PAINT 2002CONTRACTOR /7 ch
Name a /d kf_./
License No 0 , 4 / b/ 761"-/WIrj
Address /1/ 7‘ /i5 /-3o ff.
r7 R - 33/.(
Telephonr5 /3 Fax
Qualifier Name, t-%� !/ - ) Z.___---
PROPERTY
New Construction
// OWNER 1 L f ' p
Name 67, // k YJef \ I C� b.C�t, ► l■VC/
Address / � 1 , /1//,/ �yD �y�-
/ ..J/1,7e--) .
Home Telephone 3Q S_ 1 c („,- i 0
O
Business Telephone
Fax
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'I Attachment
Other
Add'I Detachment
Other
Step 1.
Job Address:
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
/zf7/i 4
Address
Apt.
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
Flood Zone
PERMIT APPLICATION
Master Permit No.
Subsidiary Permit No. 7) c -
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 submit-
ted along with this permit application.
Step 2. Submit the completed applicatioq 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
1
City
State
Folio Number i ( - 3 2. OO CA170 Description of Work `T co u d
Lot Block i A n'l —
Subdivision PB PG Zoning Linear Feet
Current Use of Property Square Feet Units Floors
Proposed Use of Property Value of Work Z/ 2d; Bldg Value
Tenant Information Tax Assessed/Appraised Value
Base Floor Elev.
ENGINEER
Name
License No.
Address
Telephone
Fax
3/31
a Zip
4 e
Page 2
1 l l OIt'I'AN'I' 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, 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�C -DADE
Signature of Owner
EL E M, Go t 1
Print Name
Sworn to and subscribed before me this
2 0d 2 '.
day of
Signature of Notary Pty5lic - State of Flori
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Personally known R, Pr o duced I entifica n
Type of Identification Produced:
STATE OF LO D
74/ Lo
i afo re of C tractor
Signature / Qualifier
/I, / eJ S
Print Name
PERMIT APPLICATION
U Y OF MIAMI -DADE
(L
S and subscribed before me this) 0 day ofC
SEAL:
a
attire of e tary Pub11+c- State of Florida
Personally known OR, Produced Identification
Type of Identification Produced:
1
, 1 , ,......... ,,,...C.,-,. - a, ,
COMPLETE HOME PAINTING BY MICHAEL
MICHAEL IWASKEWYCZ
1476 NE 130111-4 ST. PH. 305 -895 -1368
NORTH MIAMI, FL 33161 /f
= PAY TO THE , n4r JiD , & f /
ORDER OF t"! (/ J�� `
N a e k e
Washington Mutual
Washington Mutual Bank, FA
North Miami/125th Street Financial Center 1728
900 NE. 125th Street 1 - 800. 788 - 7000
North Miemi, R. 33161 24 hour Customer Serene
MEMO
�:267084L3LI' 83L4835ii31" 3563
63- 8413 -2670 3563
DATE
$
Boo. DOLLARS 8 -�
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 10 /17/2002
Applicant: ELAINE GOLL
v c- Owner: GOLL ELAINE
JOB ADDRESS: 1287 NE 100 ST
1 Contractor COMPLETE HOME PAINTING Contractor's Address: 1476 NE 130 STREET
. qq Local Phone: 305 - 895 -1368
..J
(D Parcel # 1132050080070 Legal Description: 5 53 42 GORDON SHORES PB 45 -8 E5OFT OF LOT 6 & W25FT OF LOT 7 BLK 1
V
o/) Fees: Description Amount
FEE2002 -5807 Building Permit Application Fee $60.00 Total Fees: $66.80
FEE2002 -5837 CCF $1.80 Total Receipts: $0.00
FEE2002 -5838 Notary Fee $5.00
Total Fees: $66.80
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.
Permit Status:
Work: EXTERIOR 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.
Signed:
APPROVED Permit Expiration: 4/14/2003
Building Permit
Permit Number: BP2002 -1765
Construction Value:
$2,300.00
Page 1 of 1
(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 1 assume responisibility for all work done by either
myself, my agent, servants or employes.
(Contractor or Builder) BY:
MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
DATE: / d 3/� L
OWNER'S NA E: j a PHONE: �o ) 70
ADDRESS:
*** , * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
ADDRESS OF SITE: /2?7° / /Zir '
CONTRACTOR & LICENSE (if appl'c . ble)
COMPANY NAME:
Drip Cap/Drip Edge /v //45
Soffit CA; i.-e Gv44. ,'
Roof /V /
Flower Bins As /f'
Shutters C4/ kie aim_
Awnings ob / Z,
Chimney is /4'
Doors and door jams a, vieg w o "
Garage Doors e b, k e 4 two
Railings AV L
Fences Apt
Decorative Metal to
All brick (simulated or regular)
frpt
A/4
Stucco Banding
Any other stucco features
Accessory Buildings
Other
a
PHONE -/36r-
********************** * * * * ** ** * ** * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted.
Walls /- 2 , / 3 cj
Fascia CJ- Cv�
2/B
China White 74
HC -139
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.
WOU /0/3A
Signature of Owner Date Signatur of Contractor Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED: WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
Building Official D to 4/23/01
ELECTRICAL
TYI'I.:
Minimum Fee
QTY.
Tl'I'E.
Dryer
QTY.
TYI'I:
Outlet, Appliance
Q
T1'1'1:
Service Repair
QTY.
A/C Central 1 -3 Ton
Heating Strips, each
Fan
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
NIECHANICAL
T'I'E.
Minimum Fee
QTY.
TYPE
Condensate Drain
QTY. TYPE
Generator
QTY. "I'1'PE
Refrigeration, Tons
Q
A/C Central, Tons
Q'fl'.
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.
TYPE
Miscellaneous Fixture
QTY.
T) IT
Soakage Pit
Q'fl'.
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
DA E
/!� /cV(
Zoning
Ce(i"' �
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
9
f t ) L
Page 4
OFFICE USE ONLY
CIII..CKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi - family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
I'ERN11'1' 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
Notary
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
o
l a o
( x .60 x/1000
)
(¢.005 /sq.ft.)
(¢.01 /sq.ft.)
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ h ,c5) V
ISSUING OFFICIAL
REVIEWED AND PREPARED BY: 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
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building ra'
MIAMI SHORES VILLAGE. FLORIDA
o PERMIT N° _ 6126
Architect
Contractor
or Builder
Legal Lot
Description Bl
Address of
Building t r
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 it 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.
CONTRACTCR OR BUILDER
Signed
Work to be performed under this Permit
, -, r . •.i
t
BY
Subdi-
vision
Value of
Protect $
DATE ' ' - 195
Contractor's
License No.
Amount of
Permit $
— -••∎, BY •
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered ereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications su itted to the proper authorities of Miami Shores Village. In ac-
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
f
AUTHORITY
6