT: I certify that all the foregoing info and that all work will be done in compliance with all appli,c'abl construction d zoning. I authorize the above -named contrac d he work d. les. sandy white urthermore , the paint colors will be as per are - atraurreer 07 -09 -0 o 2148 -50 BENJAMIN MOOR COLORPREVIEW 4/23/01 In E HC -34 Signature of Owner Date Signature of Contractor Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION HC MIAMI SHORES VILLAGE Paint Color Approval and Agreement /pATE: - 3 2 ,/ OWNER'S NAME: Ike c 6 ^e hA. ,HONE: 305 - ) S9 3 n i 9 4&DDRESS: 2 (a nE. 9 g s• miAy►i s H-w . 3 3 3 e **:****************************** ** * * * * * * * * * * * * * * * * * * * * * * * * *** ** II DDRESS OF SITE: 2(F c • n E iii s- E A I S Mertes r1- 331 3,1i CONTRACTOR & LICENSE (if applicable) v i) COMPANY NAME: PHONE: ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All Elements on the site must be listed and indicate the color to be painted. Walls - 3 S Fascia \NI Drip Cap/Drip Edge / 6 Soffit k-)`i. Roof Flower Bins Shutters Awnings Chimney 1-3, l e n 4--An KC 34 Doors and door jams Chop lec.4,1 -/p Garage Doors t. ol:;, k� 1 Railings Fences Decorative Metal All brick (simulated or regular Stucco Banding Any other stucco features Accessory Buildings poQ-c A bob- K C 3 Other w t t ,.5 e-s NA &k-on b'ro•.4.• 1) n6 e(wivieews (s, \t -- L3,1 en.. ) 1+C - 3 1 ' 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 .e tated. Furthermore , the paint colors will be as per the attached APPROVED: 77 /D Building Of is Date t wilmingto tan powell buff n( ign.ture of Owner Date Signature of Contractor Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION 4/23/01 HC -34 28 HC -35 Miami Shores Village 10050 NE 2nd Avenue Phone: 305- 795 -2204 Permit Number: BP2002 -1211 Printed: 7/9/2002 Page 1 of 1 Applicant: k-eA •/E � .--yLeNr■41_4 /, F/v -� Owner: JOB ADDRESS: 260 NE 99 ST Contractor Local Phone: Parcel # 1132060134320 Permit Status: Approved Permit Expiration: 1/5/2003 Construction Value: $1,000.00 Work: EXTERIOR PAINTING AS PER AGREEMENT (OWNER BUILDER PERMIT) 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 or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. Fees: Description Amount FEE2002 -3774 Building Permit Application Fee $60.00 FEE2002 -3775 CCF $0.60 FEE2002 -3776 Notary Fee $5.00 Total Fees: $65.60 Total Fees: $65.60 Total Receipts: $0.00 Signed: Building Permit Contractor's Address: Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 4 & 5 & E1/2 OF LOT 6 BLK 32 LOT SIZE (Contractor or Builder) BY: SPECTOR) 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, - ate = is or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either myself, my age r}t servants or emp es. f 3 61 9 :0 1.711.2/ 0-7 ;T: 5 .A Miami Shores Village 10050 NE 2nd Avenue Printed: 7/9/2002 JJ , Applicant: E , J V Owner: HAER1-GAN JOB ADDRESS: 260 NE 99 ST \ Contractor Local Phone: Parcel # 1132060134320 Building Permit Phone: 305 - 795 -2204 Permit Number: BP2002 -1211 Contractor's Address: Permit Status: Approved Permit Expiration: 1/5/2003 Construction Value: $1,000.00 Work: EXTERIOR PAINTING AS PER AGREEMENT (OWNER BUILDER PERMIT) Page 1 of 1 [- C - 1..t.6 1 1 II / )14 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. Signed:. (I NSP5CTOR) BY: 0 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 4 & 5 & E1/2 OF LOT 6 BLK 32 LOT SIZE Fees: Description Amount FEE2002 -3774 Building Permit Application Fee $60.00 FEE2002 -3775 CCF $0.60 FEE2002 -3776 Notary Fee $5.00 Total Fees: $65.60 Total Fees: $65.60 Total Receipts: $0.00 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 or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or emplo yees In consideration of the issua9.ca 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, statement or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either myself, my age , servants or emplo s. f Signed: r �' �7 \ :�� : (Contractor or Builder) BY: J 0 ,PROPERTY OWNER Name I\ e '1'L. Q 1 n tf Address a4.0 0 ne 99 S „-- t %(Nrr•, S*\otcs 33 ) Home Telephone "� j0 c— —1 5 ° 1 ' 141 l 9 Business Telephone 3ec If Li 3 - t J C7 Fax 3c - 4 44 3‘419 TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'l Detachment Other Step 1. Lot PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other ARCHITECT Name License No. Address Telephone Fax Block PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection Master Permit No. Subsidiary Permit No. INS'T'RUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: 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. AP'LICA'1'ION Address: Q. 4 L 1'1 E e l at S ' ill i A m l +1-o LES Address Apt. City State Folio Number description of Work '1k1 ✓rri n.)<— PERMIT APPLICATION 3 ?13 Zip Subdivision PB PG Zoning Linear Feet Current Use of Property Square Feet Units Floors Proposed Use of Property Laue of Work & Bldg Value Tenant Information Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. Address Telephone Fax Qualifier Name Page 2 1MPORTANT 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, I° 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. Signature Owner Print Name worn n and subscribed before me this day gf SEAL: TE P FLORID COUNTY OF MIAMI -DADE AI i ill7 i -'. .1211L , -4 • 1� fate a ;FI. I N ii: , coa:.ssow wue:erw N, n ��IIP• ¢ , CC786697 s , 4o uv IONF RES OF r\ O - - _ 15 -- STATE OF FLORIDA, COUNTY OF MIAMI -DADE Signature of Contractor / Qualifier Print Name Sworn to and subscribed before me this Signature of Notary Public - State of Florida SEAL: PERNGT APPLICATION day of Personally known OR, Produced Identific / ation Personally known OR, Produced Identification Type of Identification Produced: 'k p Z. KS_377 fst1 '09 Q.- D Type of Identification Produced: ELECTRICAL TYPE Minimum Fee Q . LI . . LVPI , : Dryer Q . LI . TypE Outlet, Appliance `I . Service Repair `LI 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 1sIECHANICAL TYPE Minimum Fee QTY. Tl'PE Condensate Drain QTY. TYPE Generator Q"I'1'. 'fvPI.: 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 • PLUN1B1NG TYPE A/C Condensate QTY. TYPE Drains, Roof QTY. "I'1' Miscellaneous Fixture QTl'. TYPE Soakage Pit Q'fl'. 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: Page 4 OFFICE USE ONLY C11LCKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi - family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) PERMIT FEES $3.00 per page (Scanning Fee) Miami Shores Village Bond Inspector State Educational Fund $ State DCA (Radon) $ Code Enforcement Fine Zoning Review Notary ❑ PROOF OF OWNERSHIP (Attach) O FIRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) O OTHER (Specify & Attach) $ $ h0 Metropolitan Dade County (C.C.F.) $ i (. $ SECTION Zonins Electrical Mechanical Plumbing Fire Public Works Structural Building Official ( x sq..60) x/1000 (¢.005 /sq.ft.) (¢.01 /sq.ft.) • PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ 6S, 6 U ISSUING OFFICIAL REVIEWED AND PREPARED BY: DATE: 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 Date Legal Description Historically Designated: Yes No Master Permit # r S"7 5,C /- p Phone / // x f Contracting Co. ,)c x j L L 0 }/ (L Gjtii 7..-1 Address /.53 / /4/-3 5 r Owner/Lessee / Tenant' \ Tit`? NE R - o eiziR) GAIAI Owner's Address p2Ci AZ — 9 ? it .� Qualifier SS# State # Municipal # DO 617 l/ D Competenc # Architect/Engineer Address Bonding Company Address Mortgagor Address WORK DESCRIPTION Signature of owner and/or Condo President Date Date Notary as to C s E___ c t o s. �� ;'� l`ia • • R Notary as to Owner and/or Condo President NA1& ue �" PUBLICSTATE OF FLORIDA COMMISSION NO. CC714103 MY COMMISSION EXP. MAR. 1,2002 FEES: PERMIT ') () RADON C.C.F. NOTARY BOND APPROVED: Zoning Mechanical PERMIT APPLICATION FOR MIAMI SHORES VILLAGE t- e Job AddressX 2 60 f £ , ' f 9 Et Tax Folio Building ;IX"? Electrical Phone Ins. Co. Permit Type (circle oBUILDIN4 ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN 1 1 V 7 c - /-7,001) a , v 10 Square Ft. Estimated Cost (value) X / JX > / S01)„ < WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE S 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 construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated. Owner- Builder ‘6e33/51/)a. 6 Date Plumbing Structural Engineer Disapproved Permit No. 1.0 7‘ (Signed) MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made 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. �/ & ��/ �,/ gg 19 Owner's Name and Address J 7 S - / — / � ,EJ No. Street N ! 'f Registered Architect and/or Engineer Name and address of licensed contractor_ /— � / , 7 1/72 Location and legal description "T scription of lot to be built on: Lot G Block 1C;71 Subdivision /�S S u ub b divisio i n �j Street and Number where work is to be donea46O i3(�Cf7 /� io 77 State work to be doe and urpose of building (by floors), state ex for colors (submit samples) _0..11:54°,4.44,4AA4-ir 4---.- I ( ■Z•e P ) ■)1, Date Da tA<A. for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of ! Kind of foundation Roof Covering yF Estimated Total cost of improvements $ 4 3rmit $ , / S Zone cubage required Distance to next nearest building ;ng Lot Maximum live load to be borne by each floor 1 hereby submit all plans and specifications fo 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 obligatons as an employer of Labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him 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 are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) / /7I STATE OF FLORIDA COUNTY OF DADE. }ss. Before me. the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared Read. Sworn to and Subscribed before me. 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 foregoin: application, and that he did sign the same, and that all facts therein by him stated are true. Date Notary Public, State of Florida Building Inspect:,r My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approved Date Disapproved Date NOTE: A charge of $25.00 will_ be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re- inspection fee of $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials' and/or workmanship.