269 NE 99 St (6)MIAMI SHORES VILLAGE
' BUILDING DEPARTMENT-
305-795-2204\
Building Inspection Request G j
(±)
For CAL
Permit No. p1-o® 1
Name
Address a(Ovl Iv (lc( 5+
Company QUO it
Phone #
Inspection Date
Approved
Correction ❑
Re- Insp'n Fee
Type Insp'n
Date 5 G 2)
Job Address (where the work is being done)
City Miami Shores Village
Is Building Historically Designated
Architect/Engineer's Name (if applicable)
Code Enforcement $
Total Fee Now Due $ 1 11 ' 0
(Continued on opposite side)
Miami Shores Village
Building Department
?D1J4 10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electrical
4Z-4 44
Owner's Name (Fee Simple Titleholder) f era I A2L) G' _ Phone # ( 3�� 7 /D - 0D'7
Owner's Address 2 (o 5 ,OE 5 / —
City 'T' ,,o S6fd ✓e. .r State KI -
Tenant/Lessee Name ,J /.4-
2� y A76.
YES NO X
Contractor's Company Name a. // r /(,1 ) //!C 6'74Z1 C
Contractor's Address C f
City /` a lam-. -A--
Qualifier Ferh - £ 4 Fez
County Miami -Dade Zip 3.3/3
State P1, Zip 3,36/ y
�`A- Phone #
$ Value of Work For this Permit .2 Ooo Square Footage Of Work: "c-1i9
Type of Work: ['Addition ['Alteration ['New ® Repair/Replace ['Demolition
Describe Work: ''l / f44.t-G p /a, f41N€ x77/riar A rid y� /'r -4- s c/ .,r/aj 4 i
5i' c.1 P� . G`rll7ticL iea ecuz 2e col re Lc- ?4l0/At
"/ cs,11) p4e, 6 isfe).--..2
* 1 1 l
Submittal Fee $- D 7? Permit Fee $ 3 • CCF $ CO /CC
Notary $ Training/Education Fee $ y - 0 Technology Fee $ s S 7)
Scanning $ Radon $ Zoning Bond $
**************************** Fs * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Structural Plan Review. $
Plumbing
Zip 33 / v >?
Phone #
Master Permit No.
Mechanical Roofing
hone (3 S) ' / -G / C (,/
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.
Signature
NOTARVPUBLIC:
Owner or Agent
The foregoing instrument was acknowledged before me this
n ter-
day off 20, ! by r -�
who is personally known to me or w
Sign:
Print:
My Commission Expires:
As ide ' tifica
State Certificate or Registration No.
APPLICATION APPROVED BY
Chc 12/15/03
(Certificate of Competency Holder)
who is personally known to me
4 c1F e zatt li nA . 4 1°7 4 as identifi
31 o^'d�h „ OTARY PUBLIC: C-
Sign:
Print:
My Commission Expires:
Certificate of Competency No.
The foregoing ' strument was acknowledged before me this
***** st*** r ******* * ************ * ** * * * ** * * * * * * * * * * * * * * * * * * * * * * * * ** * ** ** * * * * * * * * * * * * **
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * ** ************************************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Plans Examiner
Engineer
Zoning
ITEM
BATH TUB
UNIT
.3
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS
CENTRAL HEATING
DISHWASHER
/
RECEPTACLES
A/C (WIND)
DISPOSAL
/
SERVICE TEMPORARY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN AMPS
DUCT WORK
FLOOR DRAIN
SERVICE REPAIR/METER CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TOP
UNDERGROUND TANKS
LAVATORY
f!)
OVEN
ABOVE GROUND TANKS
LAUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
/
MOTORS 0- 1 HP
STEAM BOILERS
SHOWER
/
MOTORS OVER 1- 3 HP
HOT WATER BOILERS
SINK, POT /3 COMP.
MOTORS OVER 3- 5 IP
MECHANICAL VENTILATION
SINK, RESIDENCE
/
MOTORS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTORS OVER 8- 10 HP
ELEVATORS/ESCALATORS
TEMPORARY WATER CLOSET
MOTORS OVER 10- 25 HP
FIRE SPRINKLER SYSTEMS
URINAL
MOTORS OVER 25-100 HP
COOLING TOWERS
WATER CLOSET
3
MOTORS OVER 100 I•P
VIOLATION
INDIRECT WASTES - ..
A/C WINDOW
REINSPECTION
WATER SUPPLY TO:
AIR CONDITIONERS
•
A/C UNIT
STRIP HEATER
FIRE SPRINKLER
GENERATORS TRANSFORMERS
'HEATER -NEW INST.
GENERATORS TRANSFORMERS
HEATER - REPLACE
GENERATORS TRANSFORMERS
LAWN SPRINKLER -WELL'
SPECIAL PURPOSE
SWIAIING. @OOL•,
OUTLETS COMMERCIAL
WATER-SERVICE
SIGN TUBES
SEWER CONNECTIONS
SIGN TRANSFORMERS
UTILITY -SEWER
SIGN TIME CLOCK .
UTILITY -WATER
FIXTURES
SEPTIC TANK
ANTENNA
RELAY
TELEVISION OUTLETS
DRAINFIELD, 4' TILE/RES.
VIOLATION
PUMP & ABANDON SEPTIC TANK
REINSPECTION
SOAKAGE PIT CU. FT.
CATCH BASIN
DISCHARGE WELL
DOMESTIC WELL
AREA DRAIN
ROOF INLET
SOLAR WATER HEATER
FIRE STANDPIPE
POOL PIPING
LAWN SPRINKLER SYSTEM
GAS RANGE
METER SET (GAS)
GAS PIPING
Y
PLUMBING
'ADDENDUM TO PERMIT APPLICATION
(AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B.
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
ELECTRICAL
MECHANICAL
t.
1
i
44. tuc:.�% E.1nQ\s,&a
. ri
4 n
c ( 11 c,2o
tlz
iNcel
Uc +iOVV sL.ic
: 3 3 / 3
APPROVED
ZONING
STRUCTURAL
ELECTRICAL
PLUMBING
MECHAN'CAL
BLDG.
BY
IlLAGS
DATE
SUBJECT TO COMPLIANCE IANCE WITH ALL FEDERAL,
STATE AND COUNTY RULES AND REGULATIONS.
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: PL2004 -71
Printed: 3/5/2004
Applicant:
Owner: RODRIGUEZ ROBERTO
JOB ADDRESS: 269 NE 99 ST
Contractor QUALITY PLUMBING CONTRATOR Contractor's Address: 1565 w 35 place
Local Phone: 305 - 821 -0104
Parcel # 1132060134570
Signed: (INSPECTOR)
Plumbing Permit
Page 1 of 1
Legal Description: MIAMI - SHORES SEC 1 AMD PB 10 -70 LOT 20 & 21 BLK 33 LOT SIZE 100.000
Fees: Description Amount
FEE2004 -2368 Building Fee $220.00
FEE2004 -2369 CCF $1.20
FEE2004 -2370 Training and Education Fee $0.40
FEE2004 -2371 Technology Fee $5.50
Total Fees: $227.10
Total Fees: $227.10
-O'a
Total Receipts: -0.00
/?l, 1
Permit Status: APPROVED Permit Expiration: 8/29/2004 Construction Value: $2,000.00 f/ t
Work: CHANGE OUT FIXTURES IN 3 BATHROOMS AND KITCHEN SINK, DISHWASHER, RELOCATE WASHING MACHINE AND
MAR 0 8 PAID
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, statements 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 agent, servants or employes.
Signed: (Contractor or Builder) BY:
t,
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building may
Owner's Name (Fee Simple Titleholder) � �'� ( / 2,0..9 ePhone # � , 'O` . U 6c
Owner's Address 4J 5'57<
City',/,Q 44, e S4 State `22 S-74 Zip 78- '
Tenant/Lessee Name Phone #
Job Address (where the work is being done)
City Miami Shores Village
Electrical
Is Building Historically Designated YES NO
Contractor's Company Name
$ Value of Work For this Perm'
Type of Work: ❑Additi n
Describe Work:
Scanning $
Total Fee Now Due $
(Continued on opposite side)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756 8972
P 'C 1QED
�� Permit No P (ju I�U7
Maser Permit No.
Contractor's Address
City State Zip
Qualifier
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
Alteration
County Miami-Dade
C4 3I (3 1 F ees
Submittal Fee $ 50 .Q) Permit Fee $ 8V - CCF $
Notary $ Training/Education Fee $ 1! (j
Radon $
Zoning
Plumbing Mechanical Roofing
Phone #
Zip
Square Footage Of Work: 040 •
['New Repair/Replace ❑ Demolition
Technology Fee $
Bond $
CO /CC
la -
Code Enforcement $ Structural Plan Review. $
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 Age >t ✓ Contractor
The foregoing instrument was acknow before me th is tt✓1 The foregoing instrument was acknowledged before nee this
x-M
day of li �T , 20 ay , by t - ,� Jl r lq,( Y of , 20 , by
whgis personally known to me or who has produced 1 0 t ( j who is personally known to me or who has produced
NOTARY PUB/
Sign:
Print:
My Commis on Expires:
APPLICATION APPROVED. BY: •
Chc 05/13/03
Signature
As identification and who did tae an,oath, , ,, as identification and who did take an oath.
h/ • • ■.9.. ' %os i`it4TLE.5.. ' .. T`t
:0., " a a_ Co L-t om. o ` t Y PUBLIC:
. _ � ^ - °,; �nl Sign:
'i ;∎ ∎" I t lio.
'r t r 1` n ICI t`;lf Co t n In
Print:
***,************************ k * * * * * * * * * * * * * * * * * * * * * ** * * * * * * **
My Commission Expires:
:***************************** *.* * * * * * * * * * * * * * * * * * * * * * * * * *` *********** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
OCT 222004
Plans Examiner
Engineer
Zoning
Located at:
VILLAGE OF MIAMI SHORES
BUILDING DEPARTMENT
OWNER BUILDER DISCLOSURE STATEMENT
\ P 6c) )G- 2— being the legal property owner, for the property
Legally described as .
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),.nd I have read and understand the following disclosure
Statement, which entitles me td *brk as my own contractor, I further understand that I as the owner
must appear in person to complete all applications.
DISCLOSURE STATEMENT
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. Tlie foregoing instrument
Was acknowledged before me this 21) day of (DC , 20 64
BY 6 1T1 f ] - 3 Por r c u`-.v
Produced T . U lkoi �O
who is personally known to me or who has
as identification an
who did take an oath.
•
•
be! pia
Co ission liDD231'
E sires: Jul 13, 20
Bonded Thru
At antic Bonding Co In
Notary
4
i
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 10/25/2004
Applicant: ROBERTO
Owner: RODRIGUEZ
JOB ADDRESS: 269
Contractor
Local Phone:
Parcel # 1132060134570
Signed: (Contractor or Builder)
NE 99
Building Permit
Permit Number: BP2004 -1387
RODRIGUEZ
ROBERTO
ST
Contractor's Address:
Permit Status: APPROVED Permit Expiration: 4/19/2005 Construction Value: $8,000.00
Work: KIT CABINETS
Page 1 of 1
Legal Description: MIAMI - SHORES SEC 1 AMD PB 10 -70 LOT 20 & 21
BLK 33 LOT SIZE 100.000
Fees:
FEE2004 -10451
FEE2004 -10453
FEE2004 -10454
FEE2004 -10455
FEE2004 -10456
Description
Building Fee
CCF
Training and Education Fee
Technology Fee
Scanning Fee
Total Fees:
Amount
$480.00
$4.80
$1.60
$12.00
$3.00
$501.40
Total Fees: $501.40
Total Receipts: $0.00
- 4 ; fri ()
DEC 3 0 PAID
Signed: (INSPECTOR)
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, statements 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 agent, servants or employes.
BY:
2' -8" x 7=0" Arch
Roberto Rodriguez Residence
269 NE 99 St.
Miami Shores, FL. 33138
Kitchen