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145 NE 101 StMIAMI SHORES VILLAGE BUILDING DEPARTMENT 305 - 795 -2204 Building Inspection R equ Dat 7 Time Type Insp'n Permit No. Name Address Co Phone # For Iispector.7 Approved Correction Re- Insp'n Fee Type Insp'n Correction MIAMI SHORES VILLAGE BUILDING DEPARTM 305- 795 -2204 B + illding Inspection Reque .t Date/ ( Time Permit No. P t c)J 1 Name Address J `- o 1 s Company b Q Re- Insp'n Fee In raid P Phone # i For Inspector: P 1 I I T._ Name & Date Approved ❑ ;/1 L�� /(-/i 305- 795 -2204 Building Inspection Request Date ‘\ bime Type Insp'n Permit For Inspector: Approved Correction Re-Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT o Name Address 1"45 - < . <L. \O\ )\-- Company , C � f Phone # ^cSV i 2c 0 Date Type Insp'n Permit No. Name Address Company Phone # MIAMI SHORES VILLAGE BUILDING DEPARTME 305- 795 -2204 Building Inspection Request For Inspe � tor: Approv i Correcti Re- Insp'n Fee Time Date a 0 Time Type Insp 'nn Permit N Name Address l S' l t D f J 1 Compan Phone # (7 For Inspector:) Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMEN 305- 795 -2204 Buildin Inspection Requ. t � � MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date t 0 U Time Type Insp'n 9 CCI &O( ;66% 1- fon For Inspector: Approved Correction Re- Insp'n Fee Permit No P 1 0003 1 ) 3 Name Pe Address 45 NE, V) 1 S 4- Company Phone # Name & Date �Z) do lam /0r3 �- Axad,5 ku2- /%440&( thiats /3r,1w b • MIAMI SHORES VIL BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date )2,3 10_) Time Type Insp'n Permit No. Z b 0 Name Address Company Phone # tS \\,� 3 n`Cr), For r_____._i' l ) • - Name & Date • 2 . Approved Correction Re- Insp'n Fee 2 • CONTRACTOR(,' Name p. 1. o -,°OYIS � 1C . License No. ape O S-c a -70(1 Address 74 Li g M. w, g S- }✓,e�� _ a,ry -, . `F X312 (o V� I c 9 `,� r e Telephone( ) .ze gc', ? Fax/ 3�)) �[[ 1 1 n Qualifier Name 60(q -e_ L. i G 11 (91. PROPERTY OWNER New Construction Name RJ° O Pev Enclosure Address y NE lot S4" YYI►UVV Slr,c e5 / -) - 3i Home Telephone ( ) c y .azoo _fl I Business Telephone Alteration Interior Fax Demolish 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. JUL 1 2003 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: 1 "1 S ME E 0 1 ' • 1 1 ayy-) i V \C-w 13 l5 Apt. City State Zip Description of Work 00 I Address Folio Number Lot 2-0 t1 t I Block `f SubdivisionWarn - )Inoref PB IO PG '7D Current Use of Property 'D- Proposed Use of Property Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax MO ?c Go cops d $0454 PERMIT APPLICATION Master Permit No. SP 2,003 -- 4S Subsidiary Permit No. Linear Feet Zoning Square Feet Units Floors oa Value of Work Soo Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax Page 2 IMPORTANT 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 PROTEC"IbD 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 Signa Print • me Sworn to and subscribed before me this 7 ;) day of 2f:263 . Signature of Notary Public ta a SEAL: Personally known NOTARY PUBLIC STATE OF FLORIDA TY OF MIAMI -DADE nda OR, Produced Identification ELENA MEDINA COMMISSION 00024189 EXPIRES MAY 09 2005 BONDED THROUGH ADVANTAGE NOTARY Type of Identification Produced: PERMIT APPLICATION Signature of Contract. / Qualifier ( DY9 L- \i0. \ac .00r f Print Name Sworn to and subscribed before me this Z) day of _ JO v X03 NOTARY PUBLIC STATE OF FLORIDA • • • • • • • A-aikil . A A'A , S 'rVA' e• • • cr • a • • A 4 4 4 4 4 4 4 tateo I , A MEDINA COMMISSION DD024189 EXPIRES MAY 09 2005 ONDED THROUGH qt. ADVANTAGE NOTARY Signature of Nota SEAL: Personally known OR, Produced Identification Type of Identification Produced: ELECTRICAL TYPE Minimum Fee QTY. TYI'E Dryer QTY. TYPE Outlet, Appliance QTY. '1'1'1'1: Service Repair QTV' 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. TYI'I Generator QTY. TYPE Refrigeration, Tons QTY. A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost A/C WaliWin. 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 Q'I'V'. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace ping / Sprinkler Repair Cap - Fixture Fountain ump and Bandon 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: 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 ( x .60) x/1000 $ (¢.005 /sq.ft.) $ (¢.O1 /sq.ft.) ISSUING OFFICIAL REVIEWED AND PREPARED BY: SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE r PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2"° AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com CONTRACTOR New Construction � ^ Name S4e1/ ref", , , G a Enclosure License No. C c G .0 yz Q 7 Alteration Exterior Address 8/Sf N. 6,0 1/Z 4 4,09 Vet,- Fe x3053/ Repair Telephone 7 8G_ 29 49/ 7O Fax 69Y —,517 ?3 6 /4, 14 ,1/ Qualifier Name Q � /� y ,A 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 ••• • _ : • ;' • • • • • • • • .•• • • • • ••• se e •• • • • • • • • • • • • . • •• • • • . •• PERMIT APPLICATION • ••• • ;vtastti Permit No. OP 1003 — 3 s' / StAsi iary Permit No. p D3 - �( INSTRUCTIONS - The following steps must be taken to obtain c peralit from the Miami Shores Village: Step 1. • • • • :. • • •• •. Complete the attached permit application whicitfhtstbe Signed b the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate peacessir df ySur •applie atibn.'1t 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 Job Address: 5-3 /r' l Folio Number Lot Block Subdivision PB PG Current Use of Property Proposed Use of Property Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Address Apt. PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax PROPERTY OWNER Name Address e, a Ad Home Telephone Business Telephone Fax /44m, City Description of Work State Zip re i " w e 4! - 'ys/e/v Zoning Linear Feet ZOO r Square Feet Units Floors Value of Work / ,2 a !) Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax • •• • Page 2 ••• • • •. • .. •• • • • • ••• • • • PERMIT APPLICATION IMPORTANT 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 b e conducted on weekends or hali?l ys! •. •. • • 2. All construction of demolition areas MUST BE MAINTAINED 114 • A CLEAIN:NCAVAI:ID6A1IlfitlY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEP.T.FREFFFI EDR' Aa1D,13411RIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY M1TIPMENT OR VV`H;CL 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 FLORID Signature of Owner Y OF MIAMI -DADE Print Name Sworn to and subscribed before me this day of Signature of Notary Public - State of Florida SEAL: Type of Identification Produced: OF FLO • IDA, 1 : r Y OF MIAMI -DADE ature o alifier k kt gim/� h'e of Print Name �����' osalie D @M ' i . Swom to " fo r fi E�is day of71 1,1 "eI , � 9 • • � >trn: • Signatut/ Alotar lkPPStat rida SEAL: / / ,�4/ 11111 i 6` `\\`` % Personally known OR, Produced Identification Personally known OR, Produced Identification Type of Identification Produced: Printed: 3/11/2003 Applicant: 11 Owner: - -BROWN JOB ADDRESS: 53 Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Contractor SHEAR SERVICES INC Local Phone: ..>` Signed: NE 101 Parcel # 1132060131530 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 18 & E1/2 LOT 17 BLK 11 LOT SIZE P -(A-Z)b 1 S D, o c. r Permit Status: APPROVED Permit Expiration: Work: RE PIPE WATER SYSTEM 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 nan ' ordinances pertaining thereto and with the understandinc and approved by the proper municipal authorities. This F authorization. A further condition upon which this permit ordinances and regulations p rtaining to the work covere by his agents, servants • er4tpl., ees. Signed: r A // W IF fr y- In considerati• • : issuance to me of this permit, I with the plans, drawings,atements or specifications sut myself, my agent, serva t or employes. Plumbing Permit Permit Number: PL2003 -69 8/4/2003 RICHARD J CACCAMISE Pay to the 0414 ; s a �) order of avelltime For WACHOVIA ACH RT 067006432 -DROWN' Ki-lRY -N ST Contractor's Address: 11767 SOUTH DIXIE #187 Construction Value: $1,200.00 1 ,31/ Page 1 of 1 t . Total Fees: $0:1 3E/- Total Receipts: $0.00 Date 1051 63- 643/870 BRANCH 09066 Dollars U ance with all submitted to vithout ledge of the / for work done Q oordorma by ears ELECTRICAL TYPE, Minimum Fee QTY. TYPE Dryer • • • • • Q'1 Y, TYPE Outlet, Appliance QTY. TYPI: Service Repair QTY. A/C Central 1 -3 Ton Fan Dryer Vents, Number of Outlet, Wall Ventilation, Cost Service, Temporary Air Handler, Tons A/C Central 4 -7 Ton Piping, Flammable Liquid Fire Pump Outlet, Switch Fire Sprinkler System Signs A/C Central 8 -15 Ton Bath Fan - Vented, # Fixture - Fluorescent Pressure Vessel 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 Solar Water Heater Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Cap - Fixture Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Pump and Abandon 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 / 1/ Drains, French Miscellaneous Equipment Sink Well, Supply ••• ••• ••• • •• Page 3 • • • • • • • • • • • • •• • • • • • • ••• • ••• • ••• • • • •s• • • • • • • • • •• PERMIT APPLICATION INSTRUCTIONS: Please indicate the typl'.df work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: SECTION BY DATE Zoning Electrical Mechanical Plumbing 7-/3 03 Fire Public Works Structural Building Official Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (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 ••• • ❑ PROOF Q1 OWNERSHIP (Attach). " • • ❑ HRS / DERVI'aPPROVA1. (Septic /Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) ISSUING OFFICIAL REVIEWED AND PREPARED BY: • •• • . •• ••• • • • • ••• . ••. • • • • ••• • • • • • ••• . • • • • • • • • •. • (sq.ft. = x/1000 x ¢.60) (¢.005 / sq.ft.) (¢.01 /sq.ft.) • • • PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) . • • : ••: • :. .' • 0 BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2"° AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com permit No Application is hereby made for the approval of the detailed statement of the plans and specifications herewith sub 'tied 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, whethe{j herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner f� s Name and Address A 4 144-- Registered Architect and /or Engineer - ..._ . Employing Plumber's Name f� /Jl�sl# t SClL.$ -E—g Location and Legal Description Lot Amount of Permit $ STATE OF FLORIDA, 1 u. COUNTY OF DADE. 1 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Bkm� Street and Number where work is to be performed —No Street. State work to be performed and purpose of building (By Floors) New Building..__._ _ _.._..........._.. Remodeling____....... -. ___.__ Addition. (Signed) ■ No fi/S 12E Street ..JJ2 5 Size Septic Tank_ Type of Tank__ Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well .__.___ Nature of Water Supply: City—Well. Size of Soakage Pit- Ana 7--4l� fm. k u, (Signed) - -SL Date. Subdivldon My Commission Expires Notary Public, State of Florida 7 / �Y Repairs.....,... No. of Stories. ........ Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent Supplement, and hav com- plied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by him in the worse Co 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 sub-contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclaowledgments, personally appeared to me well known, and who, being by me first duly swan, upon oath deposes and says that he is the --- .-------- - -. - -. - - ...._. _ -- of the above described construction, that be has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. NOTE: A re inspection fee of $1.00 win be made whin snob rwiiupeotfon is mede•neosssery by improper notice for inspection, or faulty materials and/or workmanship. CLOSITS BATH Tu•• SHOWERS LAVA. TORIES SINKS $LOP SINKS LAUNDRY Tugs URINALS CATCH BASIN FLOOR DRAIN DRINKI NO FOUNT 'NS TI OTAL FIXTURES CoNTR. LIST _ CHECK SEPTIC TANK SEWER 'CONN. DRAIN FIELD SOAKAOI PIT G TRAP SOLAR HEATER DEEP WELL 8 . 8 SW NC POOL COMM LIST CHECK permit No Application is hereby made for the approval of the detailed statement of the plans and specifications herewith sub 'tied for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whethe{j herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner f� s Name and Address A 4 144-- Registered Architect and /or Engineer - ..._ . Employing Plumber's Name f� /Jl�sl# t SClL.$ -E—g Location and Legal Description Lot Amount of Permit $ STATE OF FLORIDA, 1 u. COUNTY OF DADE. 1 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Bkm� Street and Number where work is to be performed —No Street. State work to be performed and purpose of building (By Floors) New Building..__._ _ _.._..........._.. Remodeling____....... -. ___.__ Addition. (Signed) ■ No fi/S 12E Street ..JJ2 5 Size Septic Tank_ Type of Tank__ Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well .__.___ Nature of Water Supply: City—Well. Size of Soakage Pit- Ana 7--4l� fm. k u, (Signed) - -SL Date. Subdivldon My Commission Expires Notary Public, State of Florida 7 / �Y Repairs.....,... No. of Stories. ........ Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent Supplement, and hav com- plied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by him in the worse Co 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 sub-contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclaowledgments, personally appeared to me well known, and who, being by me first duly swan, upon oath deposes and says that he is the --- .-------- - -. - -. - - ...._. _ -- of the above described construction, that be has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. NOTE: A re inspection fee of $1.00 win be made whin snob rwiiupeotfon is mede•neosssery by improper notice for inspection, or faulty materials and/or workmanship. /1 3 )-co 6 )3 E-77 Date_ _ _ 7 - I ) / 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 work. Permit No. 1.1 Owner's Name and Address___ STATE OF FLORIDA, 1 COUNTY OF DADE. I ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 117A7/ N �j 3 Registered Architect and /or Engineer _ Employing Plumber's Naive _Lev �' _ e No N+ Street _1' . Location and Legal Description Lot Block___ Subdivision Street and Number where work is to be performed —No Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories (Signed) Size Septic Tank Type of Tank Capacity Gals Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well Size of Soakage Pit Amount of Permit $ ___________________ (Signed) Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts, his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida' Permanent Supplement, and has corn - plied 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 sub- contractors, on work to be performed under this •: permit, as" are licensed by Miami Shores Village. Before nee, 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 foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida Street 1. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS • BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT•NS TOTAL FIXTURES CONTR. / / CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'S POOL CONTR. LIST CHECK Date_ _ _ 7 - I ) / 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 work. Permit No. 1.1 Owner's Name and Address___ STATE OF FLORIDA, 1 COUNTY OF DADE. I ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 117A7/ N �j 3 Registered Architect and /or Engineer _ Employing Plumber's Naive _Lev �' _ e No N+ Street _1' . Location and Legal Description Lot Block___ Subdivision Street and Number where work is to be performed —No Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories (Signed) Size Septic Tank Type of Tank Capacity Gals Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well Size of Soakage Pit Amount of Permit $ ___________________ (Signed) Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts, his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida' Permanent Supplement, and has corn - plied 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 sub- contractors, on work to be performed under this •: permit, as" are licensed by Miami Shores Village. Before nee, 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 foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida Street 1. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. �p AP LICATION FOR PLUMBING PERMIT Permit No. r Date Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submityd for d!he' 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 work. Owner's Name and Address Registered Architect and /or Engineer Employing Plumber's Name _____ 1 � Location and Legal Description Lot_____— Street and Number where work is to be performed —No MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT _a t _ ---- No. _ Block Stree4 No Subdivision — . 4 7 Street / 4/ State work to be performed and purpose of building (By Floors) New Building___— _— ______ Remodeling —_ Addition Repairs No. of Stories Size Septic Tank Feet of Drain Tile____— _— _.____________ —_ —__ Dist. Feet of Tank or Drain Field from Well Nature of Water Amount of Permit $ STATE OF FLORIDA, COUNTY OF DADE. ss. y —Well My Commission Expires Type of Tank ize Soakage Pit "3 77 - - (Signed) Capacity Plumbing Ins tor. The undersigned applicant for this building permit does hereby certify that JSE understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. 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 foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Notary Public. State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR H EATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST CHECK �p AP LICATION FOR PLUMBING PERMIT Permit No. r Date Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submityd for d!he' 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 work. Owner's Name and Address Registered Architect and /or Engineer Employing Plumber's Name _____ 1 � Location and Legal Description Lot_____— Street and Number where work is to be performed —No MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT _a t _ ---- No. _ Block Stree4 No Subdivision — . 4 7 Street / 4/ State work to be performed and purpose of building (By Floors) New Building___— _— ______ Remodeling —_ Addition Repairs No. of Stories Size Septic Tank Feet of Drain Tile____— _— _.____________ —_ —__ Dist. Feet of Tank or Drain Field from Well Nature of Water Amount of Permit $ STATE OF FLORIDA, COUNTY OF DADE. ss. y —Well My Commission Expires Type of Tank ize Soakage Pit "3 77 - - (Signed) Capacity Plumbing Ins tor. The undersigned applicant for this building permit does hereby certify that JSE understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. 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 foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Notary Public. State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. DATE lI /��3 ( ISSUED TO FIXTURES FIXTURES SEWER VILLAGE PLUMBING INSPECTOR MIAMI SHORES VILLAGE TOTAL PLUMBING PERMIT $ 7 $ I ,Y SEPTIC TANK BY 4 , NO. 634 to install the following described plumbing, in accordance with the laws, statutes and regulations of Miami Shores Village, Florida and the State of Florida, governing plumbing and drain- age work done in Miami Shores Village, Florida, FOR A J STORY A BUILDING AT /4 2 y?2 �% / BUILDING ELECTRICAL PLUMBING PERMIT N9 2010 Work to be performed under this Permit Owner of Building `' . Architect Contractor or Builder Legal Lot ) Bl. Description ) Address of Building MIAMI SHORES VILLAGE, FLORIDA DATE 194 Subdi- vision Value of Project Contractor's License No. Amt. of Permit 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 drawingi L• the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. : Signed • a' f By INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regula- tions 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 responsibility for all work done by either myself, my agent, servant or employee. CONRACTOi OR BUILDER BY AUTHORITY JOB: 1� 11 AD / . / / j '2 / BUILDING ELECTRICAL : PLUMBING Inspector's Report: • • .4 • The following is ready for Inspection: • WORK : DONE BY: : REQUESTED • • . . • • • : i n „ . r • • WILL BE READY L r s /" • DATE ISSUED TO SEPTIC TANK r. TOTAL $ VILLAGE PLUMBING INSPECTOR 1',t IAMI SHORES VILLAGE PLUMBING 11 FOR A STORY BUILDING AT FIXTURES FIXTURES SEWER PERMIT NO. 634 to install the following described plumbing, in accordance with the laws, statutes and regulations of Miami Shores Village, Florida and the State of Florida, governing plumbing and drain- age work done in Miami Shores Village, Florida.