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248 NE 98 St (8)ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. TYPE Outlet, Appliance QTY. TYPE Service Repair QT 1. 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 j 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 TYP1, Minimum Fee Q.1.1. TYPE; Condensate Drain QTY. .►.1.1,1, Generator QTY. . Refrigeration, Tons Q . 1 . 1 . 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 QTY. TYPE Miscellaneous Fixture QTY. TYPE Soakage Pit QT1'. 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 j 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) ❑ OTHER (Specify & Attach) PERMIT FEES $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) $ $ f l O (sq.ft. = x/1000 x ¢.60) $ (¢.005 /sq.ft.) $ (¢.01 /sq.ft.) $ge00 REVIEWED AND PREPARED BY: SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE 1. PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $3n ISSUING OFFICIAL 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 CONTRACTOR / ' Name 3 Pal!_ ,.. .S d,J License No. f/C � Address /9f52 9 /Ad z 2 Telephone Fax 6.7 7/ 7 Fax 1sl _, , Qualifier Name J ' € /J J P..�i ,,� C e PROPERTY OWNER New Construction Name eat44/16. �� c°—/ • Address Alteration Exterior Home Telephone 30 $ . ' 7 SO 5 , / . Business Telephone 3e -5-J Demolish Relocation of Structure Fax Shell Only Foundation Only 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. 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. APPLICATION Job Address: 244 NE. 9 Address Apt. Folio Number Description of ork Lot Block Subdivision PB PG Current Use of Property Proposed Use of Property Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax PERMIT APPLICATION Master Permit No. Subsidiary Permit No. /te<n..f fr7 33/ 3 City Zoning Square Feet Unfits Floors Value of Work l �J s Bldg Value Linear Feet Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT CHANGE (✓ ) ENGINEER Name License No. Address Telephone Fax Page 2 IMPORTANT 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, 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 Signature of Owner Print Name STATE OF FLy , ii • Signature of Contractor / Qualifier Print Name UNTY OF MIAMI -DADE Sworn to and subscribed before me this day of S iiik :. � to and subscribed before me this day of _. AMP ......2.,_..„ A A Signature of Notary Public - State of Florida ignature ; Notary • , . SEAL: Personally known OR, Produced Identification SEAL: lic - State of Florida 4 0 pis Angela M Becae My Commission i1L` 150 4 -*!; ' - `' d Expires November 15. 200 aw PERMIT APPLICATION Personally known ✓ OR, Produced Identification Type of Identification Produced: Type of Identification Produced: FOR Miami Shores Village 10050 NE 2nd Avenue /7 Phone: 305 - 795 -2204 Printed:1 /29/2003 M Applicant: ANTONIO () Owner: CORNIER M JOB ADDRESS: 248 NE 98 PAY TO THE ORDER OF Contractor MR C'S SEPTIC TANK Local Phone: 305 - 651 -7859 Parcel # 1132060134180 Description Building Fee CCF Buildier's Bond Notary Fee Total Fees: Permit Status: APPROVED Permit Expiration: 7/28/2003 VANN Work: TO REPLACE TANK AND DP A t - MR. C'S SEPTIC & DRAIN, INC. OPERATING ACCOUNT P.O. M IA FL 693239 33269 - 0239 Gam. 1/111 . . �s Washington Mutual Washing On Mutual Bank, FA Miami/ /99th Street Financial Center 11199 7000 Mlaml, Fl. 199th Street 24 now mer Serve ' (C b../ 11'0000006 3 2811' .1: 26 708 M1 If 41 - - -- - Fees: FEE2003 -530 FEE2003 -531 FEE2003 -532 FEE2003 -533 Plumbing Permit Permit Number: PL2003 -24 CORNIER ANTONIO ST Contractor's Address: P 0 BOX 693239 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 - 70 LOT 7 & W1/2 OF LOT 6 BLK 31 LOT SIZE Amount $80.00 $1.20 $300.00 $38 DATE L 3 Li: 38 30 3084 2011' „T�s t..e. or Builder) BY: 6328 63- 8413/26 $ s _ DOLLARS 8 Page 1 of 1 Total Fees: $386.20 Total Receipts: $0.00 Re- inspection iplication herefor in strict compliance with all 3cifications that may have been submitted to :es or if the plans are changed without it l that he assumes responsibility knowledge t ty forworkdone ns pertaining thereto and in strict conformity esponisibility for all work done by either APPLICANT: Cornier, Antonio E LOT: 6 BLOCK: 31 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE T"h~'ATANT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: ( ]New System [ ]Existing System [ X ]Repair [ ]Abandonment PROPERTY STREET ADDRESS: 248 NE 98 St Miami FL 33138 PROPERTY ID #: 11- 3206 -013 -4180 SYSTEM DESIGN AND SPECIFICATIONS T A N K D R A I N F I E L D 900 ]Gallons SEPTIC TANK 0 ]Gallons 0 ]GALLONS GREASE INTERCEPTOR CAPACITY 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS [ 200 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM [ 0 ]SQUARE FEET SYSTEM TYPE SYSTEM: [1 ]STANDARD [ N ]FILLED 1 ['�: 'BED o' / o / r 12.2 LOCATION TO BENCHMARK: Top of Bottom ELEVATION OF PROPOSED SYSTEM SITE [ BOTTOM OF DRAINFIELD TO BE NEWLY INSTALLED t`'i1�7" .E SEPTIC TANK SHALL DE IUL -CH MBERED AND EQUIPPED WITU AN APPROVED OUTLET FILTER SPECIFICATIONS BY: Icaza, Carlos APPROVED BY: Icaza, Carlos DATE ISSUED: 1/24/03 DH 4016, 03/97 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 001 - 4016 -0) f ostds_cons_4016 -1] [ ]Holding Tank [ ] Innovative Other [ ] Temporary [ NA ] AGENT: SR0931119, COCKING MSTEPHEN SUBDIVISION: Miami Shores [Section /Township /Range /Parcel No.] [OR TAX ID NUMBER] CENTRAX #: 13 -SG -15311 DATE PAID: FEE PAID : $ RECEIPT . OSTDSNBR : 03 -0227- -R SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E -6,FAC DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME PERIOD. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE OR LOCAL PERMITTING REQUIRED FOR PROPERTY DEVELOPMENT. Fl , 12.20' NGVD. 2.2 ] [ FEET ] 4.4 ] [ FEET ] FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 26.0 ] INCHES TITLE: MULTI- CHAMBERED /IN SERIES: [Y ] MULTI- CHAMBERED /IN SERIES: [Y ] Q [0 ]DOSES PER 24 HRS # PUMPS[ 0 ] [ N ]MOUND [ N ] [ N ] [ BELOW BENCHMARK /REFERENCE POINT [ BELOW BENCHMARK /REFERENCE POINT OTHER REMARKS: This permit it not for addition(s). *Replace existing broken septic tank by a new 900 gl. C -2 septic tank with its approved outlet filter. *Install 200 sq.ft. of drainfield. *Invert elevation to be no less than 8.33' NGVD. *Bottom elevation to be no less than 7.83' NGVD. THIS PERMIT IS NOT FOR ADDITION(S) INVERT ELEVATION .41_..3.Y 6 BOTTOM OF DRAINFIELD ELEVATION TITLE: Engineer I Dade EXPIRATION DATE: 4/24/03 CHD Page 1 of APPLICANT: LOT: PROPERTY STATE OF FLORIDA DEPARTMENT OF HEJ4LTH' ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS TOTAL ESTIMATED SEWAGE FLOW: AUTHORIZED SEWAGE FLOW: UNOBSTRUCTED AREA AVAILABLE: BENCHMARK /REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE IS . RAIrfi -, BLOCK: .7 SUBDIVISION: ID #: ,/ - 2n6 * O,• S .. yt't TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. PROPERTY SIZE CONFORMS TO SITE PLAN: [ at) THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES: SURFACE WATER: dO>'O FT DITCHES /SWALES: lty-ts'Z FT NORMALLY WET? [ ) YES [el NO WELLS: PUBLIC: ,_J /,,a, FT LIMITED USE: / FT PRIVATE: 41 FT NON- POTABLE: FT BUILDING FOUNDATIONS: FT PROPERTY LINES: /6 FT POTABLE WATER LINES: 3-< FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES ( NO 10 YEAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD SOIL PROFILE INFORMATION SITE 1 4417 41 • a Munsell # /Color Texture Depth 01.14. <1,3 �+ to '- 191 / /S;•'.0 ),N! .74144 to -11; t0 t0 t0 to to to to USDA SOIL SERIES: [/.,L,..516r4 f„../t OBSERVED WATER TABLE: p44,&.. INCHES (ABOVE / BELOW] EXISTING GRADE. TYPE: PERCHED / APPARENT] ESTIMATED WET SEASON WATER TABLE ELEVATION: - /"2.- INCH [ ABOVE / ELO ] EXISTING GRADE. HIGH WATER TABLE VEGETATION: [ J YES ( -J' NO MOTTLINdi [ ] YES 1....f INCHES SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: - DRAINFIELD CONFIGURATION: [ ] TRENCH ( ✓) BED REMARKS /ADDITIONAL CRITERIA: r ' AGENT: - Pie (, PERMIT # ;• SOIL PROFILE INFORMATION SITE 2 r'a,,. ' •. [Section /Township /Range /Parcel No. or Tax ID Number) YES [ ] NO NET USABLE AREA AVAILABLE: [Ji /9 " GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2] GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE] SQFT UNOBSTRUCTED AREA REQUIRED: 4 {157} SQFT f 02 • ,:L 4 A I t . [INCHE F [ABOVE /BELO BENCHMARK /REFERENCE POINT 10 YEAR FLOODING? [ ] YES (.-J NO SITE ELEVATION: /6 FT MSL /NGVD Munsell #(Color Texture Depth /U`y2 .0/? to ''x'� : s 'lL : k 1 e> to 77 r to USDA SOIL SERIES: 1 did Z to to to to to to DEPTH OF EXCAVATION: :- INCHES ( ] OTHER (SPECIFY) SITE EVALUATED B '�' -" _ . DATE: j /27 = � 5 �. OH 4015, 10/98 (Replaces HRS -H Form 4015 (Pape 31 which may be used) (Stock Number: 5744 -003 - 4015 -1) Page 3 of 3 4 -}-- - t - ` - i.- i s - -+ t -. ; - L . • y • ■ le: Each block represents 5 feet and 1 inch = 50 feet. Notes: 7'okew (oov APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT,. Permit Application Number t7 '0i .; 92 PART II - SITE PLAN Site Plan submitted •y Plan Approved By � I � - l ua �! A L CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT 0H 4015. 1096 (Replaces HRSH Form 4015 which may be used) (Slodr Runt= 5744-002-401541 STATE OF FLORIDA DEPARTMENT OF HEALTH /- Signature Not Approved 1_ t T , _� Y t r • l a„ � • (o ,�, : a.�+ Ic - • - -J 00) Title ✓ Date 11.15/0- County Health Department Page2•of3 Page 2 IMPORTANT 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 full a ' - Arr• ^* thi a*+ri _ � r �,..l „ v v . .......... ...VOL rrUT tU my �0 ne or business uncle. __.,: _...., any other permit equals ore nay percent (50 %) of the fair market value of the structure, the entire structure must meet the present f P �. hood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business _dicier 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, P 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. STA •F ORIDAp Y OF MIAMI DADE ; RATE OF FLORIDA, COUNTY OF MIAMI -DADE ature of Owner Print Name Sworn to and subscribed before me this day of Sta t r,• a: MY COMMISSION # DD 031747 Bonded EXPIRES: � �� w riters Personally known OR, Produced Identification Type of Identification Produced: SEAL: tgnature of Contractor / Qualifier Print Name Swom to and subscribed before me this day of Signature of Notary Public - State of Florida PERMIT APPLICATION Personally known OR, Produced Identification Type of Identification Produced: PROPERTY OWNER New Construction Name /� . /� � l'°' / 'V/� r i✓/ e..< Address Repair Home Telephone 3 i s S_ 7 s( 7 /, Business Telephone Relocation of Structure Fax Shell Only TYPE OF MANAGEMENT (✓) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'i Detachment Other INSTRUCTIONS - The following steps must he taken to obtain a permit from the Miami Shores Village: Step 1. 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. 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. Job Address: c7 V 6 N 6 467, 3 3 /3 g Address Apt. City State Zip �° v� Folio Number Description of Work 74 e oNc./ DP Lot Block Subdivision PB PG Zoning Linear Feet Current Use of Property Square Feet Units Floors s-90 Proposed Uce of Property Value of Work 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 / PERMIT APPLICATION Master Permit No. P C� 0 3 ° Subsidiary Permit No. sssessed/App Bldg Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. Address Telephone Fax Qualifier Name ELECTRICAL TYPE Minimum Fee Q'I'Y. TYPE: Dryer QTY. TYPE, Outlet, Appliance QTY. TYPE Service Repair QTY. 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 Dishwasher Refrigerator, Comm. (p/PH) Indirect Wastes Temp Serv., Construction Compactor Domestic Well Low -volt, Burglar Laundry Tray Refrigerator, Domestic Septic Connection Temp for Test - 30 days Water Heater Deep Freezer Drainfield, 4" Tile/Res. Low -volt, Fire Lavatory Renew - Temp Service Septic Tank / Water Heater New Demolition Drains, Area Low -volt, Intercom/Teleph. Meter Set (Gas) Repair Circuits Sewer Connection Water Re -pipe Water Service Dishwasher Drains, Floor Low -volt, Television Minimum Fee Service, Number of Amps Shower Drains, French PLUMBING TYI'I'. A/C Condensate QTY TYPE Drains, Roof Q TYPE Miscellaneous Fixture Q TYPE Soakage Pit Q 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 Relay Repair Roof Inlet / Utility - Sewer Utility - Water Vacuum Pump Water Closet Discharge Well Ice Maker Dishwasher Indirect Wastes Disposal Interceptor 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 Water Service Drains, Floor Minimum Fee Shower 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. NI ECI:LI TYPE Q'I'I'. 'rYPF, QTY. 'I'I'PI., — ^r-"+ """ a-11.. = _ TYPE QTY. Minimum Fee A/C Central, Tons A/C Wall/Win. Tons Air Handler, Tons Barbecue Bath Fan - Vented, # Condensate Drain Cooling Tower Dryer Vents, Number of Ductwork, Cost of Fire Sprinkler System Fireplaces, Number of Generator Heating Strips, each Paint Booth Piping, Flammable Liquid Process/Pressure Piping Pressure Vessel on, Tons Vent Hood, Cost Ventilation, Cost Periodic Inspections RECEIVED AND REVIEWED BY: DATE: Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ 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 $ ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) (sq.ft. = x/I000 x0.60) (¢.005 /sq.ft.) (¢.01 /sq.ft.) REVIEWED 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 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 4 Date ri\2�\.� Job Address VA.13 N �� � Tax Folio Legal Description Owner's A d d r e s s ( . 3 - � . c t Phone 3C 7 5 `"5 Contracting Co. %\ \ tJ U= '‘TC?9\� 0 S L S Address Qualifier • \J. C:._ - Phone 1- 5 1 S " State # C . 0.'` 55 Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Mortgagor Address Permit Type (circle one): BU I 1 IN ELECTRICAL PLUMBIN MECHANICAL OOFING PAVING FENC / IGN C ©� T WORK DESCRIPTION = y Wa\ Owner/Lessee / Tenant 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 and th• all work l be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to d Notary as to Owner and/or Condo My Commission Expires: FEES: PERMIT APPROVED: PERMIT APPLICATION FOR MIAMI SHORES VILLAGE C 8 n3 e i r Q P&I ARY'SEAL O gXP)AM9 '' RADON Address otary as t. Contractor or My Commission Expires: C.C.F. /' NOTARY —13. BOND Zoning Building Electrical Mechanical Q a 5 v / Plumbing Historically Designated: Yes / No Master Permit # � ate omc AL WARY SEAL R!TA I GOV BERG MY COMMISSION' EXP JAN Structural Engineer ITEM BATH 1.8 UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIOET LIGHT CUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES A/C (WINO) OI SERVICE TEMPORARY (CENTRAL) A/C C T ( WOR DRINKING FOUNTAIN SERVICE SIZE IN AMPS FLOOR GRAIN SERVICE REPAIR/METER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY 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 FP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 FP TRANSPORTING ASSEMBLIES SINK, SLOP MOTORS OVER 8- 10 FP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL 'HATER MOTORS OVER 25-100 HP COOLING TOWERS CLOSET MOTORS OVER 100 HP VIOLATION INDIRECT WASTES A/C WINCOW REINSPECTION WATER SLFPLY T0: 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 S'KIMfi{ING POOL CUTLETS COMRCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTLRES SEPTIC TANK ANTENNA - " RELAY TELEVISION OUTLETS CRAINFIELO, 4' TILE/RES. VIOLATION PUP & ABANDON SEPTIC TANK RE I NSPECT I ON SOAKAGE PIT CU. FT. CATCH BASIN D I SCHARGE WELL CCMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER ' =IRE STANDPIPE 'COL PIPING _AWN SPRINKLER SYSTEM 1AS RANGE , ETER SET (GAS) AS PIPING ADDENDUM TO BUILDING 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.) PLUMBING ELECTRICAL MECHANICAL Date ;,qt-4 Job Address - I NF-- q8 -f Legal Description Owner / Lessee / Tenant "i � nn). C ) f2)0(( Owner's Address c2vlB ;V.� q8 Contracting PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Co . �e r Li C o S Address % L <2)G) Ni L- C61 Qualifier jOY I" l - P (G 1 �� :�� SS# i State #0 f CoD - iunicipal # Competency # Architect /Engineer N I Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING CHANICAL� ROOFING PAVING FENCE SIGN WORK DESCRIPTIONCCf" 1 I f 1 (C. P cp iocnrH Square Ft. Estimated Cost(value)$ 5 2D, OQ 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 and that all work will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above-name • contractor to do the work stated. •E1ft< i. ure o 'owner a or ►ondo President as ,o issio OFFICIAL NOTAIIY SEAL '1/'':CI A ACU NO Nom!' My Ct"' ** * FEES: PERMIT APPROVED: an. orCCondo Pieicide 434 iCpi res: - ..P' :_ _- ��, P. b'AYy,gS97 Tax Folio //" \_39 C6 - / - `"//4). Address Si D Not as My ,miss' RADON C.C.F. 7+ NOTARY Fire Master Permit # 3 L23 Phone Ins.Co. TOTAL DUE 10 !* ** Other Zonin 11 Building Electrical MechanicalV J Plumbing_ Engineering ITEM BATH TUB UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING 10 �\/\! i DISHWASHER RECEPTACLES A/C (WIND) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) 2 .F; 1 I 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 TCP UNDERGROUND TANKS LAVATORY 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 HP 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 FP COOLING TOWERS WATER CLOSET MOTORS OVER 100 IP 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 i HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIMMING POOL OUTLETS COM,ERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTURES SEPTIC TANK ANTENNA RELAY TELEVISION CUTLETS DRAINFIELO, 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 1 PLUMBING ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEEN OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) ELECTRICAL MECHANICAL NOTICE OF COMMENCEMENT TAX FOLIO NO. 7 3c9©. "O /- 94R211093 1994 MAY 02 11:48 PERMIT NO. STATE OF FLORIDA: COUNTY OF DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certaingal property, and in accordance with Chapter 713, Florida Statutes. the following information is provided in this Notice of Commencement. 1. Legal description of property and street address: c - 18 1\3E eta 5- : / m I Q' S )CS n k. L 2. Description of improvement: 3. Owner(s) name and dress: 0 M E. g r .r iaryn ` V P 3�► Interest in property: Name and address of fee simple titleholder: 4. Contractor's name and address: i\nr)-:f rQ orr \J 1 s' N U 0 C o l - � ' h�l iim , F 1 SI ii 5. Surety:(Payment bond required by owner from contractor, if any) Name and address: Amount of bond $ 6. Lender's name and address: 7. Persons within the State of Florida desicnated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7.. Florida Statutes. Name and address: 8. In addition to himself..Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and address: 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date is specified) Igna!we of Owner rint Owners Name Sworn to and subscribe Notary Public Print Notary's Nam My Commission Expir re me this ) a� day of ham . 19 COMMISSION NO. C, r'L:�:.�s.•�.r.II Y.XP MAY 6.1997 • Prepared by: Address: