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366 NE 99 St (15)MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 e Buildin g Inspection Request Date 6 Type Insp'n ai J Permit No. rr 1 11 S - 1/ X, Name ->e „_ .6-- ' . O -, Address 3 q? Company Phone # Inspection Date Correction Re-Insp'n Fee )zr Miami Shores Village 10050 NE 2nd Avenue Building Permit Phone: 305 - 795 -2204 Permit Number: BP2003 -1759 Printed: 5/4/2004 Applicant: GLADYS YAMIR ABREU Owner: ABREU GLADYS YAMIR JOB ADDRESS: 366 NE 99 ST Contractor Local Phone: Parcel # 1132060135560 Signed: (INSPECTOR) Contractor's Address: Page 1 of 1 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 3 & 4 BLK 41 LOT SIZE 100.000 Fees: Description Amount FEE2003 -6991 Building Fee $60.00 FEE2003 -6992 CCF $0.60 FEE2003 -6993 Notary Fee $5.00 FEE2004 -4531 Renewal /Extension Fee $65.60 Total Fees: $131.20 Total Fees: $131.20 Total Receipts: $131.20 Permit Status: APPROVED Permit Expiration: 10/4/2004 Construction Value: $400.00 Work: PAINT EXTERIOR OF HOUSE AS AGREED PAID EXT 5/4/04 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: Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Permit Number: BP2003 -1759 Printed: 11/7/2003 Applicant: GLADYS YAMIR Owner: ABREU JOB ADDRESS: 366 NE 99 Contractor Local Phone: Parcel # 1132060135560 Signed: (INSPECTOR) Building Permit ABREU GLADYS YAMIR ST Contractor's Address: Page 1 of 1 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 3 & 4 BLK 41 LOT SIZE 100.000 Fees: Description Amount FEE2003 -6991 Building Fee $60.00 FEE2003 -6992 CCF $0.60 FEE2003 -6993 Notary Fee $5.00 Total Fees: $65.60 Total Fees: $6 Total Receipts: Permit Status: APPROVED Permit Expiration: 5/4/2004 Construction Value: $400.00 Work: PAINT EXTERIOR OF HOUSE AS AGREED In consideration of the issuance to me of this permit, 1 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: Date \ --20 b Owner's Name er' 1i Address City Walls Signature Drip Cap /drip Edge c ker ' c 1oi . applicable laws regula APPLICATION APPROVED BY: Miami Shores Village Paint Color Approval and Agreement ciihre4../0 Phone* q 7 C� qg Zip �J`-' State ' Job Address (where the work is being done) City Miami Shores Village County Miami -Dade Zip Is Building Historically Designated YES NO Contractor's Company Name (if applicable) Phone # ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All elements on the site must be listed and indicate the color to be painted .\_. Fascia G \Q rick Soffit Roof Flower bins Shutters Awnings Q Chimney ' erIGO f- t ( r�� Doors and door jams Garage doors Railings 1 Fences V r l co-L C x v 3( c2 'rY'( ifn QG j e ci Decorative metal All brick (simulated or regular) Stucco banding Any other stucco features Accessory Buildings Other ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** OWNER'S AFFIDAVIT: I certify i ii all the foregoing information is accurate and that all work will be done in compliance with all d zo Attach Color Samples With Numbers 400fie I Qim Date er or Agent Date � Y chc 6/18/03 r���� P & ZOffiofal Miami Shores Villa ex Color Approval and Agreme Paint pp g �� S `O/D /D ''�eit..(J Phone # - D� - Owner's Name � n /' � f r' Address 6 t&.J �.� J State Zip ( 3 & qq _ --,- 4 ' Job Address (where the work is being done) City Miami Shores Village County Miami -Dade Zip - 3" - ( 3 P Is Building Historically Designated YES NO Date 11 Contractor's Company Name (if applicable) Phone # ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All elements on the site must be listed and indicate the color to be • ainted m i l o Pr i !�l walls . .11%-a JI V � � Fascia lle % O n� • Drip Cap/drip Edge } Soffit I %1- Q- U E' Roof Flower bins Shutters Awnings Chimney Doors and door jams Garage doors �,,� Railings 1 kArt Fences sN10 Decorative metal a / i4V All brick (simulated or regular) (AM r Stucco banding Q'l t Any other stucco features 1 � Accessory Buildings Other ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * 01 OWNER'S AFFIDAVIT: I ce applicable laws regulatin: c • ction an , zo Signature APPLICATION APPROVED BY: r*�� * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** i all the f• egoing information is accurate I that all work will be done in compliance with all g. — rod *(&5. (Av.vlSiOt4ert Date j 11104 Date chc 6/18/03 RECEIVED NOVo 62093 BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Buildin Electrbcai Contractor's Company Name Type of Work: ❑Addition Describe Work: (Continued on opposite side) S Miami Shores Village B .ik in g Department 10050 •.E.2ad Avenue, Miami ; ores, Florida 33138 Tel: (305) 795.2204 Fax (305) 756.8972 Permit No. ei 1751 Master Permit No. 4 Owner's Name (Fee Simple Titleholder) Owner' Address City / at t Tenant/Lessee Name Phone # Job Address (where the work is being don) 33 1 3 City Miami Shores Village County Mi �3ade Zip Is Building Historically Designated YES_______ NO__ 191,5 Contractor's Address City State Qualifier °Alteration ONew numbing Mechanical Roof Architect/Engineer's Name (if applicable) Phone # S Value of Work For this Permit Zip 3 13 Phone Square Footage Of W ork 0 Repair/Replace Scanning $ Radon $ Code Enforcement $ Structural Plan Review. $ Total Fee Now Due $ t t./ Phone # �, a91 % i Zip C •_ b pi Submittal Fee $ C � , Permit Fees • C) Notary $ 5.00 Training/Education Fee $ Teeinotogy Fee $ Bond $ 0 Demolition 1 Bonding Company's Name (if applicable) Bonding Company's Address City Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State 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 n t-be-approv d and a reinspection fee will be charged. Signatur Owner or'Agent The foregoing instrument was acknowledged befor me this day of 0c�' Q , 20 (2),, by aad 5 (�� o known to me or who h� rod who is personally p uced) _ Sign: Print: NOTARY My Commission Expires: APPLICATION APPROVED BY: :hc 10/14/03 As identification and who did take an oath. 9 ,n 31' 84 :9 fires: s: Jul 13, 20) 7 Signature Nov - 7 2003 Zip Contractor The foregoing instrument was acknowledged before me this , day of ,20_b who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: n o mg Co., lnc. (Certificate of Competency Holder) State Certificate or Registration No. Certificate of Competency No. ********************************************** rv************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** sr. Plans Examiner Engineer Zoning S120210070059 NOT A DRIVER LICENSE • — The Sunshine State — IDENDFICAflON MASER A160- 294 -63 -850 -0 GLADYS NALY ABREU 2360 NE 136TH ST #1204 NORTH MIAMI, FL 33181-0000 BIRTH DATE 09 -3043 ISSUED 01-08 -99 SEX HGT F 5-04 EXPIRES DUPLICATE 09 -30-03 10-07-02 IDENTIFICATION PURPOSES ONLY Dated 61 Owner's Name ICk ( A -€ L �" Phone # -30-- - 3 O 96 L 6 Owner's i Address - � G • \ (X3 t- • q a - j4 ` City 4 ■Cl -U., :i t b■PS State _ Zip 3 3 ' . 36G. PE-. G1 c( 'S Job Address (where the work is being done) City Miami Shores Village Is Building Historically Designated YES Contractor's Company Name (if applicable) ***************************************************,************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** indicate the color to be painted Walls Fascia Drip Cap /drip Edge Soffit Roof Flower bins Shutters Awnings Chimney Doors and door jams Garage doors Railings Fences Tee_ brear Decorative metal L) (cil All brick (simulated or regular) 4 � l\ J C1 k/ [01 k) /a Stucco banding Any other stucco features Accessory Buildings Other OWNER'S AFFIDAVIT: I certify applicable laws re 'Miami Shores Village Paint Color Approval and Agreement All elements on the site must be listed and key Hbor\ ht C b Ice r • dui of APPLICATION APPROVED BY: County Miami -Dade Zip �J 3 (� - NO Owner or Agent P& Z Official Play House Plum 9ORR 16/095 is Phone # Silvery Moonlight 50BG 63/014 Icebreaker 5ORB 72/005 ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** the foregoing information is accurate and that all work will be done in compliance with all Date l 6103 Date l0/Q3 chc 6/18/03 Owner/Lessee / Tenant Owner's Address 3 Contracting Co. Qualifi State # Architect/Engineer Bonding Company Mortgagor Permit Type (circle one) WORK DESCRIPTION Square Ft. PERMIT APPLICATION FOR MIAMI SHORES VILLAGE D a t e 1 v - 2q — 90Job Address N E Tax Folio • (4- (4- C Are u or Condo President Date _ /D — c — 1� tary f!'Z •, vP• • , . Date My Co . ssiZeladitftrOS.N NC. CC714103 R. MY COMMISSION EXP. MA1 002 Estimated Cost (value) Legal Description I I — 32 - 013 - 55 GO K , T O Historically Designated: Yes [ No Master Permit # 3 7 0,r BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN r\C1 — A,94(.--(c Lu-kja: 1 Sz - WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR JMPROVEMENTS 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 re: r : struction : • • • g. Furth e, I authorize the above -named contractor to do the work stated. —. _ Sig e P Atliaeer an. Signature of Contractor or Owner - Builder Date Notary as to Contractor or Owner - Builder Date My Commission Expires: FEES: PERMIT RADON C.C.F. 1 40 NOTARY 5 BOND TOTAL DUE APPROVED: Zoning Building M C ' (z f g Electrical Mechanical Plumbing Engineering '9 BUILDING (6 ELECTRICAL PLUMBING 0 PERMIT N ROOFING 0 0 Owner of // //,, df Building G/4_42 S 4-.e A) Architect Contractor or Builder Legal Description Address of Building b 14 11 r Lot a 4 1 L 36.6 Ale ggS7L ACTOR or BUILDER MIAMI SHORES VILLAGE, FLORIDA Work to be performed under this Permit_ r) D t^ p Z) hil l') II B1. z/ 1 43705 Date Contractor's License No CCP : N OT. - PERM: S vb J 1 - 3.1.© 6 - P73 -J16V B Ii. ADOR T. BY AUTHORITY MEM Sq. Ft. Value of / I ( Amount of a Project $3(0t) (( Permit $ This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the applica- tion berefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit h granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shgwo on the pplane or drawings or in the statements or specifications and that be assumes respon- sibility for work done by his agents, servants or employee Signed• p "" ' r'k✓ (INSPECTOR) BY ,1 consideration of the issuance to me of this permit 1 agree to perform the work covered hereunder in compliance with all ordinances and regulation, per finin the o and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. I accept • g hi - perm assu responsibility for II work done by either, myself, my agent, servant or employee. des- PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 1 1/57geo Job Address 36,4 Al- c= ! % c67 Tax Folio Legal Description Historically Designated: Yes No Owner/Lessee / Tenant h: -yel. d ",4-7 e /4- Cj eT.4e,( /j j Master Permit # Owner's Address Phone Contracting Co. Address Qualifier �P� 4 7 SS# /3 - .M6-5-Phone 66 ' - 4/ 263 State # Municipal # i)22 5 OZr7D5Competency # C' 997 s Co. Architect/Engineer Address f‘ e7,3 L O t /u • t e /c �cm.K 4 V ( et /=L Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL! ,Q /FC SIGN WORK DESCRIPTION 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 that all work will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated. tice4 Signature of owner and/or Condo Resident Date J Ai . . � ,_ , Notary as to Owner and/or o do . -sident Date My Commission Expire FEES: PERMIT RADON • 1 3 V PU OFr A . NeCri ;,9 ( ,. O, <i BARBARA ANN FUG 2 , ��' i COMMISSION NUDE: "r. N g ' Q CC36019 - P 4.7,4 �O MY COMMISSI:`I 5.7 OF °;rt , �q! , ?; ZahAa C.C.F. . CV NOTARY j TOTAL DUE , SZ.7 APPROVED: Zoning Buildin Mechanical Plumbing Signature of Contractor or Owner- Builder Electrical Notary as to Contractor or Owner -B My Commission Expir \ S '1 PO OFF' it:.P.L NOT:+o '.' <i BARBARA ANN I Uui�. 2 S l ) t O COMMISSION NUMN - .:z N ,4 Q CC360191 7l Q Q MY COMMISSION E.. : OF F\ iti . R 29 1 c ; _ . Date 1( Date Engineering ELECTRICAL 'I'YPI: Minimum Fee Q1'1'. 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 'rubs 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 QT1'. TYPE Condensate Drain QTY. TYPE: Generator QTY. TYI'F: Refrigeration, Tons QTY. A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Supply, AC Well Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Temporary Toilet PLUMBING 'I'YPF: A/C Condensate ()Ty. TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. Ti'I'E 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 2 IIIPORTANT 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. ORIDA, Signa COSY OF MIAMI -DADE Print Name . C Sworn to and subscribed before me this , 0 day oB Ignature of 11tary ' bh SEAL: StamrfAtIoridaoFficlAt nc :r =Ac ANCELA M BECKER 14" 2 / n COMMJSSiON HUOkbER Ijp w, Q CC786697 (c. cti MY COMWISS1Ok t Xriff FS Or F,.O NOV ■ `.:•)''7 Print Name Sworn to and subscribed before me this day of Signature of Notary Public - State of Florida SEAL: PERMIT APPLICATION Personally known OR, Produced Identification � Personally known OR, Produced Identification Type of Identification Produced: F.� L / J ) to-al l/ 1 43 5 t 0 Type of Identification Produced: Page 3 PERMIT APPLICATION p INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: y .� SECTION New Construction BY Name a GG , 01.51-2, qc) ✓ � `'( D TE Zoning e f d" if f'7 Electrical (0 /� Ch f v^ Business Telephone 1 0 o o x F Relocation of Structure s_h lJ 40 Mechanical Foundation Only Add'l Attachment Plumbing Other Add'l Detachment Fire Public Works Structural Building Official % j ( (r, ,+ Z 1 PROPERTY OWNER ,., a New Construction 5 'b't- Jre(A-, Name a GG , 01.51-2, qc) ✓ � `'( Alteration Exterior Address Repair Home Telephone 30 75 ( ! ^ (0 /� Ch f v^ Business Telephone 1 0 o o x F Relocation of Structure s_h lJ 40 Fax 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 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 ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) $ (sq.ft. = x/1000 x ¢.60) (¢.005 / sq.ft.) (¢.01 /sq.ft.) PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ b • 6 0 ISSUING OFFICIAL VIEWED 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 0 INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. Step 2. Submit the completed application with all necessary processing of your application, you may be asked to APPLICATION /Job Address: 3 . q Address Folio Number Complete the attached permit application which print or type to allow for a more accurate processing along with this permit application. Apt. L I �ot 01�s.s6 6 Lot 5_ - t Block Subdivisio T) SPc 1 I1 , ) PB / 0 PG�D Current Use of Property Proposed Use of Property 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. l ? \ Subsidiary Permit No. must be signed by the property owner and qualifier. Both signatures must be notarized. Please of your application. If roofing work will be done, a roofing application must be submitted documents to the Building, Planning and Zoning Department for processing. During the submit additional information. YIa u p-. City State Zip „„ �� 1 4escription of Work Pa( - it 5 -Q �)- r (� t � h ,fie- Q, h i ) -6� Zoning Linear Feet Square Feet Units Floors Value of Work 3 00 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 MIAMI SHORES VILLAGE Paint Color Approval and Agreement DATE: 10 ( /D(. OWNER'S NAME: of 5 46r€L PHONE: 30�- /- /O3 , ADDRESS: 3GG, Cr= • ?9 l,C 7�t x7kxX7kXx Xxxxxxxx x X Icae*3ccjc x*ac3cx** •c4crc�cx�c /(// ,4) Building Of cial ADDRESS OF SITE: CONTRACTOR & LICENSE (if applicable) COMPANY NAME: PHONE: 4c*x aesc3cae* >e>c.r'ca',e3cY **** rc* scicaeacae3c* rcx ***$caeaeac** �tcxxxx;exxxxx 44*)( $khc c All Elements on the site mpst be listed and indicate the color to Walls 4u be one - -r— Fascia Drip Cap/Drip Edge Soffit Roof Flower Bins Shutters, Awnings Chimney Doors and door jams /�e ►� Garage Doors Railings - Fences Decorative Metal All brick (simulated or regular Stucco Banding VG}; 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_ he work stated. Furthermore , the paint colors will be as per the attached Z� o l Date re of Owner Date Signature of Contractor Date ** ******************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED: f8 — Not `PPR' WHEN PAINTING IS FINISHED, "1O� s c` At is 9olllf CALL FOR FINAL INSPECTION 4/23/01 MIAMI SHORES VILLAGE Paint Color Approval and Agreement DATE: OWNER'S NAME: - 5 6 G . ( _ T • G 1 = PHONE: SOS - ? 5 I — (C33 C) ADDRESS: a (G c��c, S -00 ********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ADDRESS OF SITE: 3 4 ()'` CONTRACTOR & LICENSE (if applicable) I COMPANY NAME: O ` PHONE: ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All Elements on the site must be listed and indicate the color to be•painted. g v L.( Walls Fascia c� Drip Cap/Drip Edge ' e 6 Soffit `R. c� Roof i +� Flower Bins tLDO Shutters U Awnings OD I Chimney W t -i-ei . Doors and door jams i +e S ( nE Garage Doors 1� d Railings Fences Decorative Metal C' All brick (simulated or regular) L)v Stucco Banding Any other stucco features 1.�p Accessory Buildings ia) 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 th- work stated. u hermore , the paint colors will be as per the attached sam.��- .# Opt Sigw" re of Owner * * * ** * * * * * * * * ** APPROVED: Building Official Date Date Signature of Contractor Date ******************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** FACE COLOR t 1:5RCK WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION 4/23/01 k v—c 2- 2Z, S A MIAMI SHORES VILLAGE Paint Color Approval and Agreement DATE: q LS 0 I OWNER'S NAM : CttA S - 043 (€ t,Z, PHONE:30 s ` 15 (— / U 3 U . ADDRESS: '3 2 Cj - . **************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ADDRESS OF SITE: CONTRACTOR & LICENSE (if applicable) COMPANY NAME: PHONE: ************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All Elements n he site must br listed and indicate the color to be painted. Walls 1°r 13e'■ Fascia -- ge,A , Drip Cap/Drip Edge }2J . Soffit Roof Flower Bins Shutters Awnings 0 (� Chimney U i'( --6_,_ Doors and door jams Garage Doors tiU d Railings PO Fences • Decorative Metal All brick (simulated or regular) V) 0 Stucco Banding 130 Any other stucco features c') 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 d j , wo ed. Furthermore , the paint colors will be as per the attached Sig * ** of Owner * * * * * * * * * * * * * ** APPROVED: Building Official Date Signature of Contractor Date **************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Date iilo PRA WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION 4/23/01