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935 NE 99 St (10)Name GW Address Got 3)- Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date c , 1 1 \u4 Type Insp'n G1n Permit No. 4N c a- 443 . Company nrl h- 14,'-Q Phone # Inspection Date ) -I CA-A Village of Miami Shores 10050 NE 2nd Avenue Miami Shores, FL 33138 Phone: 305 - 795 -2204 Printed: 3/5/2002 Page 1 of 1 Applicant: GUSTAVE Owner: LARSON LARSON GUSTAVE Contractor COMPLETE HOME PAINTING Address: 1476 NE 130 STREET Local Phone: 305 - 895 -1368 Cellular: Parcel # 1132060340251 Legal Description: 5 -6 53 40 MIAMI SHORES SEC 8 PB 14 -33 E34FT LOT 18 ALL LOT 19 BLK 170 LOT �p Job Address: 935 NE 99 ST " I Fees: Description Amount FEE2002 -1325 Building Permit Application Fe$60.00 FEE2002 -1326 CCF $1.80 FEE2002 -1327 Notary Fee $5.00 Total Fees: $66.80 Permit Status: Approved Permit Expiration: 8/28/2002 Construction Value: $2,350.00 Work: CLEAN & PAINT HOUSE AS PER AGREEMENT 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 annthAr insnection. This Permit is granted to the contractor or builder named above to construct the br ordinances pertaining thereto and with the understanding that the work will be perforr and approved by the proper municipal authorities. This Permit may be revoked at an ,authorization. A further condition upon which this permit is granted is the understanc ordinances and regulations pertaining to the work covered hereby whether shown on by his agents, servants or employees. Building Permi Permit Number: BP2002 -443 ,...,, .,,..,. M,. - PAY TO THE q W ORDER OF a e COMPLETE HOME PAINTING BY MICHAEL 1476 NE 130TH ST. PH. 305 - 895 -1368 NORTH MIAMI, FL 33161 Signed: (INSPECTOR) 4 In consideration of the issuance to me of this permit, I agree to perform the work c with the plans, drawings, statements or specifications submitted to the proper author Washington Mutual Bank, FA P 9 P P P North Mia 900 NE. 125th Street w m5125t Street Financial Center 1728 myself, my agent, servants or employes. NorSp jtiarni. FL 3316y/ 24 no Customer Somme MEMO L!9 Washington Mutual N E ' 1.800788.7000 Total Fees: $66.80 Total Receipts: $0.00 63- 8413/2670 8314835113 DATE /7/ 2 6 Signed: (Contractor or E ?OEM L 3 Lisa 3 1„,„ 4 8 3 5 L L n. 3 II' 3 3 5 3 1 $ /3-3 DOLLARS DOLLARS lJ ., 3353 r1T :- -. -=- rt -A MIAMI SHORES VILLAGE Paint Cofor Approval and Agreement DATE: / / OWNER' S T .NS. �rJAvt L vyc PHONE /3ofj73-7 / ADDRESS: 93 s-- /w 99 Sf ********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** 9.3s 4/ 9R 3 CONTRACTOR & LICENSE (if applicable) / / / COMPANY NAME: ► e i **** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * * ** ADDRESS OF SITE: All Elements on the site must be listed and indicate the color to be painted. Walls .Si /g Fascia cr+ B / Soffit 9,'T r'1 Roof ti/19 Flower Bins C4,n4/ V% L.- .-- Shutters N /Ai''' Awnings A / 19' Chimney •4,//9- Doors and door jams C' %, me. COL Garage Doors c i ti-4.< tti� -6 Railings /0/1/ Fences /1' Decorative Metal /v/� All brick (simulated or regular) dem,1 ' Pr q• Stucco Banding /l/ /'9" Any other stucco features / Accessory Buildings N /// Other /L /// APPROVED: vim► it a Building Offic' Date 1 /A° 2/B ' 955 984 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 samples. Signature of Owner Date Signature o Contractor Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION CONTRACTOR Name y�� n /�„_�t 4 /�i "' c� f l tit, License NNoo.n 3 Address / i7� , S r �� e . /37/ if. Fe \ 33/6 / Telephones 1 Fax C/r�� , Fe. J S„ p /Jl‘ c p Qualifier Nam Al.� e c T/L_____ PROPERTY OWNER New Construction Name 6Z , 7 !/ / 6 ac_ / /7"-J'e A7 Enclosure Address i n yr r le/ HP7 ✓, C , 3313, Home Telephone 1 7S- 7 . 372! Business Telephone Alteration Interior TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add't Detachment Other Step 1. Job Address: Address Lot Block Subdivision Current Use of Property Proposed Use of Property Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other PB PG Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Zoning Square Feet Value of Work Master Permit No. Subsidiary Permit No. Apt. City State Folio Number Description of Work 0,4' I-✓ Linear Feet PERMIT APPLICATION INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: 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 q35" /t/ 99 j y Pi /av/ LiJ 33/3 S tp Units Floors Z� SQ Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT CHANGE (✓ ) ENGINEER Name License No. Address Telephone Fax Page 2 IMI'ORTAN'I' 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. A I 1 1 DAVIT - 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 Signature o iwner Print Name So� o and subscribed before me this day of F Pit :1 Signature of SEAL: 6 / S7f9 u 4 e.S t P.h'; _ C rida :sir:^ MICHA IWASKEWYCZ 1 : nit . MY COMMISSION /I CC 721000 _,, - �� P EXPIRES: April 10, 2002 ' .t F ;0.' Bonded Thru Notary Public Underwriters Personally known t/ OR, Produced Identification Print Name Sworn to and subscribed before me thi day , , O ?� it It No IC - +4^ 3.0 1''" SEAL O Se AM A M BECKER * /i CO OR NUMBER ' !W -4 .r CC786697 T,..0 Ni MY CO ..ISSSON CXPIRMS OF FAO NOV. 1 5 Personally known OR, Produced Identification Type of Identification Produced: Type of Identification Produced: ■ PERMIT APPLICATION Y OF MIAMI -DADE ELECTRICAL .1.1,1,1;; Minimum Fee QTY. .1.1,P1; Dryer QTY . .1.11,1; Outlet, Appliance QTY. TV Service Repair Q ' FV , 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 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 ,1.1.1,1; Minimum Fee QTY TYPE Condensate Drain QTV .1.1,1,1,; Generator QTY. mg.: 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 PLUNIBING .i.Yl,i, A/C Condensate QTY .1.1,1,1; Drains, Roof Q'FV .1.1,1,1;; Miscellaneous Fixture QTY. .1.1.1,1,, Soakage Pit QTY. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Re s air 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: SECTION BY DATE Zoning — e 7' 6 Electrical �� %� Mechanical Plumbing Fire Public Works Structural Building Official, ^C� ---- 2—..2-- . /rte Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi - family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) Metropolitan Dade County (C.C.F.) $ Inspector State Educational Fund $ State DCA (Radon) $ Code Enforcement Fine Zoning Revie ❑ HRS / DERM APPROVAL (Septic / Sewer) $3.00 per page (Scanning Fee) Miami Shores Village Bond ❑ PROOF OF OWNERSHIP (Attach) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) PERMIT FEES 3 $ 5. op ISSUING OFFICIAL REVIEWED AND PREPARED BY: r (sq.ft. = x/1000 x0.60) (¢.005 /sq.ft.) (¢.01 /sq.ft.) PERMIT APPLICATION • CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL DATE: CONDITION OF APPROVAL Revised July 2001 10050 14. ^�2 , AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 2/11/2004 Applicant: GUSTAVE Owner: LARSON JOB ADDRESS: 935 Contractor COMPLETE HOME Local Phone: 305 - 895 -1368 Parcel # 1132060340251 NE 99 PAINTING Signed: (INSPECTOR) Signed: (Contractor or Builder) Building Permit Permit Number: BP2002 -443 LARSON GUSTAVE ST Contractor's Address: 1476 NE 130 STREET Page 1 of 1 Legal Description: 5 -6 53 40 MIAMI SHORES SEC 8 PB 14 -33 E34FT LOT 18 ALL LOT 19 BLK 170 LOT Fees: FEE2002 -1325 FEE2002 -1326 FEE2002 -1327 FEE2004 -1423 Description Building Permit Application Fee CCF Notary Fee Renewal /Extension Fee Total Fees: Amount $60.00 $1.80 Total Fees: $133.60 Total Receipts: $133.60 Permit Status: APPROVED Permit Expiration: 2/28/2004 Construction Value: $2,350.00 Work: CLEAN & PAINT HOUSE AS PER AGREEMENT (PAID EXSTEMTION OF PERMIT2 /11/2004) FEB 1 1 PAID 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. BY: O3 -`7 �/ G " 9f5 Tax Folio/) 5T / © 5 i Date ' � ( Job Address / :% Legal Description � 9� � fi � �� e/ Owner / Lessee / Tenant Gr U STJ} V W • L.-BR 5oN Master Permit It P�'� Owner's Address q 41 97 s 7 Phone Contracting Co. ROBERT N ( Address 73S ,VE ?7S/ Qualifier (TDBERT A (cl - }/ -- Phone ?3 l P Z. State +'k Municipal (� ^ ^^^petency 4k /3b i t Q frIns.Co. Architect /Engineer Bonding Company Mortgagor Permit Type(circle one): BUILDIING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION /9/ T /AU- 4 7U e02- SAVP.46S•. Square Ft. Estimated Cost(value) ("MO 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 -na ed contractor to do the work stated. Ps- e 15 _. ractor or Owner- Builder Signat g. Date:, 5 APPROVED: M Commission Expires: PERMIT APPLICATION FOR MIAMI SHORES VILLAGE f�Q and /or Con o President N•1ary to Owner and/ ** * * * * * * * * FEES: PERMIT , :q - ' RADON C.C.F. Fire Buildin Zoning It ** * * **,B *c. JOSEPHINE CHURCH ! 11i,�lT o�etl': . a ' . rC. a 1.12 p. Exp. Aprl 30.1 No. CC197545 Mechanical Plumbing_ . aa.. ^.. Address Signat r of Date:O( r� - /.L: 'r_ rte. tary 1 s to Cont �•`+ _ of..: No. CC197545 Commission Ex a * r ** NOTARY .c -1 TOTAL DUE ¥4 e D Other Electrical Engineering