CABINETS AND FLOORINGType Insp'n
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date3'� ?'O2 Time
Permit No. t 3 3 f
/
Name V »v �v
Address t•3 i iJg f 57-
Company 4/15 11L
Phone # 3D - 7s 5' 67 73
For Inspector: 3
Correction
Re- Insp'n Fee
H. TROY MARTIN
CLINTON R. BRIDGES
803 NE 99TH STREET 305 -754 -5173
MIAMI, FL 33138
PAY TO THE
ORDER OF
iI- T( t5 /E I 5 U, l (q
:OD
L' A T
UP Washington Mutual
--4267084 L3 L':393111 L54`23611 II' • 102
NOTES
Washington Mutual Bank, FA
Miami Shores Financial Center 1722
9640 NE. 2nd Avenue
Miami Shores, FL 33138
1- 800.788 -7000
24 hour Customer Service
63- 8413/2670
39315423655 /!
DATE : 12 7 ®/
111
102
DOLLARS
C.UST_OMER
•
All dimensions & size designations
. given are subject to verification on
job site and adjustment to tit job
conditions.
THE
_
HOME DEPOT
•
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• • • • • • • • •
• • • • • • • • • •
• • • • • • • • •
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111 129
-- icy tx 42_ 42 '- <_'7 t- 60 - --
33 ......_ _....._.......... -- 72 — .._....._ - - 6 ,, _- ..... --• 51
1 1 0 , . y 24 -- . 2' 316 — 1 B .,_.._. 24
_ -- 27 —3 -- 214 12 33 - ---
4.430 I V ' 430 1 rry : W18 WA2430
27 IT D ISH. SE 30 :BD: EZR
33
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Cal i
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36
30
This is an original design and must
not be released or copied unless
applicable fee has been paid or job
order placed.
8040E3414
Troy Martin
803ne99si
mia.shores
B12 IW
1U15 (36" REF -•ICTP
WR3618
• 15 -__ 33 ..-- .. -._. 15 • 48
15 - --_ :43 63
31 ' 30
81 — ...
— - - - 114 -
Designer
Wayne
24
33
12 18
12
45 4E80
Scale : 1/4 " = 1'
36 3602
.i
138
Dwg
Design : 11/04/01
Date : 11/04/01
PROPERTY OWNER
New Construction
Name 4L —T- tO ( (M 4 led
Enclosure
Address "v8 y (Ja °(9 3t
l i I J I . 5 c 5
Alteration Exterior
Home Telephone ,.50 / /3 ...." 7 , , � 7
3
Business Telephone 38 c_'7 �7 ' d s4.-g
Alteration Interior
Fax n c — 754 — 6V-- $ `I
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.
50
APPLICATION
Master Permit No. .J 0 3' 1
° /h 08 Subsidiary Permit No.
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
Job Address: �3 q 1 )P4''i /gJreS L—
Address Apt. City State Zip •
Folio Number ^ � 2_0(0 - a7`f--�o9D g Description of Work ?e,i4 e K � � � Qi - akrP) -C' ®off
Lot Block
Subdivision PB PG
Zoning
Current Use of Property Square Feet
Proposed Use of Property kValue of Worli(
Tenant Information Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
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
Linear Feet
Units Floors
_ Bldg Value
;O
ENGINEER
Name
License No.
Address
Telephone
Fax
CONTRACTOR
Name
License No.
Address
Telephone Fax
Qualifier Name
Page 2
4 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, 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.
ATE OF FLO P'7BAMI=DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE
`Signat : of Owner
r c( 141 0 9-02T
Print Name � � Print Name
Swo s.: d subscribed before me thi s50 da y of / Sworn to and subscribed before me this da y of
ure of No Public - Sta of Flori
•
�1• �' AP10ELA M BEC,::H
\ 1�;' i n :1uL5En
,; 4• rl . C ,766e97
.• .O 9 .:,V �B :'!,1 :� - X71 RIS
CF F
Personally known O R,'Produ Idenfi'ficatti - onn
Type of Identification Produced'�1 1.e3S',3 .
SEAL:
Signature of Contractor / Qualifier
Signature of Notary Public - State of Florida
SEAL:
PERMIT APPLICATION
Personally known OR, Produced Identification
Type 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
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
0 -
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 QTY.
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
0 -
PLUMBING
TYPE.
A/C Condensate
QTV.
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
CI OWNER - BUILDER FORM
(Attach)
® FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
CONCURRENCY
(New Construction)
L OTHER
(Specify & Attach)
$3.00 per page (Scanning Fee)
Miami Shores Village
Bond
• PROOF OF OWNERSHIP
(Attach)
Metropolitan Dade County (C.C.F.) $ U 6
Inspector State Educational Fund $
State DCA (Radon) $
Code Enforcement Fine
Zoning Review
• HRS / DERM APPROVAL
(Septic / Sewer)
Cl IMPACT FEE
(New Construction)
• OTHER
(Specify & Attach)
$
SECTION
Zoning
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
BY
DATE
(sq.ft. = x/1000
x ¢.60)
(¢.005 /sq.ft.)
(¢.01/sq.ft.)
PERMIT APPLICATION
CI CONDO ASSOCIATION APPROVAL
(Attach)
BPR APPROVAL (Restaurants)
CI CONTRACTOR REGISTRATION
(On File)
PER'MIT FEES
REVIEWED AND PREPARED BY: DATE:
CONDITION, OF APPROVAL
Revised July 2001
10050 N.E. 2` AVE., MIAMI SHORES, FL a (305) 795 -2207 0 FAX (305) 756 -8972 o http : / /www.miamishoresvillage.com