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PAINTMIAMI• SHORE S VILLAGE Paint c414I ippi oval and Agreement ATE: 1 1 . :: . OWNER'S AME: - C•vitx.e: -1- Diet PHONE: 3& S 1 `? S- 3 5 - ADDRESS: _S-`U .. ' L_ ° . 7' 47,,;#7 5 "7 �= c ***************1:*/tr * ** * ** ********** * * * * * * * * * * * * * * * * * * * * * * * * * * * ** 4 ADDRESS OF SITi :Ff:�'/. *ttA --.• :9 S'' t`h > '��.: 41, . b &iai Ft CONTRACTOR & LICENSE (if applicable) COMPANY NAME: PHONE: **************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All Elements on the site must �� Walls '��t,„z; , o) ed. V r. �t'� �j �( \ Fascia C � -:- .1: - 6 ' `) \ Drip Cap/Drip Edge 'Soffit fkoof /Flower Bins Shutters Awnings Garage Doors Railings Fences Decorative Metal APPROVED: Building Offici (5erftkii) / Chimney Doors and door jams —All brick (simulated or regular Stucco Banding 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 the work stated. Furthermore , the paint colors will be as per the attached sample . A'AiT/44 7-3 /- Signature of Owner Date Signature of Contractor Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** 1A be fisted d indicate the color to be pai �L X 9 t3 mt 7 \ccc, c z WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION 4/23/01 )UCT NUMBERS 358, 283, 601, 6 Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 2/5/2003 Applicant: VANESSA SIREN Owner: SIREN VANESSA JOB ADDRESS: 945 NE 98 ST Contractor Local Phone: Permit Status: APPROVED Permit Expiration: 8/4/2003 Work: EXTERIOR PAINTING AS PER AGREEMENT Building Permit Permit Number: BP2003 -196 Contractor's Address: Parcel # 1132060143450 Legal Description: MIAMI SHORES SEC 3 PB 10 -37 LOTS 19 & 20 BLK 80 LOT SIZE 100.000 X Fees: Description Amount FEE2003 -782 Building Permit Application Fee $60.00 FEE2003 -783 CCF $0.60 FEE2003 -785 Notary Fee $5.00 Total Fees: $65.60 Construction Value: $1,000.00 Page 1 of 1 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. 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 specifica ' • ns u rutted 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 e Signed: BY: REG X01 020603 1248 MCP,01 004661 CHARGE $65.60 (Contractor or Builder) BY: • • •• • • ■ � ` Psi V e:;)444*414::9*‘ • • • N ...,,, qt Nt. 4 ` b y . N % ' • • NN. r PROPERTY OWNER C Name s�S� 6 7.tei3 / jz i S, g- Address 3 - 41;46q1`, FC, 3/ 3 7 Home Telephone .3 6 s _ 15 - r , , 3 5 7 j� - Business Telephone '305— —7 3 �n � 3 > j — 7 Fax 7v4 - 7 5 — 31 7 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 Step 1. Job Address: PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other ..Aot .. • • • • • • • • • • • • • • • • • • • • • • ... • • • • • • • • • • • • .... ... ... • • • ... • • • • • • • • .. • • • ••• INSTRUCTIONS - The following steps must he taken to obtain a permit from the Miami Shores Village: Complete the attached pergiel tp{jlic':tigp'whi:'Itwurbe sirted by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a tyre atCurtte prl issinrof yoer application. If roofing work will be done, a roofing application must be submit- ted 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 Address Apt. City State "'d }— Zip ((� Folio Number "'description of Work M V "t E CTf 0 �— ©r I 4 J e Block Lot Subdivision PB PG Current Use of Property Proposed Use of Property Tenant Information PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax PERMIT APPLICATION Master Permit No. • ••• : : .• Subsidiary Permit No. .. . .... • • Zoning Linear Feet Square Feet L Units Floors 1- 'slue of Work I/ - -- 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 Page 2 IMPORTANT NOTICES DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR tA•1DSATtD PERMIT.ANO PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to! Mont lay through from7f 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, N AT C NLDITLON free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM•DIRI rN E):RN. • • • • 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMiENT OR 4✓EHIELLS,t>,ND 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, 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. STATE F FLORIDA, COUNTY OF MIAMI -DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE Si ature of Owner Print Name Sw. to • ' subscribed before me this SEAL: • • • • • .•. My Commission DD150048 SEAL: %o Expires November 15, 2006 • • • • • ••• • • • • • • • • • • • • • • • • • • Signature of Contractor / Qualifier Print Name Sworn to and subscribed before me this day of ° W86g l itA Becker Signature of Notary Public - State of Florida PERMIT APPLICATION Personally known OR, Produced Identification Personally known OR, Produced Identification Type of Identification Produced: l JL 565o PI D ^'7 _ T of Identification Produced: ELECTRICAL TYl'l; Minimum Fee QTY. 1 6'PE Dryer " • QTY. ; TYPE Outlet, Appliance Q I I. 'I IPI Service Repair Q'1 I. A/C Central 1 -3 Ton Heating Strips, each F - • • • • • •• •' 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 MECIIANICAL TYPE Minimum Fee QTY. TYPE Condensate Drain QTY. TI'1'I: Generator Q I. 'II I'I: Refrigeration, Tons Q i l . A/C Central, Tons 011. 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. TYPE Drains, Roof QTY. TYPI: Miscellaneous Fixture QTY. TYI'I'; Soakage Pit 011. 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 ... •• • • • • • • • • • ••• • • • • • • • • • • •, • t • ••• • • ••• •• • • • 1 PERMIT APPLICATION • INSTRUCTIONS: Please indicate the type o work x n; terformed and quantity(ies) in the space provided below. 1 RECEIVED AND REVIEWED BY: DATE: SECTION BY DATE Zoning �.� G C1D l /'3j/ Electrical Mechanical Plumbing Fire Public Works Structural Building Official 9.j.liftrai Page 4 OFFICE USE ONLY CHECKLIST ❑ 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 Metropolitan Dade County (C.C.F.) Inspector State Educational Fund State DCA (Radon) Code Enforcement Fine Zoning Review Notary • .• .• • • • .. • • . • • • . • . • • • • • • • • • • • • • PERMIT APPLICATION •• . • • . • ❑ PROOF OF OWNERSHIP •.• • O COltlii0 ASSOCIATION APPROVAL (Attach) • •• •• ❑ HRS / DERM APPROVAL, (Septic / Sewer) •.„ • • ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) PERMIT FEES $1 V 4 $ p $ 5. 0 6 ISSUING OFFICIAL REVIEWED AND PREPARED BY: DATE: D) (X .ft x/1000 (¢.005 /sq.ft.) (¢.01 /sq.ft.) (Attach) • • • • • . . • .; ;❑;B APPROVAL (Restaurants) • • • • • • • • • • • • •• ❑ CONTRACTOR REGISTRATION (On File) TOTAL 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