PAINT309 NE 99 ST
FINAL EXTERIOR PAINTING
q 0 (
Passed
Inspector Comments
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Inspection Date: 01/03/2006
Inspector: Grande, Claudio
Owner: SMITH, TIMOTHY
Job Address: 309 99 Street NE
Project: <NONE>
Miami Shores Village, FL 33138-
Contractor: HOME OWNER
Building Department Comments
Thursday, December 29, 2005
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone 05)795-2204 Fax: (305)756 -8972
Block:
Permit Type: Paint
Inspection Type: Final
Work Classification: Miscellaneous
Phone Number 305 - 790 -1400
Parcel Number 1132060135490
Lot:
Page 1 of 2
Issue Date: 12/19/2005
Owner's Name: TIMOTHY SMITH
Permit Type: Paint
Work Classification: Miscellaneous
Job Address: 309 99 Street NE
Miami Shores Village, FL 33138-
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit
Expires: 12/19/2006
Contractor(s) Phone Primary Contractor
HOME OWNER
Yes
Comments:
EXTERIOR PAINTING
Additional Information
Type of Work:
Additional Info:
Color:
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 responsibility for all work done by either myself, my agent, servants, or
employes. I understand that separate permits are required for ELECTRICAL,
PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING
POOL 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. Futhermore, I authorize the above -named contractor to do the work
stated.
Fees Due Amount
CCF $0.60
Education Surcharge $0.20
Notary Fee $5.00
Permit Fee $60.00
Technology Fee $1.50
Total: $67.30
Invoice Number
PT - 12 - 05 - 23151
Total:
DEC 19 PAID
Amt Due
$67.30
Amt Paid
$67.30
$67.30
Building Department File Copy
Applicant Signature
Permit Status: APPROVED
Permit Number: PT -12 -05 -1269
Phone: 305 - 790 -1400
Parcel #: 1132060135490
Block: Lot:
Section: PB:
Total Square Feet: 0
Total Valuation: $ 200.00
Required Inspections
Final
NOTICE: In addition to the requirements of this permit, there may be
additional restrictions applicable to this property that may be found in the
public records of this county.
AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER
GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT
DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES.
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electric .1 Plumbing MMechanical Roofing
Owner's Name (Fee Simple Titleholder) 1 R. l e Stu. ic) I._ Phone # S g-1 Z'o .
Owner's Address 3b 9 N ' 19 sr
City /t'(IA-MI Slla S State
Tenant/Lessee Name
Job Address (where the work is being done) 7 /l.1 g 9? (Sr.
City Miami Shores Village County Mir '-D Zip .17/-44
Is Building Historically Designated YES NO
Contractor's Company Name
Contractor's Address
o4o,o -R.
City State Zip
Qualifier
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Permit 4 2CX , C3 Square Footage Of Work:
Type of Work: ❑Addition ❑Alteration DNew 0 Re air/R lam
p ' ap ❑ Demolition
Describe Work:
Total Fee Now Due $
(Continued on opposite side)
- bjc on PMr LT A
* * * * * * * * * * * * * * * * * * * * ** * * * * ** b ees . **x * *. * * * * * * * * * * * * * *** * * * * * **
Submittal Fee $ Permit Fee $ • ( CCF $ 0. on CO /CC.
00 i
Notary $ 5- 00 Training/Education Fee $ r Technology Fee $ 1 •
Scanning $ Radon $ Zoning Bond
Code Enforcement $ Structural Tian Review. S
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax; (305) 756.8972
RECEOVED
DEC 005
Permit No. P! ""f 1
aster Permit No.
Zip 3213P
Phone #
Phone #
{
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
APPLICATION APPROVED BY:
chc 05/13/03
Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this 1 The foregoing instrument was acknowledged before me this
day o , 20 b C - 6 2 k . e 1 1 " ` . Sm C7-H- day of , 20 _, by
who is personally known to me or who has produced who is personally known to me or who has produced
I Y�
As identific ion and who did take an oath. as identification and who did take an oath.
NOTAR ) P i BLIC ' NOTARY PUBLIC:
Sign: I�'�y,; S'fAtA Si n:
� . g
, T' `wl� ..�'' l,kan eZ ■
Print:
Bond d Thru • c , Inc.
My Commission Expires:
* * * * * * * * * * * ** **************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Plans Examiner
Engineer
Zoning
Miami Shores Village
Paint Color Approval and Agreement
Date /2 —/'t i
/d / cC/t1A ' Phone # 311c .�/ 9, 31) 79-
Owner's Name l / >�"l�l � M.
Owner's Address _ 3b� /V� � 9 Sr. 33(3$
City / $ h'1'o�s State mil, Zip
Job Address (where the work is being done) 3'o 1 Al-E 5.67 c=
City Miami Shores Village
County Miami -Dade Zip 33/8
Is Building Historically Designated YES NO L/
(if applicable) 6S G&)9`F.Z. Phone #
Contractor's Company Name (' pp ) �Y
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All elements on the site must be listed and indicate the color to be painted
WaIIs AL a 0 7t/ reAJrFPbcr W14-i It (pt-r
Fascia wr -4irC
Drip Cap /drip Edge 'W f-J / Tr S'w 7 0 9-,
w>4-1r6 SEA 7 nis
Soffit
Roof
All/4
Flower bins n/ /a
Shutters LJ4 1 gW - 7 00S
-
Awnings lv /A
Chimney N/A
Doors and door jams B1,,4Ck. b (F)cls1i N 6r U) N I re 4244 3
Garage doors NIA
Railings IV/4
Fences
Decorative metal ^
All brick (simulated or regular) SW a 0 14-4 ( aiu e A S u-nV`3e,
Stucco banding nl /A
Any other stucco features G n I. to r» IJ S l 'w H i rg
Signature
APPLICATION APPROVED BY:
Owner or Agent
p& Official
SW 7005
Pure White
)LEAsf S Airs k
La
Sti 02o F6NGE pos
1.c.3 {-1 1 .
ebx.op, sA1uc As /'a •ue 7i, sr
Accessory Buildings A1 /A
Other 41_L y PIb1A I I ,(LJH /jam
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
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.
Date
'Date
l- 'i ? -».i •
( Z/
chc 6/18/03
CUSTOMER NAME:
JOB:
USED FOR:
DATE:
PRODUCT:
REX #:
OUART
A80W00051
SHERWIN- WILLIAMS 12/19/05
Sher- Coior(tm) Order!! 2053 - 0019178
EXTERIOR ARCHITECTURAL
SUPER PAINT LATEX
FLAT ACCUTINT 4010
2074 FENCEPOST WHITE
SHER -COLOR FORMULA
BAC COLORANT OZ 32 64 128
NI-Rat Umber - 9 - -
Y3 -Deep Gold - 1 - 1
Non Returnable Tinted Color
CAUTION. To assure consistent color.
always order enough paint to complete
the job and intermix all containers
of the s e color before aopl cation.
Mixed solo s may vary sl ghtty from
color strip or color chip
11 11111 1iuA11iaiiii
SHERWIN WILLIAMS COMPANY
STORE # 2053
N.M.BEACH FL 33162
Attc% Sivu;c4 •
7o 7 i& ?el
GUAu, (1
/q. D4'
Qr2:■
Y
COLOR NAME AND OR NUMBER:
1 5 GALLON FORMULA
EXTRA WHITE
640514808
ry
3
OAT
u) Ds) `79-
SAMPLE
7-
-�J
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date Time
Type Insp'n
Permit No
Approved
Correction
Re- Insp'n Fee
o
Company
Phone #
For Inspector) 1 ► Name & Date
pCH fla 063/00277
:06 3
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 2/6/2003
Applicant: S Yh fS
Owner: 1 IUTTON mo 11 n 4,7\
JOB ADDRESS: 309 NE 99
Contractor
Local Phone:
Parcel # 1132060135490
Fees:
FEE2003 -802
FEE2003 -803
FEE2003 -804
Description
Building Permit Application Fee
CCF
Notary Fee
Total Fees:
Amount
$60.00
$1.20
$5.00
$66.20
Total Fees: $66.20
Total Receipts: $0.00
Permit Status:
Approved
Permit Expiration: 8/5/2003
Work: EXTERIOR PAINTING AS PER AGREEMENT
If there is no permit package a
fee is $50.00, w
ES D E MOLYNE -TRUST
JAMES
M EFL 3 3 1 2460
1DAY TO THE
Bankof
?s•
0030691,17 28
D ATE
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 - 70 LOTS 15 & 16 & W1/2 17 BLK 40 LOT SIZE
premier Banking
Building Permit
Permit Number: BP2003 -205
DO LL S
14 0\ DO Ile 4 X
-MARGAREGi
ST
Contractor's Address:
Construction Value: $2,000.00
2277
63-4j630 fl
627
•
Page 1 of 1
to verify, there will be no inspections. Re- inspection
Ispection.
'stall the equipment or device described in the application herefor in strict compliance with all
lance with any plans, drawings, statements or specifications that may have been submitted to
+ork is not done in compliance with such ordinances or if the plans are changed without
mtractor or builder named above assumes the responsibility for a thorough knowledge of the
rawings or in the statements or specifications and that he assumes responsibility for work done
BY:
• in compliance with all ordinances and regulations pertaining thereto and in strict conformity
gyres Village. In accepting this permit I assume responisibility for all work done by either
ontractor or Builder) BY:
DATE: 2
MIAMI:SHQREB VILLAGE
OWNER'S AME:
ADDRESS: S o
* * * * * * * * * * * * * * * **
Paint Color' lipp bvhi'and Agreement
I -- --
.. • • • • • •l• ..
ADDRESS OF SITE:
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME: PHONE:
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted.
Walls W Le
Fascia W 1/Z-tP
Drip Cap/Drip Edge
Soffit
Roof
Flower Bins
Shutters
Awnings w
Chimney w 1, 1
Doors and door jams
Garage Doors
Railings
J v
Decorative Metal k%kc,
All brick (simulated or regular)
Fences
Stucco Banding LA,
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
sa ples.
Signature of Owner
APPROVED:
Building Offal
• ••• • •••
• • • • • •
. . . •••••
• • • .. •
• • .. • • • •
:/■,/ PHONE: '3 d S'
, , d...1?. A9 2y
* * * * ** • *,c** Sc** r* * ** * * * * * * * * * * * * * * * * * * * * * * * * * **
(-14
a)
-
Date
6 1 1,A te.v .)
Date Signature of Contractor Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
4/23/01
PROPERTY OWNER,
New Construction
Enclosure
Alteration Exterior
Address SO 0 Ai, Z. 97
305 � -03
, y
, -,
3
Alteration Interior
Home Telephone
Demolish
Business Telephone
Shell Only
Fax
Foundation 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'l Detachment
Other
P
Step 2.
)(Job Address: 30 7 A/ ► q
Address
Folio Number
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
• • • ... •
• • • • • • •
• • • • • • • • • •
Apt. City
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
... • • • ..
•
• •
• •
•
•.
•• • •; ••; ,4 ster Permit No.
PERMIT APPLICATION
• • : • Stlb�idfary Permit No.
• •
.. • .. •
••• ••• • •
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
•• • • • •• ••• ••
Step 1. Com he attached permit application whicL is(b ;situ by jhe 1?tuperty owner and qualifier. Both signatures must be notarized. Please
6n or pe to allow for a more accurate ito�sIng otVotu•ipp�ication. 4f roofing work will be done, a roofing application must be submit-
et d'81 with this permit application. • • • • • • • • • • • •
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.
•
APPLICAT►_7N
I-\3 1 / 3 cy
escription of Work
State
Zip
Zoning Linear Feet
Square Feet Units Floors
Value of Work Nit d ■ / 0 0 U Bldg Value
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
••. •
••. •
• • •• • • •
• • • • • • •• ••
• • • ••• • •
• • • • • • • •
••• • • • • ••• • •
••• •
•
PERMIT APPLICATION
IMPORTANT NOTICES
• • •
DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIUAT$b'PERIv?I1''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 I11 ACL'44, NtivrAD iallTARY CONDITION free from construction debris.
3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEW? FRET• tReaDG TT4If[S i) E)Zf(IS.
4. SWALES MUST BE PROTECTED FROM BEING DAMAGED'UEQ131 beVI:11CL>ES,•4ND 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 13E 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 STATE OF FLORIDA, COUNTY OF MIAMI -DADE
.1
Si eture of Owner
0 t 1 L.4 • Li 1
SEAL:
otary
Publi
FI gndela M Becker
• My Commission DD150048
o d Expires November 15, 2006
Signature of Contractor / Qualifier
Print Name Print Name
Sworn to and subscribed before me day of , Sworn to and subscribed before me this day of
Signature of Notary Public - State of Florida
SEAL:
Personally known +o OR, Produced Identification Personally known OR, Produced Identification
Type of Identification Produced: Type of Identification Produced:
ELECTRICAL
TYPE,
Minimum Fee
QTY.
TYI'E.
Dryer
.j11'.
'1'1'1'1:
1 ut e Appliance
QTY.
TYPE
Service Repair
Q I'Y.
A/C Central 1 -3 Ton
Dryer Vents, Number of
Fan
Ventilation, Cost
Outlet, Wall
Ductwork, Cost of
Service, Temporary
Periodic Inspections
A/C Central 4 -7 Ton
Fire Sprinkler System
Fire Pump
Outlet, Switch
Fireplaces, Number of
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 QTY.
Minimum Fee
TYPE
Condensate Drain
QTY. TYPE
Generator
QTY. TYPE Q'I'1'.
Refrigeration, Tons
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
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
PLUMBING
TYPE
A/C Condensate
QTY.
TYPE
Drains, Roof
QTY.
TYPE
Miscellaneous Fixture
QTY.
TYPI:
Soakage Pit
Q'I'Y.
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
•
r
• • • • • •
• •
• • ••• • • • • ••.
PERMIT APPLICATION
• • ••• • •••
•• •• • • • •
• • • • • • •
• • • • • •
INSTRUCTIONS: Please indicate the type bf wdfle being perfbrmed 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)
❑ PROOF OF OWNERSHIP
(Attach).. ... • •
•
❑ IMPACT FEE
(New Construction)
SECTION
Zoning
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
❑ OTHER
(Specify & Attach)
PERMIT FEES
$3.00 per page (Scanning Fee) $
Miami Shores Village
Bond
❑ HRS / DEAN APPRO I; : : : �] BPR APPROVAL (Restaurants)
•. ... • . • • ••
(Septic / Sewer)
• •
••• • • • ••• •
• • • ••• • •
• • • • • • •
••• • • • • ••• •
• • . • • • •
• • • •
• • • • •
• •
• • • •
• • •
Metropolitan Dade County (C.C.F.) $ r . 0 (sq.ft. = x/1000
x ¢.60)
Inspector State Educational Fund $ (¢.005 /sq.ft.)
State DCA (Radon) $ (¢.01 /sq.ft.)
Code Enforcement Fine $
Zoning Review
Notary
$ <, 1)
• •
•
•
•
•
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
• • •. (Attach)
Cl CONTRACTOR REGISTRATION
(On File)
TOTAL $ - a
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
O wner's Name and Address
Location and legal description of lot to be built on:
Lot ^°1 V ` t lock # 0
//§treet and Number where work is to be done 3 0
}SS.
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.
Any 71
Registered Architect and /or Engineer \1
`Name and address of licensed contractor O
Subdivision
a/S work to a done and purpose of building (by flo rs6rior colors (submit gmpl s)
.._
and for no other purpose.
Remodeling
Addition
Remarks (Signed)
Repairs
r
Date /
Street
New Building
To be constructed of Kind of foundation Roof Covering
19
No. of Stories
5y ' d 9
'timated Total cost of improvements S gn Amount of Permit $ 3 7 CD
Zone cubage required Plan Cubage
Distance to next nearest building Size of Building Lot
Maximum live load to be borne by each floor
I hereby submit all plans and specifications for 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.
STATE OF FLORIDA
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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 c�onstrruction, that he has carefully read the foregoing application, and that he did sign the same. and that all facts therein by him stated are true.
Permit No. " I ru Date i f I / % /v Read, Sworn to and Subscribed before me.
Disapproved `� Date
�\+ Notary Public. State of Florida
(Signed)
Building Inspector 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 625.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and/or workmanship.