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BLOCK WALLPROPERTY OWNER ® Name C= /� 1.C' 0 /e /7/„.4.,•,;,,9,... e 6. Name _ , 1 uo.P r , : Ix Address 331 ,t(4 -, J '7/ 4 M," duo, Telephone 3es 2 ; .. 991/4 /� 7 9 `j' - f ,c2 33/3, Home Telephone yor/ ? ✓ . pz Business Telephone Fax 341r1 ? "— ?28 ENGINEER ® Name C= /� 1.C' 0 /e /7/„.4.,•,;,,9,... e 6. License No. phi f Qg ¢ r � / A ddress 9 c: ,e9 ,. Telephone 3es 2 ; .. 991/4 /� 7 Fax TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'l Attachment Other Add'I 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 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. APPLICATION / , G- Job Address: _334 Apt. Folio Number ( 3- R O 1 '1 0 Lot S S „ A�dress I) 6+ Block y/ P5 /O — �O Subdivision /f ,3,206 0/3•t02PB_ZO_ PGA Current Use of Property Rt--ri VA/et= E l Proposed Use of Property , Defile'" 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 Master Permit No. Subsidiary Permit No. i2 oS ] PERMIT APPLICATION W/;4/-f i J;10021-?` City g" State Zip Description of Work %D kto ,, eX:✓,r' 4-0 t / 1 /l'j W,41( /t- riVP[f Zoning Linear Feet Square Feet Units Floors Value of Work 4( Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. CONTRACTOR Name License No. Address Telephone Fax Qualifier Name 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. SEAL: Personally known STATE OF FLORI ri A • UN jY OF MIAMI -DADE RY p OFFICIAL NOTARY i`.AL 1P d ANGELA M B`cC1(E1t 2 1 ' mrAt.A;cvon 111 NUL:7Eh .+a. ¢ CC706E )7 O M' O :AMIS,S:IO�d Y.° ES OFFS Prod`uded Identification Lary Public PERMIT APPLICATION STATE OF FLORIDA, COUNTY OF MIAMI -DADE Signature of Owner Signature of Contractor / Qualifier Print Name Print Name Sw r nd subscribed before me this / day of , Sworn to and subscribed before me this day of �! ! • ature o Signature of Notary Public - State of Florida SEAL: Personally known OR, Produced Identification Type of Identification Produced: t y1) D-920 33-03--'0 Type of identification Produced: ELECTRICAL TYI'E Minimum Fee QTY. TYPE Dryer QTY. TYPE Outlet, Appliance QTY. T''PI? Service Repair QTY. 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. TYPE Generator QTY. 'I'YPE Refrigeration, Tons QTY. A/C Central, Tons QTY. 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. TYPF, Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. TYPE Soakage Pit QTY. 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. I RECEIVED AND REVIEWED BY: DATE: SECTION BY DA E Zoning / /O / Electrical Mechanical Plumbing Fire Public Works Structural �� / 0 �9�® / / el/e is/ Building Official 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 Inspector State Educational Fund $ State DCA (Radon) Code Enforcement Fine Zoning Review $ lb o ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) LI OTHER (Specify & Attach) $ Ic2O() Metropolitan Dade County (C.C.F.) $ • 0 (sq.ft. = x/1000 x ¢.60) $ $ (¢.005 / sq.ft.) (¢.01 /sq.ft.) REVIEWED AND PREPARED BY: 1 D PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) S, 6 d .... F: t1► ISSUING OFFICIAL TOT DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2"° AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com a-> 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 build- ing 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. Owner's Name and Address." Registered Architect and /or Engineer Name and address of licensed contractor Street and Number where work is to be done Disapproved 4-A4" (Signed) E et_ _ Location and legal description of lot to be built on: Lot Block Subdivision j . No Street State work to be done and purpose of building (by floors) ..__lin_.!46.c_ `Z t f.. "4.5.... 4 tb` 0 P e) e ---Pe—s. ..?_x:5...4 -- kg. I e �� JQ4`ca ""`� and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Estimated Total cost of improvements $ A / so Amount of Permit $ 4145-- 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 the 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 pennit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compile. General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar complianc• fr., all contractors o . -co • . *s em oyed by him in the work to be performed under this permit; and will post or cause to be pos rasp- tion on e e of ' ork suc public notice or notices as are required by the Act. The undersigned agrees to employ only suc tr - . . work t e perfo• ed under this permit, as are licensed by Miami Shores Village. Remarks (Signe Roof Covering STATE OF FLORIDA, COUNTY OF DADE. Ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared 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 foregoing application, and that he did sign the same, and that all facts therein by him stated are true. // Permit No e�a/' Date../ z' 2- Read, Sworn to and Subscribed before me. Notary Public, State of Florida ,19 t L- ec or My Commission Expires PLANNING BOARD DATE Chairman r Member Member Member Member .. Member Council Approved Date Disapproved Date NOTE: A charge of $1.00 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 $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. 3 3 kil/b 99 and who, of the ab therein by Permit No Disa eing by e descri im stat B i ldin 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 build- ing 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. Date e t , 19_ 1 _A _ _ No., Street Owner's Name and Address Registered Architect and /or Engineer Name and address of licensed contractor____--------- _ - __ — C1_42, Location and legal description of lot to be built on: Lot r Block Subdivision Street and Number where work is to be done State work to be done and purpose of build' i (by floors ) ____ New Building Remodeling Addition To be constructed of of foundation R2of Covering Sex Estimated Total cost of improvements _. ` "Ati pairs No. of Stories Amount of Permit $ 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 the 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 obligations 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 s ch public notice or notices as are required by the Act. The undersigned agrees to employ only such subcp1tractors, on work t med udder t is permit, as are licensed by Miami Shores Village. Remarks (Signed) _ STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared - to me well known, m s • my sworn, upon oath deposes and says that he is the uction, that he h., carefully read tide foregoing application, and that he did sign the same, and that all facts Date_ �' _ . 1 © Read, Sworn to and Subscribed before me. 2 5 : t Date Notary Public, State of Florida My Commission Expires r PLANNING BOARD DATE Chairman Member Member Member Member __ Member Council Approved Date Disapproved Date NOTE: A charge of $1.00 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 $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. n -Gqt) ch'' At v c — MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby wade for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing 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 ordinance 7 of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Bile shall be complied with, whet he in specified or not. A copy of approved plans and specifications must be kept at building • ri : of the work. be sent to Disapproved (Signed) Owner's Name and Addres Registered Architect and /or lyngln Name and address of licensed contractor. ( �` Location a d lc al description of lot to be built 1� Lot Block _.. Street and Number where work is to be done State work to be done and purpose of buildin (by floors) 1 3" 1- t c - Zla - � ss. New Building Remodeling To be constructed of / I;;ind of foundation Estimated Total cost of improvements $ Zone cubage required Distance to next nearest building Maximum live load to be borne by each floor Date. ._..f'1 Building — Inspector Chairman Mcrmber Member ...... • Addition Repairs 7 N and /r 4 l — and for no other purpose. No. of Stories Roof Covering Amount of Permit S. _Plan Cubage Size of Building Lot I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may The undersigned applicant for this building permit does hereby certify that he understands and accepts his of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Flo and has complied with the provisions thereof, and will require similar compliance from coat or su in the work to be performed under this permit; and will post or cause to be posted f or notices as are required by the Act. The undersigned agrees to employ only such s permit, as ire licensed by Mia i Shores Village. , ��t�J �� Rpinarl� � � a � ( Signed )- STATE OF FLORIDA, COUNTY OF DADE. i Before me, the undersigned authority, a notary public, duly authorized to administer oaths geared PLMQNINC BOARD DATE Member Member Member • o. gations as an employer a, Permanent Supplement, ctors employed by him work such public notice performed under this take acknowledgments, personally ap- 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 foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Permit No.. 7 p ( � / Date Read, Sworn to and Subscribed before me. __.__ ` Notary Public, State of Florida My Commission Expires Council Approved Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning hoard. A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. E csT. 1•••7C • •• °. tsr, r. : • A • r (.. ; L L C 4