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1470 NE 101 St (5)Date O "013 - 0 Job Address /'/7o K ter 5fieFr /-01 10 B -ocK : I 5VADNI5im Legal Description Owner / Lessee / Tenant /4 r Crt/wE 6/14/ Owner's Address /q70 p NE /0/ .92155— �� Contracting Co. (16. A IGK f)31,061‹ 51.57E46,27 Address 9 Qualifier V E5 bows) ss# - State # 3g5 Municipal 1# Competency # PAW WORK DESCRIPTION ige/ Pjeg. 3) g., - JA'/ Square Ft. /,333 WARNING TO OWNER: YOU MUST RECORD A NOTICE OFI SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVE) TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER NOTICE OF COMMENCEMENT). Application is hereby made to obtain a permit to do w on the attached addendum (if applicable). I certify standards of all laws regulating construction in thi permits are required for ELECTRICAL, PLUMBING, SIGNS,' OWNER'S AFFIDAVIT: I certify that all the foregoing i be done in compliance h 1 applicable laws regula/ authorize the abov ontractor to do the work Signature o Date: 6 Notary;f' •' er and /or Condo President My C • Expires �� Jeffrey C. Abbott u. ,-Commission # CC 739016 I ca ^` a Expires May 3, 2002 CV BONDEDTHRU -c0 n '. TI .. ' ' onuniyG Ct' INC. I FEES: PERMIT RADON C.C.F.I Fire i =Buildinl Mechanical Plumbil I i APPROVED: PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Zonin or Condo President Oi% ASPN{FL .W— Vpwl Estimatl Tax Folio /I -32 a-5'M-eta /14A-R Csrkre5- Master Permit # C173 Phone 05, 75Y- - 7V V a /t 57A7t /Ali 7 PlA1 4fau,Ft!. 333 t7 Q 40107 Phone Ins .Co. Acc0, Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING VI PENCE SIGN Date Type Insp'n Permit No. Name Address Compan Phone # For Inspector: Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 30 5 - 795 -2204 Building Inspection Request 0 - Time ci NOTICE OF COMMENCEMENT 018478298 2001 AUG 31 10:25 PERMIT NUMBER: TAX Foi o NUMBER: J 3 � 06.-- — O� " - loco STATE OF FLORIDA COUNTY OF DADE THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information in provided In this Notice of Commencement. Legal description of property and street address: La.: 1ti BLocK : I 41 /P/A1z 6 T5 Iq7d NE /01 7" A4r40/1 s f[. ?3i3 Description of improvement Akio✓4tt, or exIST7N6 /f5 //f1#GT p /L w4y Anib /NsTMGL4Tia N OF McK P4v'Ele5 / Owner(s) name and address: 5TeMeN GyNDE KAHN iH70 NE i f 5r� Mi4Ml Sito1Es, F- 333 Interest in property. 5 141 1LN Name and address of fee simple titleholder. Contractor's name and address: v 5, ki ck &rrocK Sys ritrs / ZNc . Qy/ /11 SINE h 7 ii>t. ,r� -ra„) / A- 333 i7 Surety. (Payment bond required by owner from contractor, if an Name and address: Amount of bond: S Lender's name and address: ai a.f uaan Persons within the state of Florida designed by OwneP • • ' om no 'ices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name and address: In addition to himself Owner designates the following person(s) to receive a copy of a Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes, Name and address: Expiration date of this Notice of Commencement (the expiration date is one (1) year from the date of recording unless a different date i ' •) SIGNATURE OF OWNER Print Owner's Name: 5 W /V 6tMN Swom to and subscribed before me on this 426 day of these , 1.1 01. Personally Known, or t -" Produced ID Oath taken, "V Oath not taken T Prepared by: d$ ACK Utocrc 57SreMST� Address: 9y/ /U. 572-1E• betv9 7 /7 Notary Public: 7C -r iL III Tf Print Notary's Na'' " Commission Ex r . F C - boo dnmiss xp res May 3, 2002 739015 BONDED C‘• BONDING CO.. ING . 1 PERMIT NO. ADDRESS: . MIAMI SHORES VILLAGE BUILDING / ZONING DEPARTMENT' SECTION BY DATE ZONING ELECTRICAL MECHANICAL ' JOB ADDRESS APPLICANT PHONE # APPLICATION (# SHEET OF MISCELLANEOUS / v C T 44 - e.e, P/v/ ,4•0 /-tm) ("?; 14° 31) 7 CRITIQUE SHEET PLUMBING FIRE PUBLIC WORKS STRUCTURAL BUILDING OFFICIAL 1. Sub4act to com pilana with elt Federal. State. County.Ydlage rues t!;d r egutatSons. Yttlage ESSUOtell no responstbtltty tor accuracy of /or resutts (roar these plans, 2. This copy of plans must be ivttitbie on buHding site or no inspection vdtl be conducted COMMENTS INITIALS STATE OF FLORIDA) COUNTY OF DADE) . / The undersigned Affiant, 5/00/ � N , does hereby attest that the ''AA (properr � t owner) attached survey, performed by n 1A , ,/II L lVTh5/f 7455ocom5 � ZNc performed on (name of surveyor's company) 7 is an accurate representation of the existing conditions and (date of s . vey) Further, Affiant sayeth naught. Affi. • ' o f :� 04/ Uswi 7 itn � . and print) t :( sign and pr'. 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.. SWORN TO AND SUBSCRIBED before me this ,?O day of s2C0 Affiant is personally known to me, L / produced 'Ave* Lie& C as identification. / P TV Pv Jeffrey C. Abbott s E p es May 3, 2002 BONDEDTHRU OF C• ATLANTIC BONDING CO.. INC. STATE OF FLORIDA ) SS. COUNTY OF MIAMI DADE ) STATE OF FLORIDA ) ) SS. COUNTY OF MIAMI DADE ) Signature of Acknowledger: (ACKNOWLEDGEMENT-INDIVIDUAL) The foregoing instrument was acknowledged before me on '46,5r az 7/ by /(Attic/ , who is personally known to me or who has produced /GYc/(/S as identification and who did (did not) take an oath. Name of Acknowledger: S-reioNEN , k,M ) ��11 (Typed, Printed, or Stamped) Title or Rank AMeoiaiv Serial No .(if any): (ACKNOWLEDGEMENT - CORPORATION) The foregoing instrument was acknowledged before me on by , of a corporation, on behalf of the corporation. He/She is is personally known to me or has produced as identification and did (did not) take an oath. Signature of Acknowledger: Name of Acknowledger: (Typed, Printed, or Stamped) Title or Rank Serial No.(if any): C horeJ leaf i 10050 N.E. SECOND AVE MIAMI SHORES. FLORIDA 33138-2382 Telephone: (305) 795 -2207 Fax (305) -8972 COVENANT Of CONS' RUgTION WITHIN RIGHT OF WAY WHEREAS, STS &cN A- A) (owner) fdllowing described property: Legal description /folio #: /1 3aos-oa y - oxpD , Lot /0 Biock_ / , Subdivision Tax Folio #: /1 - 3?0 S — gay — 0-160 ! hereinafter referred to as the Owner of the y � EsTATE s r6uests permissior to install: X Asphal concrete. brick pavers () Landscaping [ ] Other t�r7 within the public road right of way of /4 <d / _ 0( r/ (address) IN CONSIDERATION of the approval of this permit by the Village, the Owner agrees as follows: To maintain and repair, when necessary, tlhe attve- mentioned item(s) installed within the dedicated right of way. It it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said items within public right of way includinglrestbration of street by reason of the Owner's failure to do so, such expense shall be paid by the Owner Or siren constitute a lien against the above described property until paid.. 3. The owner does hereby agree to indemnif and hold Miami Shores Village or dade County harmless from any and at liability, which may rise by virtue or permitting the installation of these items within the public right of wily. 3. The Owner does hereby agree to remove dr rel +sate their facilities at their own expense, within 60 days notice by the Village to do so. Failure to comp with this notice will result in the Village causing the item(s) to tin removed and a lien being plated DA the property and/or assessed against the Owner for all costs incuiired in the removal and disposal of tF a item(s). 4. The urderOgned further agrees that these t:ondhions shall be deemed a covenant running with ttie land and shall kernain in MI force and effect and be bin4ing on the undersigned, their heirs and assigns, until such time as th obligation has been canceled by an affidavit filed in the Public records of Dade County, Florida by the Viiige Manager of Miami Shores Villa ,e (or his fully authorized representative). SIGNED, SEALE1j, EXECUTED AND ACKNOVI EVGE on this -X day . UNE / a SIGNED. SEALED AND DELIVERED in the pYesence$ of: Jeff rey C. Abbott ce, Commission # CC 739016 • Expires May 3, 2002 BONDEDTHRU 4'0F ATLANTIC BONDING CO.. INC. • • 0•14 ti' i J. • it i ii 11/,65• Zoning . I i . * Cif .6'.: t.. Fr! tr CG • '12.22' • . 3/, :30 • EC. • 16.2 ° nutiP Room • tv • 36.51)• C , 8 . . . QE5. l /47 0 FL. ,cr't..sr ,- ,,. I.) to ` 0 ?,33 •.0 `� 1 `. 3 � O '�"' �'� ) t . �l • 22.3., ' . i i r I 4E CG: .._ !n� P•,: fl 5, 4V. •• 26 3' • ` r r o - aac4 t - 4 2.f•C0'IVC,. CAP. ..l3UigHEAD FENCE ,. LO,`!G .5E4 - )tif/a L 02 °20..04" .:4.105.1 _ CN.I05.85 8.15.CAYAIE BAY • 20.5 S. 2'0' •, i i s % • 1/ 1r juo cra TA) >.1 0.10'CL. p. a.. 26734 0 Side Setback 12' Street Circular driveway tCULAR DRIVE (Front) • \ ermined as required or additional spaces lust meet setback (10'sidcyard) 'annot impact or cause existing tree removal r damage (must bc outside dripline) 'aving cannot exceed 50 %, of arca (frontage) 3f yard space: 12' utas. ,width /lust bc approved by P&Z Director 'ERMIT REQUIREMENTS: .Completed permit application . Two topics of complete survey dated 11l1in the last 6 months (affidavit :quircd for surveys over 6 months old) . Two sketches of the proposed work towing all ditriensions(Icnglh. width. etc.) Liitslcd paving on the right of way(swale) taw be approved depending on location frees and drive %'av approaches Maierxls to bc used: concrete. asphalt. r uttcrlockine t,a,vrc 12' \ ■ 12=' \ Double driveway 5' 18' Street Swale M TRIANGLE OF VISIBILITY: All driveway /roadway entrances and exits shall be constructed so that vehicles may enter and exit without posing danger to occupants, pedestrians, or other vehicles. Structures and landscaping shall not obscure vision above 2.5' within the triangle commencing at the point of intersection of the driveway and sidewalk/right -of -way for a distance of 10' along the driveway and 10' aloft!! the right -nf wav RESIDENTIAL DRIVEWAY AN PARKIENG STANDARDS MAY 2001 PROPERTY LINES Sidewalk �. . 15' STREET TREES (12' High) ,5'' Side Setback Concrete ribbons CIRCULAR DRIVE (swalc) 1. Permitted as additional parking to spaccs on property (must have 2 existing parking spaccs on property) 2. Must meet required setback 5'(swale) 3. Paving cannot exceed 50% of arca (frontage) where located: 10' max. width 4. Cannot impact exist. trees under drip lint (two street trccs 12' high required on swalc) 5. Most bc approved by P&Z Director i , * . . .. ...., . . ... • ..,". 4.-..;•.•..".4.'7.!•-;..v, . ,..' •• • • •••:": 1 '; , '"'''''. ,4 , 11‘, , ' -;.;' .., ....;. , . 07, ., _ . . _.1...............s. ......:,.......... I • ..- !1:' ''') ...7., •.. .. . . ... . ■ . - ...- • 1. ,... ,• - f: . e 4:-..T.-..... 7.1`. h. ,:. 7 7. 1/4,,). l• - • " ,, . , ' ,... ''.... ,..., .,.",.......' : :. ..' ':. .4 • ,,....., • .: VV ■•• ''. , .6 .. 0 9 ., • •„• • 1 • . . . . .' • " '"' :• .''''.; --4-••• . ,...,), :•, it , i, . 1 ,.;.„,, . ..., .,.,,... . . . e • • • • ' • • • ; • ' 4 • • . ' •B • ! .• .. • • .. ' 1.11 ; .• • POI. e 3 • 1 /2'Pito-.5 ..Ap.proveiri lc); \ ; ELEC. —..- r.) 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ADDRESS: . MIAMI SHORES VILLAGE 1UILDING / ZONING DEPARTMENT' SECTION BY DATE ZONING • _ ELECTRICAL MECHANICAL PLUMBING FIRE PUBLIC WORKS STRUCTURAL BUILDING OFFICIAL 1. Subject to compliance with ett Federal. State, County.YWlage Autos t':<1 regulations. Willie asses no responstbplty for accurecy otlor results fresa these plans, 2. This copy of pleas must be %Ytlltb!. ea building site or no inspection will be conducted. JOB ADDRESS / / 7o If.-c-',/o/ S APPLICANT /1 /L' CRITIQUE SHEET PHONE I# APPUCATION 6 ¢L�C w / &U C� SHEET . OF e,/e4 ji%1 MISCELLANEOUS o / 5 oociNRL I ND tC1lt_D s CE iD 66 CA • } .Co /(Ca O 0101H OF 7 N E W :L . LOCH 35 GATE U N I N y • 1Y/ / / COMMENTS INITIALS w wf4c /(_.L �v����� y � zy<< !.� K 6wl y cy ,v d E 't % l_� oZ / culla 6 Dec C.C. c 0A/s7 u r -- 1� D EcK (.) c Ls i v? cc.v J E73 w rile= sE725/94 . 5f tom/ Ls't/ TIf w/ 277 o i*a 1 &G-4 , - 141 Co t1L/ 7? , t &-� , • Lcv / t 7 7 5 1 - / 2s F �� �!� s 6cc� ? P� I, Afed,d97 4,07 BUILDING AND ZONING DEPARTMENT 10050 N.E. SECOND AVENUE MIAMI SHORES, FLORIOA 33138-2382 TELEPHONE (305) 795.2204. • FAX (305) 758.8972 RECEIPT contractor /owner, picked up 2 sets of plans for (address) 0 `► d � , i • m the Building and Zoning Department on (date) to have corrections done to plans and/or get County stamps. I understand that the plans need to be brought back to Miami Shores Building and Zoning to continue the permitting process. PERMIT NO. . ADDRESS: . MIAMI SHORES VILLAGE lUILDING / ZONING DEPARTMENT" SECTION BY DATE ZONING ` : ELECTRICAL MECHANICAL PLUMBING FIRE PUBLIC WORKS STRUCTURAL BUILDING OFFICIAL 1. Subject to compliance with ad Federal, State, County. Vutage Lutes and regulations. Wage assumes no responstbNity for accurecy odor resutts koca these plans. 2. This copy of plans must be iyatlabte on budding site or no (nspectlon Mil be conducted. APPLICANT k 41 A) DATE • JOB ADDRESS / / 70 Xi. C . / 0� S 7. CRITIQUE SHEET PHONE t# APPLICATION ) LK W / / to CK o7dm a SHEET . OF 0/0601//2g MISCELLANEOUS / UNIN( • „ 07 COMMENTS (A/ 6t//46 L -'/ C.14,./ - f des Gc, i-L,K r/i' cil /v it e </ ,0 4-74; co/vs-vlu re ecic w 6 Ls Aid r / -C,t_e_p w -"- 5ijo .i 4_,t7/ rt./ (/,07Y i*e,raos(Tv ®� C , 5/47 c / / [ /`c C- /Nil / 7 aiveg7< INITIALS CONTRACTOR Name t C r 1 S A I . , _ / t _ C � , n • License No. ©S eQ� Y , `— C � O Addr 1 ►v� (7 j ewa,e-e N .1i -tA ctA.A.t,‘ ' vi, Te S ta q2 / O7 Fax l 1 z 2379 Qualifier N >f.T m , , A ^_ rr r -1 Fn PROPERTY OWNER Name S k 2 _ I Q _ _ L,1_ ( , 1 Name ► e .l G � 1" _ _ Lds Address J o 11/41; ►01 SIR.. ItA aktv:, c,u.9 -re Home Telephone Business Telephone Fax TYPE OF MANAGEMENT (✓ ) New Construction ✓ Enclosure Alteration Exterior V 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 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 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. APPLICATION Job Address: 14‘10 Address PERMIT TYPE (✓ )) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other N6 in Apt. D - 4 00(o Folio Number Lot Subdivisio Current Use of Property Proposed Use of Property Tenant Information PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Master Permit No. Subsidiary Permit No. SO Lip City Description of Work State PERMIT APPLICATION Zip CI05►fri9 }eA.1OV C Q q.U.tvt - ,, e C1JS Zoning cc��,,,,,, Linear Feet Square Feet 4 YO x • nr O Units Floors Value of Worl e ', ' C 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 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 F orida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. ST IP OF FLORIDA, CO ►II Y OF MIAMI -DADE Signature of Owner Signa ur o I Contractor / Qualifier rrePq &U / Print Name n Print Name Sgm o to and subscribed before me this �` 5 'I. `� day of "��c(`/ ��. to • nd subscribed before me this `7A�1 STATE OF FLORIDA, CO ice' MI SEAL: gnature of Notary Public - State of Florida ,ie SUSAN R. HARDY ! MY COMMISSION # CC 741810 ' EXPIRES: May 11, 2002 1 Personally known OR, Produced Identification • Type of Identification Produced:8- 09�i U • A /4( 5o v-- ' t- 4 13 - 3 1 1(, -6 PERMIT APPLICATION ignature o SEAL: w to Sta " . ' ,: � '.. c -a luau L BECKER 2 + * COMMISSION C 7 8 NU MBER No < C C786697 . Y �O RAY 4,00 C .ISSIORt 7 _ES � H O C 14G'. 5 ;EN Personally known OR, Produced Identification Type of Identification Produced: ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. TYPE Outlet, Appliance QTY. TYPE Service Repair QTY. 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 Q'I'ti' . 'I,E 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. TYI'E Drains, Roof QTY. 'I'1'I'i; 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: 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 ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) $ ,6 0 $ $ J( Yo (sq.ft. = x/1000 x ¢.60) $ (¢.005 /sq.ft.) $ (¢.01 /sq.ft.) 4 -g^1D.j) REVIEWED AND PREPARED BY: SECTION �l e Zoning Electrical Mechanical Plumbing Fire Public Works BY DATE Structural Building Official PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) PERMIT FEES • TOTAL $ b, ISSUING OFFICIAL DATE: CONDITION OF APPROVAL Re July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com Legal Description Lessee Owner's Address Contracting Co. Qualifier State # WORK DESCRR PTION -/' S 71' PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Job Address / / 3 / 2 -76 ' /S7/// S/ / /g// ./` / Tenant 4? / , /Gt, f/ � �'� ®`/s'vi Address �� X20/9L� ' �6}G�2 SS4 Phone / ��/ 5Ooc - Municipal # Competency # ��� � Ins.Co. Address Y Address Architect /Engineer Bonding Company Permit Type(circle one): BUI D NG ELECTRICAL PLUMBING MECHANICAL ROOFIN Square Ft. /371 / 1 Estimated Cost(value) /37 7 5, 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 c- tify that all the foregoing information is accurate and that all work will be done in compliance �' all applicable laws regulating con and zoning. Furthermore, I authorize the abov ,- -d contractor to do the work stat ig ature Date: My Commission Expires: ** * SGr/7L,", ; f .z / C ?4/2 a,i 7 or Condo President Not y as to Owner and /o.>; ;9 pdo President JANE ROSENAU My Commission CC288885 Expires May. 24,1997 Bonded by HAI 890422 -155 FEES: PERMIT 301,6 RADON C.C.F. APPROVED: Fire Mechanical Address Si Date: Tax Foli Notary as to Contactor- orOwner= Builder My Commission Expires: NOTARY PUBLIC. STATE OF FLORIDA. MY COMMISSION EXPIRES: MAR. 21. 19§%, BONDOD THRU NOTARY DUOLIC UNDERWRITORM * * * 4 /A4 475- Master Permit # 3 5fg g Phone 75 er =Bu i1der ENCE SIGN NOTARY TOTAL DUE 3 Other Zoning Buildin_ V Electrical Plumbing Engineering 3/, 30: -. �FJ - • hOb ARE