1421 NE 101 St (6)CONTRACTOR
/ / / a - v
Nam ..1A90fro S,.TI/"0 -, /A
Name e rl
Zi#
it/
License No.
Business Telephone
Address 24/: #/
g _
Te 5 7� 77 �.5 C - 7 5
' NameA ,W ; t
- 2_
Qualifier
7r j � ,��
PROPERTY OWNER
/ / / a - v
Nam ..1A90fro S,.TI/"0 -, /A
Address /442/ ' /' /'
//IA P,/ j j ' 3
7/3g
Home Telephone -QS 79/
Alteration Exterior
Business Telephone
Repair
Fax /j /�
Alteration Interior
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'l Attachment
Other
Add'I 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 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 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:
/7 /1/4 i� � Zfl ��/��Y�, ,7 33/30
Folio Number
Lot /
Block
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
Address Apt. City State Zip
Description of Work ?"7./ ,..C9 9/e - fill
Zoning Linear Feet
Square Feet .' Units Floors
Value of Work %: �� Bldg Value
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
3
PB S� Pb S3
Subdivision _
/e
Current Use of Property Si /95.0"iy
Proposed Use of Property Sir/f/
Tenant Information j (L
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
Master Permit No.
Subsidiary Permit N7
PERMIT APPLICATION
ENGINEER
Name
License No.
Address
Telephone
Fax
Page 2
IMPORTANT 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 13Y 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 $2,500 or intend to obtain financing, you may wish to consult with
your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at:
22 N.W. 1st Street, 1°' Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in
accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and
Choosing a Contractor.
TE OF FLORIDA, COU Y OF MIAMI-
( n�atue_of Owner
/4o t?a e)
ature o
Print Name
..$wo and subscribed before me this
O ! J: 1t 1 I! l''i.
it�ry Publ, - State of Flori
SEAL:
Personally known
Angela M Bette'
My Commission DD15004i
Friig is November 15, 2006
vK , Produced Identification
_ .4r 4
Print Name
om to and subscribed before me this ( da
Alto J
6
t re ' otary Publ
SEAL:
PERMIT APPLICATION
e of Contractor / Qu
of
STATE OF FLORID .., . :,.,
. ifier
Florida
N Angela M Becker
My Commission DD150048
®r" Expinas November 15, 2008
Personally known "L/ OR, Produced Identification
Type of Identification Produced: �� ti‘3 - 6 ° 5 7 -3 q 6 Type of Identification Produced:
ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPE
Dryer
QTY.
TYPI'.
Outlet, Appliance
Q•IV.
TYPE
Service Repair
Q•fY.
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
TYPE
Minimum Fee
QTY.
TYPE
Condensate Drain
QTY.
TYPE
Generator
QTY.
TYPE
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
QTY.
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
CV
/ I_ � Ve:'
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
- '
-1
Official
v
ii "
i/ i,
ii
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
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
PERMIT FEES
$
$ - o
( x . f t. x/1000
(¢.005 /sq.ft.)
(¢.01 /sq.ft.)
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ 2,4t a
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
LOCATION MAP
wmIIIIIIVnuu, dllVlllllluu6
III
NOT VALID UNLESS SEALED WITH
AN EMBOSSED SURVEYOR'S SEAL
Scale: 1 "_loo
For
L E G A L D E S C R I P T I O N
Lot 12, Block 3, REPLAT OF TRACT A OF MIAMI SHORES BAY PARK ESTATES, according to
the plat thereof, as recorded in Plat Book 56, at Page 86, of the Public Records
of Dade County, Florida.
Mr. & Mrs. Peter G. & Ellen Jensen
MARIO PRATS JR. & ASSOCIATES, INC.
LAND SURVEYORS - LAND PLANNERS
300 S.W. 107th. Avenue
Suite 214
Miami, Florida 33174
(305) 5 1 -6000 Fax: (305) 221 -1239
1 HEREBY CERTFY: That the 'PLAN OF SURVEY'. represents the above deserted properly and it was completed
under trey supervision and/or erection. to the best of my knowledge and beget. and It also complies with the
Mini num Technical Standards set forth by THE FLORIDA BOARD OF LAND SURVEYORS, puauartt to Chapter 21
HF+6. Florida Administrative Code and Chapter 472.027. Aorlda Statues.
SURVEYOR'S NOTES:
1) There rrey be addaorns Restrictions not shown on this survey that map be found n the Pubic Records of this County. Examination
d ABSTRACT OF TITLE wit have to be made to detannins recorded instruments. If any !Reding this prcpsity.
2) Location and idert f'cation of Utilities and or adjacent to the property were not seared as such itormation was not requested
3) Ownership is subject to OP11 ON OF TTftF.
4 ) Typed Survey: BOUNDARY.
5) Unless otherwise noted. the Firm has not attempted to locate Faoti g$ ardfa Foundations (underground).
6) This PLAN OF SURVEY. has been prepared for the exdusire wed the entities name hereon. The Conrad° does not extend
to any wormed party.
professional
Stated Ronda
ABBREVIATIONS:
RMI - Right-of-way
Res - Residence
N -North
E Etat
S • South
w - west
STY - Story
PRM - Panrr ne d Reference Monument
PCP - Pemainenl Control Paint
P.O.B. - Path of Beginig
PC - Pont d Cuvat re
PT - Pala d Tangency
PRC - Point of Reverse Curvature
Aw • Delta
Tv. - Tonged Distance
SEC • Sedion
TWP - Tosmtnp
ROE _ Range
B.M. - Bench Mark
CBS - Concrete Block Structure
Cone • Concrete
Sak • Sidswaan
CIL - Contains
Dace: March 24, 1992
J.N.: 5476
z
•
O'
_FoVuD P.2. N•
RC) Fovuo I�
AF\ot,1 PtpE.
PLAN OF SURVEY
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31' 57'
Scale: 1"
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it
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35.00 •
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9over.5
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6�
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tRa1 ptpt,
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 11/26/2002
Applicant: JAMES
Owner: HOWARD
JOB ADDRESS: 1421 NE 101
Contractor DECORATIVE MASONRY INC Contractor's Address: 842 N. E. 99 St.
Local Phone: (305)757 -7765
Parcel # 1132050240290
Fees: Description Amount
FEE2002 -6742 Building Permit Application Fee $60.00
FEE2002 -6743 CCF $1.20
FEE2002 -6744 Notary Fee $5.00
FEE2002 -6745 ,: Buildier's Bond $300.00
$366.20
Total Fees:
Total Fees: $366.20
Total Receipts: $0.00
Permit Status: Approved Permit Expiration: 5/25/2003 Construction Value:
Work: RE LEVEL BRICK PAVERS IN REAR PATIO -NO CHNAGES IN LAY OUT
If there is no permit packag
fee is $50.00, which must be r
This Permit is granted to the contract
ordinances pertaining thereto and with t
and approved by the proper municipal s
authorization. A further condition upon
ordinances and regulations pertaining t:
by his agents, servants or employees.
Signed:
In consideration of the issuance to m
with the plans, drawings, statements or
myself, my agent, se
X
Building Permit
Permit Number: BP2002 -2040
HOWARD
JAMES
ST
Legal Description: MIAMI SHORES BAY PK ESTS AMD
Page 1 of 1
PB 56 -86 LOT 12 BLK 3
DOLLARS
PAY TO THE
ORDER OF
DECORATIVE MASONRY, INC.
PH. 757 -7765
842 N.E. 99th STREET
MIAMI SHORES, FL 33138
»0006 2 3» .1:06 300004 7.: 00 1 18 1 0 48 25 2"
BANK OF AMERIC
BANK OF AMERICA N.A.
9190 BISCAYNE BOULEVARD
MIAMI SHORES, FLORIDA 33138
FOR
63 -4/630
0623
Soda,' balums
III l a/ • __Si
mint, lore6 (fit-I
ilo s i"
� R ,i
STATE OF FLORIDA)
COUNTY OF DADE)
The undersimed A
attached survey, perfo ed by
performed 03 2
(dal f fey)
locations of all structures on the property as of this date.
The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the • •
property without first providing a survey less than six (6) months old. The Affiant, as property owner, further
agrees to remove or obtain permits for any structures which now may exist on the property which are not
permitted or which may violate zoning or building code regulations. The Affiant further understands that the
existence of any such structures may affect final inspections as applicable to this or other permits..
Further, Affiant sayeth naught.
Witness(sign and print)
Angela M Becker
IT My Commission DD150048
Expires November 15, 2008
is an accurate representation of the existing conditions an
. AFFIDAVIT
name of surveyo 's company)
Witness(sign and print)
ereby attest that the
SWORN TO AND SUBSCRIBED / before me this day o
Affiant is I personally known to me 1,/ produced ( v ` (�
P Y FAA �63o- y y6�S7. y�s idcntifiration.
•
•
Da 4 +a j 1 7/79' Job Address /`M/ oL/ /✓ee f /' _sr Tax Folio
Legal Description Historically Designated: Yes
Owner/Lessee / Tenant 1 °L2 r • ( I 1 -ii Master Permit # Z 3/
Owner's Address ) 4 a / )U C / O ( 57 Phone 3c "D F -
SA/c 33 /Q6
M al /� '
Contracting Co. /r» /A / /C!- C - rk4 C fa / Address 9072 7 _ /� A ✓� rv? "4'1
Qualifier At ev At/ S a& SS# - 3 arr 4 7®o7
State # Gar c 03 :S g7 / Municipal #
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
co /N./CAE
WORK DESCRIPTION 04?/ v4 • - WA cA y / 3, 1 erS .&- '7■ /- K-s' L C. 0097 0:"/
m -' y� YSfe,s/e on/ 8'2(45' TyAi pc, niriigRS d F�/Q o sy r J7 10 ,g9/e EA
Estimated Cost (value) 1 2 ? 5 0 •
Square Ft. / 8 0 0
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 -named contractor to do the work stated.
Signs e of own d/or Condo President Date
Notary as to er and/or Condo President
My CommisSivn �Y� L,. OFFICIAL NOTARY SEAL
NO R1/4 0 ZAP g / (Ja ?y NTI
.OEL
* 1't �t 0 CO NUMBER
.i4.•, Q CC797277
& MY COMMISSION EXPIRES
OF Ft DEC. 17,2002
FEES: PERMIT
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
RADON
a -I„Z S'S'
Date
No
Competency # Ins. Co. .4L e - , £c IJ/ rY
r '-if
vCJ.2'Ka
Signature of Contractor or O Builder
a jo- /
c` /W
Date
. off
z -4-9
Date
Notary as to Contractor or Owner- Builder
Mv� C�c mmission.Exgir •
O FICIPI NrifARY.SrAL 4 ��
GLAF)1 V` 3J,f: teddy..
.NOTARY .Ti�.f' •ST'ATEO'rF'LOR tJ 0 ejri y64•r"1ilato
COMMISSION SSION NO. CC't t COMMISSION eE','f 0=
MY COMMISSION EXP. MAP.. 1'! ?0:d t .. com mIssiontxp Mil
C.C.F. -- VI NOTARY �. BOND SO 0 r
TOTAL DUE 3_,(,
APPROVED: q
Zoning Building �'`F'' ` Electrical
Mechanical Plumbing Engineering
FE3- 18 -99 THU 04 :09 PM Dennis Roe 305 886 6901
NOTICE OF COMMENCEMENT
RN � ' FOLIO T NO, TAX F NO. 11 3� r? S / '/ 0,24-70
STATt OF FLORIDA:
1 COUNTY OF OADE:
THE UNDERSIGNED hereby gives notice that imps vernest, wig be made to certain real property, and in aeoordance with
Chapter 713, Florida Statutes. the batwing information Is provided M this Notice of Commencement
1. Legal description or property and street address: 14or / /A(B / 9 / S 7re t
..4• La sr. fat. .•• 4
2. Description of improvement: 2(4lH'1L yet OX/4"774* Me/144r 4P /t✓,4y t
/dVJY' / o O C. 4., V t . , r¢ YJ7'dev Aeo - pcmot7 e #
3.OtiM71e1(S) name and address: ~ f �%+. { � c *Ai 4re4 0At% ,4�N0
i J l V 3+...G. -r.
/V9-. d r— 1 4( S(
Interest in property: tr - •
Name and address ate* simple titleholder: r""
a. Contractor's name and itddress• / /Ae►Vj/ /c. C'o-v r4A C rveit .TNC.
92A7 Stet /Se ,4V , "1, 4 ' I � 04 —1319C
5. Sutey:(Payment bond required by owner from convector. 6 any)
Name and address:
Amount of bond $
6. Larder's name and address: ( .: !ti ‘L 1, c f .
7. Pennons within the State of Florida designated by Owner upon wtiom notices or other documents may be served as provided
by Section 713.13(1)(a)7., Florida Statutes,
Name and address:
8. to addition to himself, Owner designates the Mowing persons) to receive a copy of the Liana's Notice as provided in
Section 713.1S(1)(b), Florida Statutes.
Name and address:
9. Etcpiratian date of this Nodes of Commencement: (the expaaton date Is 1 year born the date of recording unless a
different date is spedfled)
taaw
Print Owners Name / I d`-1 ' ►r r? vi
Sworn to and subscribed before me this ti day of gal , t iro
Notary Public b2 r.., t
Print Notary's Name
My Commission Expires:
FLOR,OA, COUNTY OF DADE
*teem carry this war.. r,e. coo el Nw
airlift! NI in Ma plat. on
A0.0
W NESS w, 4 and o W Orttdat Seol.
r+
ic. 4I(. of Cik.kokd Coonry Co.*
D.C.
HAM
Prepared by: a ICI G
Address: 944 Su./ /4 0 Ave
M «„ FL 33/7$
50D
5011
CONCRETE
EDGE
RESTRAINT
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PAVER PL'i'(
Scale: 1"
2 3B" THICK BRICK PAVER
i YP i C•91_ sE c rI o.
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4 .4 5
35.00
,.$5'
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2o. co
2.3 .
FINISH GRADE
1" SAND BED
.� // LIMERO(K BASE
— (COMPACTED TO
95% DENSIII' )
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PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
Job Address �14Z/ 7 /
Legal Description 3 S 12 ,'
Owner / Lessee / Tenant Afrs 0 S, , v,
Owner's Address / ` ! e (7 I
Tax Folio!) ,3o/D$' I/ P49 e
Master Permit # 3c1/a
phone 7 Sr - oa-P.6t=
Lontracting Co. /I-r�f1 7 0 440..47 L . Address 7� S c7 M Ct,) . drl
ad N2 4_0_4;
Qualifier
State# Competency# ,.1 OW 4 (/W 1
44 Architect /Engineer 7 42e; Address c7a4e--
Bonding Company Address
Mortgagor ' Address
Permit Type (circle one): ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
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WJORK DESCRIPTION 6.26.1X
Square Ft.
phone /3P"
Ins. Co.
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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. 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.
-- Otit'iEk'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 ts-do the work stated.
Furthermore,
Signature cf
Date:
Notary as to Owner and /or Condo President
My Commission Expires : Notary Public, State of Florida at Large
* My commission Expi May 26, g
ONDEO T U HUCKIERRY, SIBLFY
8 HA RVEY INSURANCE & BOND ,11NC.
PERMIT FEE: APPROVED: mire
er and /or Condo President
ignatu
Date:
ontractor or Owner- Builder
Notary as to Contract or_� r
a Bui1 eer,
Notary mom, stats of M onde at Large
My Commission Expires : My Commis ion Expire May 26, 19g6
* * * BONDED T)*U HUCKLEBERRY, SIBLEY
8 HARVEY INSURANCE 8 BONDS, INC.
Other
`7 Zoning Building �) / / Electrical
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Mechanical Plumbing Engineering
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FIRE DEPARTMENT
PUBLIC WORt(S
PO! ICE DEPARTMENT
BUILDING DIRECTOR
PLANNING & ZONING BOiiW
VILLAGE COUNCIL
APPROVAL
PRELIMINARY_ FINALo
COMPLIANCE WITH THE SOUTH FLORIDA BUILDING CODE AS ADOPTED
BY MIAMI SHORES VILLAGE IS REQUIRED. THE ARCHITECT, BUILDER &
;ING R GULAT ONS OR NOT SPECIFICAL INDICATED HEREIN.
N.
THESE PLANS ARE APPROVED FOR ISSUANCE OF A BUILDING PERMIT
❑ WITH NO VARIANCES ❑ WITH VARIANCE(S) LISTED IN "REMARKS"
NO OTHER DEVIATIO 'S FROM THE MIAMI SHORES BUILDING AND ZONING
ORDiNANCES WILL BE PERMITTED, UNLESS SPECIFICALLY LISTED BELOW.
AU. OTHER APP' ICAW.E STATE AND COUNTY LAWS MUST BE COMPLIED
WITH BY ALL PARTIES.
Authorized Signature Date