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1217 NE 100 St (13)( 7 - Miami Shores Village Buildin g Permit 10050 NE 2nd Avenue M Phone: 305- 795 -2204 Permit Number: BP2002 -1164 4 Printed: 6/28/2002 0 Applicant: ALBERT & KRISTINE ANDERSON 0 Owner: ANDERSON ALBERT & KRISTINE (t5 JOB ADDRESS: 1217 NE 100 ST PAY TO THE ORDER OF Contractor ARCO CONTRUCTION Local Phone: 305 - 892 - 6507 Parcel # 1132050090631 Fees: FEE2002 -3636 FEE2002 -3637 FEE2002 -3638 FEE2002 -3639 --p Permit Status: Work: BATNRnr 4. a ARCO CONSTRUCTION CORP. NORTH MIAMI, FL 33181 Legal Description: 5 53 42 EARLETON SHORES Description Building Fee CCF Notary Fee Buildier's Bond Total Fees: Yl as s • <� • aS 11=0. ale FOR �vt -/ t _� ✓ L S First Union National Bank firstunion.co Org. 003 R/7 067006432 ! r - 1 :06 ?00643 21 :209 : 0 p L9490 L 31t < < < u'OO L90 ?tI' Approved Permit Expiration. 1 ') I"l Contractor's Address: 1665 NE 137 TERR Amount $150.00 $6.00 $5.00 $300.00 $461.00 63.6431670 BRANCH 13093 DATE $ Y6/2c2 Page 1 of 1 PB 43 -80 LOT 2 BLK 5 LOT SIZE 1907 . y U y `ilnllaon OLLARS Total Fees: $461.00 Total Receipts: $0.00 Re- inspection ication herefor in strict compliance with all ifications that may have been submitted to s or if the plans are changed without )onsibility for a thorough knowledge of the that he assumes responsibility for work done s pertaining thereto and in strict conformity ;ponisibility for all work done by either (Uontractor or Builder) BY: At9aasoo Is,i7 oou 'rio - 10vxs (boo 11 th QWL-I NJG z 0 z I-AN rwizfrf . - rs CPC NI l 1 I N4 c6 zogp ONT'- (eION U i o EATHO NfI 1 H cA - I®N ' ii; .7w0L1 4 ' __ _ _ ___ _ _ -New - pfz`foxp .� D9 9 I_ h" 3 ' - 6 'i /3'• 3 I) EL5cresc N 14'65N1? cei L H OUNT6P Fociw i 6 6 — Q 6 — kAu. Mowt j ey -i acdu2.0 PROPERTY OWNER Nmeow cowfrria/enoil COPP License No. Name /1 , 4 Te'ePh°no,s' g926ro ax Q uaVgaghm,t - - - AvA-- , 01,161usrfti Address P 11 kJ E 06 57 Home Telephone 3 0 5 75711 6' a. Business Telephone Foundation Only Fax Other CONTRACTOR Nmeow cowfrria/enoil COPP License No. Address /6 /577 , A/P fi 5 J81 Te'ePh°no,s' g926ro ax Q uaVgaghm,t - - - AvA-- , 01,161usrfti TYPE OF MANAGEMENT ( 1 ) New Construction Enclosure Alteration Exterior Repair. Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'I Detachment Other INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step I. Job Address: Folio Number Lot Subdivision Current Use of Property Proposed Use of Property Tenant Information 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 /2 /7 d,6 ta0 € PERMIT TYPE ( ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Address Apt. Block PB PG PERMIT CHANGE ( ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Master Permit No. Subsidiary Permit No. City AtiM10111UN State PERMIT APPLICATION Zip Description of Work /,7e/SJ Zoning Linear Feet Square Feet Units Floors A Value of Work y0 0(f. v 4. Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax Page 2 IMPORTANT NOTICES I. 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. APFIDAVIT - 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 O,F' j~LQRIDA, COUNTY , OF MIAMI DADS 4 1 Signature of Owner A..i A ode r- so 44 Jr, Print Name Sworn to and subscribed before me this . / 41- day of Sit naturc St AI,: 6/14 SEAL KERRY IIERNANDEZ NOTARY PUBLIC fiTATE OF FLORIDA COMM $. ION NO. CC832806 MY CO ISSION EXP. MAY 3 003 Personally known _ _. OR, Produced Identification Type of Identification Produced: E OF FLORIDA, 9p Ty0F . I -DADE • , . .• • // i►. f Contractor / Quail ter j(ALF N A- ;�fV G'ofo Print Name to and subscribed before me this , !aturc of otary Publi fate of Flori SEAL: Personally known Type of Identification Produced: PERMIT APPLICATION OR, Produced Identification 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 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 ()Ty. 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 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 Aeplace 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 [ STRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: SECTION BY DATE Zonin: Electrical Ve�� �%lMraL. f Z o . a 2 Mechanical Plumbin: MEM r� Fire Public Works Structural IMMeta• 2,d-0 Building Official Page 4 OFFICE USE ONLY LI OWNER - BUILDER FORM (Attach) CJ FIRE DEPARTMENT APPROVAL (Commercial / multi - family) LI CONCURRENCY (New Construction) LI OTHER (Specify & Attach) CHECKLIST ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (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 $ o_ $3c o $ REVIEWED AND PREPARED BY: (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) 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 Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Permit Number: BP2002 -1290 Printed: 7/25/2002 Applicant: ALBERT & KRISTINE ANDERSON Owner: ANDERSON ALBERT & KRISTINE JOB ADDRESS: 1217 NE 100 ST Contractor Local Phone: Parcel # 1132050090631 Fees: Description Amount FEE2002 -4070 Building Permit Application Fee $60.00 FEE2002 -4071 CCF $0.60 FEE2002 -4072 Notary Fee $5.00 Total Fees: $65.60 Total Fees: $65.60 Total Receipts: $0.00 Permit Status: Approved Permit Expiration: Work: EXTERIOR HOUSE PAINTING 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. Signed: X Signed: 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. Building Permit Contractor's Address: 1/21/2003 Construction Value: $500.00 Page 1 of 1 Legal Description: 5 53 42 EARLETON SHORES PB 43-80 LOT 2 BLK 5 LOT SIZE SPECTOR) BY: (Contractor or Builder) BY: t ft s• 63-8082126707/2 0 Q 4698 (Vai-e 1$ GO A . ni) A. J. Anderson, Jr. I or Kristine Anderson 1200 N.E. 129th Street North Miami, FL 33161 r vay to the tait4 • order /b 0 ‘( it7 .r Thlfars ■ MIAMI BEAIH FEDERAL RE IT UNION Exploring, Enjoyin and Protecting the Planet Se For • , 1:26708082 - 00000057920311' : 4698 folossage!Check. wwwynasu er.thbon 1•080CHECK•OK • , • ' , • Pam contains 2 phshcansonm waste Phrhod with soy-busod frO 4 q1 ff4.411.r. MIAMI SHORES VILLAGE Paint Color Approval and Agreement DATE: OWNER'S NAME: /kJ 414.c_.eson - PHONE: II 71152 ADDRESS: 11 ki a /60 s T ***********************.************* * * * * * *. * * * * * * * * * * * * * * * * * * * * * ** ADDRESS OF .SITE: La . 7 hJ E CO0 s r CONTRACTOR & LICENSE (if applicable) COMPANY NAME: PHONE: *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * All Elements on the site must be listed and indicate the color to be painted. Walls als - 1 ci Fascia .2 1 5 7 'T Drip Cap/Drip Edge RI 5 7 9 Soffit 1 5 7 q Roof NI f 11 Flower Bins 02 1 5 7 q Shutters a 15 7 9 Awnings 2 7 Q Chimney [( / A ( - 9r 5 7 q Doors and door jams Garage Doors Railings Fences Decorative Metal All brick (simulated or regular) Stucco Banding Any other stucco features Accessory Buildings Other u 915 -7 0 a) 3 E 0 a) 3 0 a OWNER'S AFFIDAVIT: I certify that all the foregoing informati, YOU LO R R E V Pat INT. RM and that all work will be done in compliance with all applicable lavv i , s uia,iii 6 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 J -7-/22A).- sa pleI Signature of Owner Date Signature of Contractor Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED: WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION '19. 7/2 34d- Building Offi ' 1 Date 4/23/01 PROPERTY OWNER New Construction Name 14J 144 d e (�0 n Alteration Exterior Address Alteration Interior Home Telephone PL 7/) 7 Business Telephone 9 51- d --- Foundation Only / 7 `/ Fax Other 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 prope y 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 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. A PPLICATION Job Address: lai7 ide 100 sr Address N State Folio Number Description of Work F ci o r' Mouse Lot Subdivision PB PG Zoning Linear Feet Current Use of Property Square Feet Units Floors Proposed Use of Property ( Value of Work O'O' DO Bldg Value Tenant Information Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Block Apt. PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Ak City PLA- PERMIT APPLICATION Master Permit No. Subsidiary Permit No. P '0110 • / (9- 3313? Zip ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. Address Telephone Fax Qualifier Name Page 2 EN 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. AF'F'II)Av 1'I' - 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. STA if O � R IVi., COUNTY OF MIAMI -DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE Signature of Owne Signature of Contractor / Qualifier A.1 , ode (Se Print Name \ 1 Print Name S to and subscribed before me this C� C�day of �. , _ , Sworn to and subscribed before me this day of SEAL: � Flo R,. ciA ;a ri::L..... u2. , : a r W . L \i-i'4.. ` Q Cr.V C : " - 1 OF F� _ -_ Signature of Notary Public - State of Florida SEAL: PERMIT APPLICATION Personally known OR, Produced Identification L Personally known OR, Produced Identification Type of Identification Produced: f L /7 S1 4 " 0 30 ' '-O Type of Identification Produced: ELECTRICAL T ,. ► , E Minimum Fee Q . ► . V .. . Dryer QTY. . Outlet, Appliance Q.►.V.. 'Fyn: Service Repair `►.►.V.. 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'PE. Minimum Fee QTY. TYPb: Condensate Drain QTY. TYPI: Generator QTY. TYPI: 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 TYPE: A/C Condensate QT1'. 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: SECTION BY DATE Zoning p , /i VI: / y Electrical Mechanical Plumbing Fire Public Works Structural Building Official `%.if��(`' 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.) $ 0 LOC) Inspector State Educational Fund $ State DCA (Radon) Code Enforcement Fine Zoning Review Notary ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) O IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) $ CQ D $ $ 0 REVIEWED AND PREPARED BY: ( .ftt. = x/1000 (¢.005 /sq.ft.) (¢.01 /sq.ft.) PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) O BPR APPROVAL (Restaurants) O CONTRACTOR REGISTRATION (On File) PERN111' FEES TOTAL $ - ISSUING OFFICIAL. 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 Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village. Florida. and all provisions of the Laws of the State of Florida. all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with. whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. Owner's Name and Address Registered Architect and/or Engineer Name and address of licensed contractor Location and legal description of lot to be built on: Lot 4 Block .) STATE OF FLORIDA COUNTY OF DADE. } SS. MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Street and Number where work is to be done __ // State work to be done and purpose of building (by floors), state exterior colors (submit samples) 7" (7` �`' and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements S ) & 0 r 0 0 Amount of Permit S 1 Zone cubage required Plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all plans and specifications for said building. All notices with reference to the building and its construction may be sent to The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatons as an employer of Labor under the Florida Workmen's Compensation Act, being Section 5966. Compiled General Laws of Florida, Permanent Supplement. and has complied with the provisions thereof. and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit: and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors. on work to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) No. / / 7 Street - sue– r / O"t1 Date r // C t-"* . L. 19 / / Subdivision W7 2 5 JA) 1/ ®q E /6t/ / 7 Before me. the undersigned authority. a notary public. duly authorized to administer oaths and take acknowledgments. personally appeared to me well known. and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoin: application, and that he did sign the same, and that all facts therein by him stated are true. Permit No. C9 �4 Date 3 % Y 9) Read. Sworn to and Subscribed before me. Disapproved L 3 � �i Date Notary Public. State of Florida (Signed) Building Inspector My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approved Date Disapproved Date NOTE: A charge of 525.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re- inspection fee of 525.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and/or workmanship.