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PAINTInspection Nurrtber: INS Inspection Date: 04/17/2006 Inspector: Grande, Claudio Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: . , ' 5)795 -2204 Fax: (305)756 -8972 Project: <NONE> Owner: BOUTOT, MARTIN Job Address: 803 99 Street NE Miami Shores Village, FL 33138- Contractor: COMPLETE HOME PAINTING BY MICHAEL Building Department Comments Thursday, April 13, 2006 Block: ermit Number PT-3- 06=711 Permit Type: Paint Inspection Type: Final Work Classification: Miscellaneous Phone Number (305)762 -6611 Parcel Number 1132060340090 Lot: Phone: 305 - 895 -1368 Passed Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Page 1 of 2 Issue Date: 3/28/2006 Owner's Name: MARTIN BOUTOT Permit Type: Paint Work Classification: Miscellaneous Job Address: 803 99 Street NE Comments: EXTERIOR PAINTING Additional Information Miami Shores Village, FL 33138- Building Department File Copy Applicant Signature Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Expires: 03/20/2007 Contractor(s) Phone Primary Contractor COMPLETE HOME PAINTING BY MI 305 - 895 -1368 Yes Type of Work: Exterior Color: BEACH HEAVEN, MUSTARD REED, COF Additional Info: Classification: Residential 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. Parcel #: Block: Section: Permit Status: APPROVED Permit Number: PT -3 -06 -711 Phone: (305)762 -6611 1132060340090 Lot: PB: Total Square Feet: 0 Total Valuation: $ 2,450.00 Required Inspections Final Fees Due CCF Education Surcharge Notary Fee Permit Fee Technology Fee Total: Amount $1.80 $0.60 $5.00 $60.00 $1.50 $68.90 Invoice Number PT - 3 - 06 - 24177 Total: Amt Due $68.90 Amt Paid $68.90 $68.90 NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. MiamiShdres Village MF�€E)E- Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 �y •. S 1 ^ hi 3 ' Zq 1 0(0. Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING Permit No. rCG " l I I PERMIT APPLICATIO , I � Master Permit No. FBC 2001 Permit Type (circle). Building `Eta ric t bing Mechanical Roofing Owner's Name (Fee Simple Title o s er) O A. L \c \,■, ' \ ) -ot ,AA— Phone # ___ -j, — (d Q Owner's Address 803 ne 9 c s _ City kkc.0.... SV State c=k Zip 3 3 i3$ Tenant/Lessee Name - 'ti-x.k4 Phone # — AQa le(p Job Address (where the work is being done) Total Fee Now Due $ b;• 90 0 (Continued on opposite side) City Miami Shores Village County Miami -Dade Zip Is Building Historically Designated YES NO X Contractor's Company Name CIMTPIeli /74"',,, 6/4-if a /Phone # C r/ d 9� - /at Contractor's Address /Y 76 it /,3 d City 1 4 44 1-/ State PC Zip 3/6/ Qualifier )4/1. c..14/ Z— State Certificate or Registration No. Certificate of Competency No. 47/I/ /31 Architect/Engineer's Name (if applicable) Phone # $ Value of Work For this Permit 2,Z /S'Y Square Footage Of Work: .3 t3? Type of Work: ❑Addition ❑Alteration n ew ❑ Repair/Replace Demolition Describe Work: P l_taati e G E & qL. /0&/ 1 7 4 e4r T to 64 f V `L- * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee ff $ Permit Fee $ `o 0 • CCF $ I - 80 CO /CC Notary $ J - Training/Education Fee $ d •C) Technology Fee $ 1 - Scanning $ Radon $ Zoning Bond $ Code Enforcement $ Structural Plan Review. $ • Bonding Company's Name (if applicable) Bonding Company's Address City State 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 Owner or Agent The foregoing instrument was acknowledged before me this / 7 day of /1 20 , by / P - /3 0.--,..4.-74-9 who is personally known to me or who has produced . l „ NOTARY PUBLI Sign: /' '-t- r i W /+ id take an oath. Print: ft e- i'1I91e w My Commission Expires: 1 c NOTARY PUBL d Sign: Print: My Co ************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: chc 05/13/03 A 4re- Zip Signature 0' Contractor The foregoing instrument was acknowledged before me this '-D day of V by F4 I C4# 3 5 . who is personally known to me or who has produced as identification an ho did take an oath. rc p 'need A . ti =. c B ' , il . � . � nding Co., Inc. ******* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** sion Exp 1 Plans Examiner Engineer Zoning Stucco banding applicable laws )s"*" Signature • Miami Shores Village Paint Color Approval and Agreement >rDate 4\ \ ∎ `� Phone 41 S OT- ( PA —( L � ( Owner s Name � Y �% l e „C Owner's Address `?U3 AE.-. 91 ��" 3 (3� City � �n State Zip 3 4 Address (where the work is being done) )7°3 yka 10- A___ 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 ,,p f Qdl� Walls V ' t,‘,3 \._c,,, b�-�C Vi a' - ji& t 1 v ✓ ' Fascia Q e�A.c VQ►.e -4 „Rig Drip Cap /drip Edge Capper ou /9 Soffit 6eJ•. kaven 2fi Roof N/ 4 Flower bins w / W Shutters w / Pt Awnings W/ Pt /`ALL L Q rt e Chimney Z / . .11.r 4'wr u ti c, 4, ‘J Doors and door jams Garage doors 2 / O Railings N/ fr Fences 01 IT Decorative metal ti/ ler All brick (simulated or regular) Allot • APPLICATION APPROVED BY: Owner or Agent & Z Official 38133 1B beach haven 3/C Date 1,22 218 Any other stucco features Accessory Buildings ^' / Other N ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** OWNER'S AFFID that all the foregoing information is accurate and that all work will be done in compliance with all ction and zoning. Date 3 —e ' - 47.)(e 3 11010 (0 chc 6/18/03 Type Insp'n Permit No. Name Address MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date 7 D Time Rea 01 -f99 S 3 /I/ ' 97-gf i Company I.r14TYLI.� > Phone # 3�._.� - 7S / ` 7 For Inspector: 7 - ff—®,7 Name ate Approved ' �7 :1 M � Correction ❑ Re- Insp'n Fee ❑ Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Permit Number: BP2002 -998 Printed: 5/28/2002 Applicant:11° ( Owner: —LUDtENr A. -w JOB ADDRESS: 803 NE 99 Contractor Local Phone: Parcel # 1132060340090 Permit Status: Signed: Signed: Building Permit LUMEN ST Contractor's Address: Fees: Description Amount FEE2002 -3025 CCF $0.60 FEE2002 -3027 Building Permit Application Fee $60.00 FEE2002 -3028 Notary Fee $5.00 Total Fees: $65.60 Approved Permit Expiration: 11/24/2002 Construction Value: Work: EXTERIOR PAINTING AS PER AGREEMENT (OWNER BUILDER PERMIT) $100.00 Page 1 of 1 Legal Description: MIAMI SHORES SEC 8 PB 14 -33 LOT 12 & W1/2 OF LOT 13 BLK 169 Total Fees: $65.60 Total Receipts: $0.00 If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection fee is $50.00, which must be paid in advance before calling for another inspection. 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 application herefor 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 is 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 shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. (INSPECTOR) BY: 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 m self, my agent, servants or employes. (Contractor or Builder) BY: .�; MIAMI SHORES VILLAGE Paint Color Approval and Agreement �Zy o Z OWNER'S ' NAME: I , i /Z6 c( Xil (4 rxorrE:.355s— zs71-9 ADDRESS: DATE: ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ADDRESS OF SITE: 9d, CONTRACTOR & LICENSE (if applicable) O r/du/vt COMPANY NAME: PHONE: ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All Elements on the site must be listed and indicate the color to be painted. Walls ) z C.., .�7 n --q Fascia (,(4 1 Drip Cap/Drip Edge / el ----- Soffit t/ „) d_ , Roof 7//' Flower Bins i k A , i 6 + Z 41k Shutters �" Awnings % " / _r�4«uI M® II-46P Chimney �t� Doors and door jams , � - t 1 t ( i Garage Doors c.i ( tte, Railings (,/ Fences Decorative Metal / la All brick (simulated or egular) // Stucco Banding Any other stucco features Accessory'Buildings Other APPROVED: Building ial Bu g Date - V/oZ___ 0 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 auth rize the above -named contractor, if applicable, to do the work stated. Furthermor , the paint colors will be as per the attached sa Signatur of Owner Date ' Signature of Contractor Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION 4/23/01 l l H. TROY MARTIN CLINTON R. BRIDGES 803 NE 99TH STREET 305 -754 -5173 MIAMI, FL 39138 PAY TO T �� / jG. 1 $ /6 6 v ORDERO F p �J ! (� / (5X1?)/ &�/��j� 7 -- DOLLARS QV Washington Mutual Washington Mutual Bank, FA Miami Shores Financial Center 1722 9640 NNE. 2nd Avenue 1.800.788 -7000 t lylii It 0;:. 138 24 hour Ct atomer Service NOTES 41 DATE < I: 26708413 LI:393..1154 236""1 S" 014 63- 8413/2670 39315423 142 roam, r..n... P L A T I N U M C U S T O M E R The Sunshine State — LICENSE NUMBER M635- 358 -64 -323-0 HAROLD TROY MARTIN 3168 DAY AVE COCONUT GROVE, FL 331334240 BIRTH OMTE SEX HOT. REST. Be:IORSE. 08 -0344 M 642 ISSUED EXPIRES 02-1347 08-0303 DUPLICATE 04 -2749 SAFE ORNER aadizNOO?e Operation of o motor vehide cons itutea consent to any sobriety test requited by taw. MIAMI SHORES VILLAGE Paint Color Approval and Agreement DATE: OWNER'S NAME: 0- , T A 'n-1 PHONE: >e, ADDRESS: $' 3 to c 1-1-- *** ****************** . *************** * * * * * * * ** *. * * * * * * * * * * * * * * * * ** { ADDRESS OF SITE: CONTRACTOR & LICENSE (if applicable) gJ y COMPANY NAME: PHONE: ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All Elements on the site must be listed and indicatc the color to be painted. Walls B ?EC 3, Fascia CC- Z C F -- � 3 Drip Cap/Drip Edge 04- Soffit L(4-rJC ? Roof 1 Flower Bins Shutters _ Awnings r 3 yr H L II 2_ F P- I Chimney "a LA t) Ec 3 3 c _ T Doors and door jams -61, C A-_ ?g Garage Doors t._/;)-A-- w W- ? €L� 3 L F' 7' Railings V`} (�-- Fences Decorative Metal ° /1) lv "( All brick (simulated or re /AO) r) /)/7 APPROVED: Stucco Banding ft/ / 79_ Any other stucco features Accessory Buildings Other /(00 OWNER'S AFFIDAVIT: I certify that all the fore Y� fy g oi g 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 wok stated. Furthermore ,the paint colors will be as per the attached Building Official Date 14 % I 40-efil n H H 0 06 4 ".„„ 11 , N',, :1/ vi/6_, Signature o Owner I5ate Signature of Contractor Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION 4/23/01 PROPERTY OWNER New Construction ,' / \Name 1i , ---Kp N WI i<11 / Enclosure Address 10 .5 K-) €_. 9 CI 6✓1iri k PL 'k- 35 i . Home Telephone 30 — 7 S _0 73 Repair Alteration Interior Business Telephone 3 Q S- 7 S 7 _ sc L Demolish Fax - 30__C- 2Sg -d SY 1 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 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. A PPLICATION J X, b Address: g q Address Folio Number Description of Work ? � 1 VV 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 PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address, Telephone Fax 1 11 j 5,11e0 FL Apt. City State PERMIT APPLICATION Master Permit No. Subsidiary Permit No. x T1) 331r Zip Zoning Linear Feet Square Feet Units Floors K Value of Work %Qt,(— 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 Le: Page 2 L L IMPORTANT NOTICES 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. AFFIDAVIll - Please read carefully e. 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 $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, P` Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. Print Name l S to and subscribed before me this ST ignature of N SEAL: r r„v>a ,� • t T ‘; - . - - .'Tr 0 ooea: Boa nan:s�.z p f Q CC 7B 6697 'Y !f '� r.�v ctrsi.:tw xFI CF F� . P � Personally known RIDA, COUNTY OF MIAMI -DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE OR, Produced Identificatiorf Signature of Contractor / Qualifier Print Name Signature of Notary Public - State of Florida SEAL: PERMIT APPLICATION Sworn to and subscribed before me this day of Personally known OR, Produced Identification Type of Identification ProducedFJ. J) , � I$ 3$c — t� �_� � /ye of Identification Produced: ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. TYPE Outlet, Appliance QTY. TYPE Service Repair QTY. A/C Central 1 -3 Ton Fan Dryer Vents, Number of Outlet, Wall Ventilation, Cost Service, Temporary Air Handler, Tons A/C Central 4 -7 Ton Piping, Flammable Liquid Fire Pump Outlet, Switch Fire Sprinkler System Signs A/C Central 8 -15 Ton Bath Fan - Vented, # Fixture - Fluorescent Pressure Vessel 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 Minimum Fee QTY. TYPE Condensate Drain QTY. TYPE Generator QTY. TYPE 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 Solar Water Heater Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Cap - Fixture Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Pump and Abandon PLUMBING TYPE A/C Condensate QTY. 'TYPE 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. RECEIVED AND REVIEWED BY: DATE: Page 4 OFFICE USE ONLY ECKkIST O 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 Di PROOF OF OWNERSHIP (Attach) to HRS / DERM APPROVAL (Septic / Sewer) IMPACT FEE (New Construction) OTHER (Specify & Attach) g � 0 Metropolitan Dade County (C.C.F.) $ ( O ( sq.ft. = x/1000 x ¢.60) Inspector State Educational Fund $ (¢.005 /sq.ft.) State DCA (Radon) $ (¢.01 /sq.ft.) Code Enforcement Fine $ Zoning Review $ REVIEWED AND PREPARED BY: PERMIT APPLICATION CI CONDO ASSOCIATION APPROVAL (Attach) ® BPR APPROVAL (Restaurants) CI CONTRACTOR REGISTRATION (On File) PERMIT FEES DATE: SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official 0 BY DATE d-Y /4 e2. CQNDITION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL o (305) 795 -2207 c FAX (305) 756 -8972 o http : / /www.miamishoresvillage.com PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY l q (OWNER TO RETAIN COPY) Date f�� /, Job Address g* 99 S7 Tax Folio // ja Jij /690 9 Legal Description/c2# U J f 6 9 � / V' Master Permit it �'� .Yfr Owner / Lessee / Tenant rk � uc3-m-0 Owner's Address 4-0 1� 99- Contracting Co. Address Qualifier State# Competency # Tns.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): :UILD ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN WORK DESCRIPTION C $✓ l rNs� ?AO e (WT a C Signature of Owner and /or Condo President Date: PERMIT FEE: APPROVED: Zoning Mechanical Fire SS# - - Phone Building Xr Plumbing iNA5 Phone ( U " /66 Square Ft. Estimated Cost kiti crbd 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. Signature o Owner - Builder Date: Notary as to Owner and /or Condo President Notary as to Contractor or Owner - Builder My Commission Expires: My Commission Expires: * * * * * * * * * * * * * * Other Electrical Engineering