166 NE 101 St (15)MIAMI SHORES VILLAGE
BUILDING DEPARTMENT IkX
305- 795 -2204
S` B ' lding Inspection Re • uest
Date
Type Insp'
Permit No.
Name Ws-lc
Address I O 1 `G N L lZ fau
Company O (A-tU
Phone #
Inspection Date -4- t_ 1
Approve��
Correction ❑
Re-Insp'n Fee ❑
Date
Type Insp'
Permit No.
N
Approved
Correction
1
Re- Insp'n Fee
MIAMI SHORES VILLA E
BUILDING DEPART
305- 795 -2204
Building Inspection Requ
Address
Company
Phone #
For Inspector:
T'
Name & Date
Soy- Q3 -O639
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 3/25/2003
Applicant: RAUL
Owner: LOPEZ
JOB ADDRESS: 166 NE 101
Contractor
Local Phone:
Parcel # 1132060131970
Fees:
FEE2003 -1758
FEE2003 -1759
FEE2003 -1760
Description
Builder's Bond
CCF
Building Fee
Total Fees:
Amount
$300.00
$5.40
$145.00
$450.40
Total Fees: $450.40
Total Receipts: $0.00
Permit Status: Approved
Work: PAVERS
If there is no . permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection
f ee is $50.00, Wh h m' sc!•-.i,e.neirl -i ors _edv.2,ne.e.{ .f.rsae,n..11:artw_i ∎►_..ww43,w-
This Permit is gra
ordinances pertainin
and approved by the
authorization. A furt
ordinances and regu
by his agents, serval
Signed:
In consideration of
with the plans, draw,
myself, my agent, sc
/Signed:
PAY
TO THE
ORDER OF
Permit Expiration: 9/21/2003 Construction Value: $9,000.00
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 6 & E1/2 LOT 7 BLK 15 LOT SIZE
ARTISTIC ENVIRONMENTS, INC.
9316 SW 56TH ST (305) 275 -1393
MIAMI, FL 33165
e/i97/,_s //4-
,6 'V-- P/
METROBANK
Dadeland Once
Miami, Florida 33156
FOR Le),,_) Pu""-
Building Permit
Permit Number: BP2003 -475
LOPEZ
RAUL
ST
Contractor's Address:
r n ri t ri
Page 1 of 1
1901
Si
t W j 63- 1176 -670
DATE 1
timer Ran.
PO. -Boca
all
d to
the
c done
amity
• CRITIQUE SHEET
JOB ADDRESS ,/ W� /D S�
APPLICANT
PHONE #
• APPUCATION "iJ U
SHEET OF
MISCELLANEOUS
DATE LUNING
PERMIT NO,
ADDRESS:
MIAMI SHORES VILLAGE
BUILDING / ZONING DEPARTMENT •
SECTION BY DATE
ZONING'
ELECTRICAL
MECHANICAL
PLUMBING
FIRE
PUBLIC WORKS
STRUCTURAL
BUILDING OFFICIAL
1. Subject to compliance vdth eft Federal. State.
County.Vdtage crass snd regulations. Wage =sums
noresponslbU at
tty for accuracy oflor resutts flo
or
plans.
2. This copy of plans must be available on
building site or no inspection Mil be conducted.
COMMENTS
3 /ii /o3 (� Na , & 4 7 7 - a' " / /W Foie ,y - r*ictiG
_ P6r X4a hew n D
L—
s .AP_OA
INITIALS
JO;
10
I,
IL
11
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r0
a
9
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a
1 DO'
1 r
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6 16
34 .5 ti
17
10 1
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• • ••. •
•. • • •
5562 N.W. _ 70i STREET, SUITE 202
MIAMI, FLORIDA 33126
TELEPHONE: (305) 264.2660
F AX: (305) 264-0229
DRAWN BY:
••• • •
Survey of Lot: 6 AND THE EAST 1/2 OF 1 T 4>7 Bitct 15 ; ••
Subdivision: AMENDED. PLAT OF MIAt11' :SHOF S • S • ECTIdN :NO. :1
According to the Plat thereof as recorded •iY? the•Plat Book No. 10
at Page No. 70 of the public records of MIAMI -DADE County, Florida.
Prope Address: 166 NE 101 ST S 7, 1138
For: RAUL LOPEZ JR • •••• • • • • •• • ••• • •
• • •
•
A/C •AIR ONDMONER PAD.
A.E. • A EASEMENT.
NR . Ay INUM ROOF.
.4/5 • ALUMINUM SHED.
ASPW. ASPHALT.
B.C. • BLOCK CORNER.
BLDG. • BUILDING.
B.M. • BENCH MARK.
B.O.B. • BASIS OF BEARINGS.
C. • CALCULATED.
C.8. • CATCH BASIN.
C.B.S. • CONCRETE BLOCK
STRUCTURE.
C8W • CONCRETE BLOCK WALL
CH. • CHORD DISTANCE.
CH. 8. • CHORD BEARING.
CL. • CLEAR.
C.L.F. • CHAIN UNK FENCE.
C.M.E. • CANAL MAINTENANCE
EASEMENT.
CONC. • CONCRETE.
C.P. • CONC. PORCH.
C.S. • CONCRETE SLAB.
D.E. • DRAINAGE EASEMENT
D.M.E. • DRAINAGE MAINTENANCE
EASEMENT.
DRIVE. • DRIVEWAY,
o - DEGREES.
E. • EAST.
E.T.P. • ELECTRIC TRANSFORMER
PAD.
ELEV.. ELEVATION.
ENCR.- ENCROACHMENT.
F.H.. FIRE HYDRANT.
P.I.P. • FOUND IRON PIPE.
F.I.R. • FOUND IRON ROD.
F.F.E. • FINISHED FLOOR
ELEVATION.
f wi
NOM =� � �t • •
z , it i . • ti �.
LAND SURVE
. . •.• ••• ••
N
LOCATIO ,KETCH • Scale 1 °
AB BRFYIATIONS Ann MEANINR
Ale
F.N.D. • FOUND NAIL 8 015K
FR.. FRAME.
FT.. FEET.
FNIP. • FEDERAL NATIONAL
INSURANCE PROGRAM/
F.N.. FOUND NAIL.
H.. HIGH (HEIGHT).
IN. & E0. • INGRESS AND EGRESS
EASEMENT.
L.P.. LIGHT POLE.
LF.E.. LOWEST FLOOR
ELEVATION.
L.34 E.. LAKE MAINTENANCE
EASEMENT.
'• MINUTES.
M.. MEASURED DISTANCE.
MON. . A NUMENT.
MM. • M HOLE
M/L. • MO UMENT LINE.
N.A.P. - OT A PART OF.
NOVO- NATIONAL GEODETIC
VERTICAL DATUM.
N.. NORTH.
N.T.S.. NOT TO SCALE.
II • NO.. NUMBER.
0/S. • OFFSET.
OH. • OVERHEAD.
0.H.L. . OVERHEAD UTILITY UNES
OVH.. OVERHANG.
O.R.B.. OFFICIAL RECORD BOOK.
PVMT.. PAVEMENT.
PL • PLANTER.
P/L.. PROPERTY LINE.
P.C.C. • POINT OF COMPOUND
CURVE.
P.C.. POINT OF CURVE.
PT.. POINT OF TANGENCY. ??
POC. • POINT OF COMMENCEMENT h "CENTER LINE.
PO8.. POINT OF BEGINNING. A. - ANGLE.
/O/
P.R.C.. POINT OF REVERSE
CURVE.
PROP. CDR.- PROPERTY
CORNER.
P.B. • PLAT BOOK.
PG • PAGE.
PWY . PARKWAY.
PRIM. PERMANENT REFERENCE
MONUMENT. '
PLS. • PROFESSIONAL LAND
SURVEYOR.
R. RECORDED DISTANCE.
RR. • RAILROAD.
RES. • RESIDENCE.
RAN.. RIGIIT•OF.WAY.
RAG.. RADIUS OR RADIAL.
R.P.. RADIUS POINT.
RGE.• RANGE.
SEC.. SECTION.
STY.. STORY.
SWK. • SIDEWALK.
S.I.P. • SET IRON PIPE L.B. 06044
S. • SOUTH.
S.N.D.. SET NAIL. 6 DISK 111.06044.
SP.. SCREENED PORCH.
• • SECONDS.
T.. TANGENT.
TWP. • TOWNSHIP.
U.E.. UTILTY EASEMENT.
UTIL. • UTILITY.
U.P.. UTILITY POLE.
W.M. . WATER METER
W.F.. WOOD FENCE.
W.S.. WOOD SHED.
8
• CENTRAL ANGLE.
W.. WEST.
LEGAL NOTES TO ACCOMPANY SKETCH OF SURVEY (SURVEY):
EXAMINATION OF 1HE ABSTRACT OF TITLE' WILL HAVE TO BE MADE TO DETERMINE RECORDED
INSTRUMENTS. 11 ANY, AFFECTING THE PROPERLY. TIES SURVEY IS SUBJECT TO DEDICA1IONS,
LIMITATIONS, RESTRICTIONS, RESERVATIONS OR EASEMEN LS OF RECORD. LEGAL DESCRIPTIONS
• PROVIDED BY CLIENT OR ATTESTING TITLE COMPANY.
1 P OUNDARY SURVEY MEANS A DRAWING ANLVOR A GRAPHIC REPRESENTATION OF 1119 SURVEY WORK
ERFORMED IN THE FIELD, COULD BE DRAWN AT A SHOWN SCALE AND/DR NOT TO SCALE.
FASEMENTS AS SHOWN ARE PER PLAT BOOK. UNLESS OTHERWISE SHOWN.
1142 TERM 'ENCROACHMENT MEANS VISIBLE AND ABOVE GROUND ENCROACHMENTS
ARCHITECTS SHALL VERIFY ZONING REGULATIONS. RESTRICTIONS AND SETBACKS AND THEY WILL
BE RESPONSIBLE OF SUBMIrn to PLOT PLANS Win/ THE CORRECT INFORMATION FOR THEIR
APPROVAL FOR AUTHORIZATION TO AUTHORITIES IN A NEW CONSTRUCTION, UNLESS OTHERWISE
NOTED, THIS FIRM HAS NOT ATTEMPTED TO LOCATE FOOTINGS AND/OR FOUNDATIONS.
FENCE OWNERSHIP NOT DETERMINED.
THIS PLAN OF SURVEY, HAS BEEN PREPARED FOR THE EXCLUSIVE USE OF THE ENTITIES NAMED
HEREON. THE CERTIFICATE DOES NOT EXTEND TO ANY UNNAMED PARTY:
THE FNIP FLOOD MAPS HAVE DESIGNATED THE HEREIN DESCRIBED LAND TO /30
• • •
• • •• •
ST
ST.
x r x x
0.00 x
1 0.00
SURVFYORS'S NOTF9. 1) IF SHOWN, BEARINGS ARE
REFERRED TO AN ASSUMED MERIDIAN, BY SAID PLAT
IN THE DESCRIPTION OF THE PROPERTY. IF NOT,
THEN BEARINGS ARE REFERRED TO COUNTY
TOWNSHIP MAPS.
2). IF SHOWN, ELEVATIONS ARE REFERRED TO
6.M. ELEV.
OFN.O.V.D. OF 1929.
3). THIS IS A SPECIFIC PURPOSE SURVEY.
4). THE CLOSURE'IN THE BOUNDARY SURVEY IS
ABOVE 1:7500 FT.
I HEREBY CERTIFY: THAT THI9'BOUNDARY SURVEY'
OF THE PROPERTY DESCRIBED HEREON, AS
RECENTLY SURVEYED AND DRAWN UNDER MY
SUPERVISION, COMPLIES WITH THE MINIMUM
TECHNICAL STANDARDS AS SET FORTH BY
THE FLORIDA BOARD OF PROFESSIONAL LAND
SURVEYORS IN CHAPTER 61017.6, FLORIDA
ADMINISTRATIVE CODE PURSUANT
TO 472.027, FLORIDA STATUTES.
3 -Z7 -C/
•IBARRA (DATE OF FIELD WORK).
PROFESSI L LAND SURVEYOR NO. 5Z
STATE OF FLORIDA. (VALID COPIES OF THIS SURVEY WILL
BEAR THE EMBOSSED SEAL OF THE ATTESTING LAND
SURVEYOR).
BY /
REVISED ON
Situated in Zone: X Community /Panel /Suffix: 120652- 0043 -J
Date of Firm: 07/17/1995 Base Flood Elevation:
Certified to: RAUL LOPEZ JR.
COMMONWEALTH LAND TITLE INSURANCE COMPANY
EQUITY LAND TITLE, INCA.
RESOURCE BANK,' ITS SUCCESSORS AND/ORV ASSIGNS AS T)1EIR INTEREST
MAY APPEAR
SURVEY No.
SHEET N0.
Date': 03/26/2001
1EGEN12 TYPICAL
WOOD FENCE.
CHAIN LINK FENCE.
C.B.S. WALL (C.B.W.)
EXISTING ELEVATIONS.
PROPOSED ELEVATIONS.
REVISEDON
U .
/ OF
SEAL
i
•
c5)
5582 N.W. 77H STREET. SUITE 202 p lay UTAMI. FLG710A 33129 • • • • • • f SURVEY NO O ' TELEPHONE: (306) 220.3171 y�!� FN(: (305) 554.7822 !!!"""��� i . • A it
p14 •••
LAND SURVEYORS SHEET NO OF
p noaddy
kuiuoz
11)
• • • ...
•.• • • • ...
SKETCH OF :SFIFREY .'sdalg
. . • • . • • •
••• • ••• •
• •• ••• ••
• •
• • •
•
. • •
•
•• • • • • • ••• •.
•
( off 4
, —
CONTRACTOR
Name 6t99_ LQ L0N1A CbNSTQL'11 G-
License No. 00 ono g S
Address suu $4 CT
��3�
le i1 PL 3 - )17`/
Telephone/ 0g. S I2 Fa x D - c -� �// /
�6
Qualifier Name2 `� j b Lfri 4 5
PROPERTY OWNER
New Construction
Name w n
t `` v
Lo n 2
t
Address
1 b bve
I o J <s 1 nIrar)i Pt .
Hone Telephone
Repair
Business Telephone
Alteration Interior
Fax
Demolish
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
.4
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'I Attachment
Other
Add'I Detachment
Other
Step 1.
Job Address:
Folio Number
Lot 6 - --�
Subdivision
Current Use of Property
Proposed Use of Property
Tenant Information
11 - 3206 - 011 -19 ?0
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other J
l66 ive 101sT
Address Apt.
Block /s
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Nance
License No.
Address
Telephone
Fax
• . ..• • • • ••.
•• •• • • • • • •• .• •
• • • • • •
• • • ..•
• • • • • • • • • • •
• • ..• • • • • .
••. • • •
• • • • •
• • • • • • PERMIT APPLICATION
• • • • •
• •
Master Permit No.
• • • • •lutsiiiiat'}? Peiinit No.
• •••
...•••••. •
City
Description of Work
• • •
INSTRUCTIONS - The following steps must be taken to:ib'ain_ a pc ri tit 1..Um 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 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
Flood Zone
State
3.3)38
Zip
PB /D PG 70 Zoning Linea Feet
Square Feet I/ 0 L P Units fJ Floors
5
d Value of Work '7�ro� "— Bldg Value
Tax Assessed /Appraised Value
Base Floor Elev.
ENGINEER
Name
License No.
Address
Telephone
Fax
Page 2
IMPORTANT NOTICES
DO NOT BEGIN ANY WORK WITHOUT HAVING RECEI ¥ a V1LIi3M'E® P£1kM1TAND PERMIT CARD. Applying for a permit does not grant
the right 10 begin construction. HOURS OF CONSTRUCTION al tr: rtonMthr 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 orii•lidayn. • • • • • • • • •
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 TOILET'S 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. 1, 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 inforniation 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 nay 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 Comrnencernent. 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- of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and
Choosing a Contractor.
Print Name
Sworn to and subscribed before me this
Z
Personally known
Type of Identification Produced:
• • ••• .
• • • • • • • •
• • • • •
• • • • •••
• • • • • • •
• • • .• • •
T17 __
J. ABEUA
SEAL: 1 » COMMISSION NUMBER
A „R ' : O DDoo8eg5
OF F t OQ` MY COMMISSION EXPIRES
-_ MAR. 13 2005
OR, Produced Identification r
• • • ••
• • •• •
•
• • •
• • •
• • •••
••• • •• ▪ • ▪ • • • •
• • • • • • • •
• • • • • •
• • • • • •
• • • • • • • • • • •
STATE ! FLORIDA, COUNTY
Si ratur if Contractor Qualifier
Z& —' 11 D ft-P1
Print Name
Sworn to and subscribed re me this day of
PERMIT APPLICATION
IAMI -DADE
(
Signature of Notar `PU� Sta.of f . ocid
tiP ub r✓
O !� FAAfdGSCO J q�
O n te COMMISSION NUMBER BE
SEAL:
p DD008895
MY COMMISSION EXPIRES
""q 11,tr)n5 .
Personally known /I OR, Produced Idcnttfteatidn
Type of Identification Produced:
PROPERTY OWNER
New Construction
Nanie 1, P) L- a
L icl Z C \cl—
Address
16z. iN:..
► A r) 1
I Q k .Cr
Ft. - 12 1 3 51
Home Telephone
Repair
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 ob` -ai3 Ram the Miami Shores Village:
Step 1.
• • •
Complete the attached permit application which must b S ign4i l i tfe aroaerty ehmcner are qualifier. Both signatures must be notarized. Please
print or type to allow fora 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
ob Address: ) 10 1 Si
Folio Number esc 'ption of Work P4 €R--S
Lot Block
Subdivision PB PG Zoning Linear Feet
Current Use of Property quare Feet / 070 4 Units Floors
Proposed Use of Property Value of Work 9 00 -- Bldg Value
Tenant Information Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
Address Apt. City
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
• • ••• • • • •••
•• •• • • • •• •• •
• • • • • • • • •
• • ••• • • •
••• • • •••
• •• • • • • •• •
••• • • • • •
• IVIagttr Pei mlt NO.
••
• Sut sidiary Permit No. '
State
PERMIT APPLICATION
37/33?
Zip
ENGINEER
Name
License No.
Address
Telephone
Fax
CONTRACTOR
Name
License No.
Address
Telephone
Fax
Qualifier Name
STATE FLORIDA, COUNTY F MIAMI
C Or: D\
igna caner
orn to and subscribed before me this day of
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 CONiTRU(; TIPN a % limited bit: Mon .ay 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 w ol$da ;s. • • • •
2. All construction of demolition areas MUST BE M!UNTAIN D I+I•A ELI:AId, ItlEA't SANITARY CONDITION free from construction debris.
3. STREETS AND NEIGHBORING PROPERTIES SMALE I GEIar ea& I M Ulla 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.
STA OF FLORIDA, • U rY MIAMI -D
Si
Print Name Print Name
Signature of Notary Public - State of Florida Signature of Notary Public - State of Florida
SEAL: SEAL:
o Contractor / Qualifier
Sworn to and subscribed before me this day of
PERMIT APPLICATION
Personally known OR, Produced Identification Personally known OR, Produced Identification
Type of Identification Produced: Type of Identification Produced:
SECTION
BY
D TE
Zonin
Electrical
1'
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
jJ %M11111
Page 4
OFFICE USE ONLY
••• • • • • • •
• •• •• • • • •• ••
• • • • •
•
- -- - - -
••• • • • • ••• • •
••• • • • •••
• • • • • • •• •
• • • • • • • • •
• • • • • • •
• • • • • • • • • •
PERMIT APPLICATION
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
•0 PP OF.QF QWATEL - IP
• • •
•
• • • • • •
• (.IZttxti� • • •
•
❑ HRS / DERM APPIIOVAA.
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
PERMIT FEES
$ 1
$ 3 e?) 4 )
$ S, LI 0 (s = x/1000
x ¢.60)
$ (¢.005 /sq.ft.)
$ (¢.01 /sq.ft.)
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL
tt 0
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
ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPI.
Dryer
')'I.1,
Tyr.:
Outlet, Appliance
QTY.
' rvi'l.;
Service Repair
Q IN
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
NIECHANICAL
TYPE
Minimum Fee
QTY.
TYPE
Condensate Drain
QTY.
TYPE
Generator
QTY.
TYPI:
Refrigeration, Tons
QTY.
A/C Central, Tons
Cooling Tower
Heating Strips, each
Vent Hood, Cost
A/C Wall/Win. Tons
Dryer Vents, Number of
Paint Booth
Ventilation, Cost
Air Handler, Tons
Ductwork, Cost of
Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
Process/Pressure Piping
Supply, AC Well
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
Temporary Toilet
PLUMBING
TYPE
A/C Condensate
QTY.
'I'YPE
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:
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date C7 ime
Type Insp'n
Permit No.
Name
Address
Company
Phone #
For Inspector: 12. yl U � � Name t
Approved
Correction ❑
Re- Insp'n Fee ❑
� l
C
RAUL I. LOPEZ
305 - 554 -4589
9400 WEST FLAGER STREET, APT. 211
MIAMI, FL 33174
PAY TO THE
ORDER OF
W Washington Mutual
Washington Mutual Bank, FA
Miami /Westchester Financial Center 1734
8100 SW. Coral Way 1 - 800. 788.7000
Miami, FL 33160 24 hour Customer Smote
NOTES
1: 267084L3 L':83 L"24402211190' 5038
63- 8413/2670
8312440229
DATE /e
$ 3 S4 c'd
DOLLARS 8
5038
onr. e.■.
NA
WHEREAS,
requests permission to install:
within the public road right of way of
M iami Sh,oreo
10050 N.E. SECOND AVE.
MIAMI SHORES. FLORIDA 33138 - 2382
Telephone: (305) 795 -2207
Fax: (3051756 -8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
4 Z', 1.0e12 ,7-72 .
(owner)
[v - sphalt, concrete, brick pavers
[ ] Landscaping
[ ] Other
SIGNED. SEALED AND DELIVERED in the presence o
, hereinafter referred to as the Owner of the
following described property:
Legal description /folio #: �O(0 0/ 3 / "70
Lot () E / 7 Block / s Subdivision iriZ "7 t - S /
Tax Folio #:
/6e Al 6 / 771.,.‘cT
(address)
IN CONSIDERATION of the approval of this permit by the Village, the Owner agrees as follows:
I . To maintain and repair, when necessary, the above- mentioned item(s) installed within the dedicated right
of way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said
items within public right of way including restoration of street by reason of the Owner's failure to do so,
such expense shall be paid by the Owner or shall constitute a lien against the above described property
until paid.
2. The owner does hereby agree to indemnify and hold Miami Shores Village or dade County harmless from
any and all liability, which may rise by virtue of permitting the installation of these items within the public
right of way.
3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days
notice by the Village to do so. Failure to comply with this notice will result in the Village causing the
item(s) to be removed and a lien being placed on the property and/or assessed against the Owner for all
costs incurred in the removal and disposal of the item(s).
4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and
shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such
time as this obligation has been canceled by an affidavit filed in the Public records of Dade County, Florida
by the Village Manager of Miami Shores Village (or his fully authorized representative).
SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on this J am• .y of
�.
PPR 0licc-f
a
14
5 ,)
1
' . + 1
101
0
ZO
8'
el
,....i.."
2Z
��� 0
�i
1
5582 N.W. 7th STREET. SUITE _,._
MIAMI. FLORIDA 33126
TELEPHONE: (305) 264 -2660
FAX: (305) 264-0229
DRAWN BY: AA.
Agenirs>
• • •
Survey of Lot : 6 ANI) THE EAST 1/2 OF LOT 7 IN BLOCK 15 � •E •
Subdivision: AMENDED. PLAT OF MIAMI SHORES SECTIOIS:■O:. 1
According to the Plat thereof as recorded in the Plat Book
at Page No. 70 of the public records of MIAMI -DADE • C�o�Zrity,
• • ••• •
• Property Address: 166 NE 101 ST, MIAMI SHORES, FL 3313$ •
For: RAUL LOPEZ JR
•
A.. ARC. '
NC - AIR ONDITIONER PAD.
A.E.. A CHOR EASEMENT.
A/R . AL MINUM ROOF.
A/S - ALUMINUM SHED.
ASPH:'. ASPHALT.
B.C.. BLOCK CORNER.
BLDG.. BUILDING.
B.M. . BENCH MARK.
B.O.B. . BASIS OF BEARINGS
C.. CALCULATED.
C.B. +CATCH BASIN.
C.B.S. - CONCRETE BLOCK
STRUCTURE.
CBW = CONCRETE BLOCK WALL.
CH.. CHORD DISTANCE.
CH. B.. CHORD BEARING.
CL. - CLEAR.
C.L.F.. CHAIN UNK FENCE.
C.M.E.. CANAL MAINTENANCE
EASEMENT.
CONC.. CONCRETE.
C.P.. CONC. PORCH.
CS. *CONCRETE SLAB.
D.E.. DRAINAGE EASEMENT
O.M.E. - DRAINAGE MAINTENANCE
EASEMENT.
DRIVE.. DRIVEWAY.
o - DEGREES.
E.• EAST.
E.T.P.. ELECTRIC TRANSFORMER
PAD.
ELEV. = ELEVATION.
ENCR.. ENCROACHMENT.
F.H.- FIRE HYDRANT.
F.I.P.. FOUND IRON PIPE.
F.I.R.. FOUND IRON ROD.
F.F.E.. FINISHED FLOOR
ELEVATION.
� wi,
Nava �urur uxu
LAND SURVE ORS
LOCATION SKETCH Scale 1" N73•
is
10
ABBREVIATIONS AND MEANINQ
F.N.D. . FOUND NAIL 8 DISK
FR. - FRAME.
FT.. FEET.
FNIP.. FEDERAL NATIONAL
INSURANCE PROGRAM.'
F.N. . FOUND NAIL.
H. = HIGH (HEIGHT).
IN 8 EG. z INGRESS AND EGRESS
EASEMENT.
L.P.. LIGHT POLE,
L.F.E.. LOWEST FLOOR
ELEVATION.
L.J4E. - LAKE MAINTENANCE
EASEMENT.
' - MINUTES.
M.= MEASURED DISTANCE.
MON.. MONUMENT.
MM. - MNJHOLE
MIL. - MONUMENT LINE.
N A.P. NOT A PART OF.
NGVD• NATIONAL GEODETIC
VERTICAL DATUM.
N.. NORTH.
N.T.S.- NOT TO SCALE.
M•NO. - NUMBER
0/S.. OFFSET.
OH.. OVERHEAD.
O.H.I.. OVERHEAD UTILITY LINES
OVH. - OVERHANG.
O.R.B.. OFFICIAL RECORD BOOK.
PVMT. PAVEMENT.
PL = PLANTER.
P/L. - PROPERTY LINE.
P.C.C.. POINT OF COMPOUND
CURVE.
P C.. POINT OF CURVE.
PT.. POINT OF TANGENCY.
POC.. POINT OF COMMENCEMENT
POB.. POINT OF BEGINNING.
NE
iL
11
t�
9
/0
LEGAL NOTES TO ACCOMPANY SKETCH OF SURVEY (SURVEY):
EXAMINATION OF THE ABSTRACT OF TITLE WILL HAVE TO BE MADE TO DETERMINE RECORDED
INSTRUMENTS, IF ANY, AFFECTING THE PROPERTY. THIS SURVEY IS SUBJECT TO DEDICATIONS,
LIMITATIONS, RESTRICTIONS, RESERVATIONS OR EASEMENTS OF RECORD. LEGAL DESCRIPTIONS
PROVIDED BY CLIENT OR ATTESTING TITLE COMPANY.
P BOUNDARY SURVEY MEANS A L:RAWING AND/OR A GRAPHIC REPRESENTATION OF THE SURVEY WORK
ERFORMED IN THE FIELD, COULD BE DRAWN AT A SHOWN SCALE AND/OR NOT TO SCALE.
EASEMENTS AS SHOWN ARE PER PLAT BOOK, UNLESS OTHERWISE SHOWN
THE TERM 'ENCROACHMENT' MEANS VISIBLE AND ABOVE GROUND ENCROACHMENTS
ARCHITECTS SHALL VERIFY ZONING REGULATIONS. RESTRICTIONS AND SETBACKS AND THEY WILL
BE RESPONSIBLE OF SUBMIT PLOT PLANS WITH THE CORRECT INFORMATION FOR THEIR
APPROVAL FOR AUTHORIZATION TO AUTHORITIES IN A NEW CONSTRUCTION, UNLESS OTHERWISE
NOTED, THIS FIRM HAS NOT ATTEMPTED TO LOCATE FOOTINGS AND/OR FOUNDATIONS.
FENCE OWNERSHIP NOT DETERMINED.
THIS PLAN OF SURVEY, HAS BEEN PREPARED FOR THE EXCLUSIVE USE OF THE ENTITIES NAMED
HEREON, THE CERTIFICATE DOES NOT EXTEND TO ANY UNNAMED PARTY:
THE FNIP FLOOD MAPS HAVE DESIGNATED THE HEREIN DESCRIBED LAND TO BE
F.R.C.. POINT OF REVERSE
CURVE.
PROP. COR.. PROPERTY
CORNER.
P.0. - PLAT 1300K.
PG = PAGE.
PWY = PARKWAY.
PHM - PERMANENT REFERENCE
MONUMENT.
P.L S.. PROFESSIONAL LAND
SURVEYOR.
R RECORDED DISTANCE.
1113. - RAILROAD.
RES.. RESIDENCE.
H/W. = RIGHT -OF -WAY,
FiAD. = RADIUS OR RADIAL.
H P. = RADIUS POINT.
ROE.. RANGE.
SEC. • SECTION.
STY.. STORY.
SWK. - SIDEWALK.
S.I P. - SE IRON PIPE L.B N6044
S. SOUTH.
S.N.D. = SET NAIL & DISK L.B.116044.
SP. - SCREENED PORCH.
- SECONDS.
T.. TANGENT.
TWP. - TOWNSHIP.
11. E.. UTILTY EASEMENT.
U1 IL.. UTILITY.
UP.. UTILITY POLE.
W 14.• WATER METER.
W.F.: WOOD FENCE.
W S.. WOOD SHED.
0 • CENTRAL ANGLE.
W.. WEST
= CENTER LINE.
ANGLE.
5r
c�
• •• ••
• • • • • •SU! V[YMu•• . • • •
itr ••• • • •
• • • • •
6 15 • • • • • •••
SHEET NO.
• • • • •
1 0 . 00 1
0.00 X
$LRVEYOR$'S NOTES: 1). IF SHOWN, BEARINGS ARE
REFERRED TO AN ASSUMED MERIDIAN, BY SAID PLAT
IN THE DESCRIPTION OF THE PROPERTY. IF NOT,
THEN BEARINGS ARE REFERRED TO COUNTY
TOWNSHIP MAPS.
2) IF SHOWN, ELEVATIONS ARE REFERRED TO
B.M.4 ELEV
OF N.G.V.D. OF 1929.
3). THIS IS A SPECIFIC PURPOSE SURVEY,
4). THE CLOSURE IN THE BOUNDARY SURVEY IS
ABOVE 1:7500 FT.
1 HEREBY CERTIFY: THAT THIS 'BOUNDARY SURVEY'
OF THE PROPERTY DESCRIBED HEREON, AS
RECENTLY SURVEYED AND DRAWN UNDER MY
SUPERVISION. COMPLIES WITH THE MINIMUM
TECHNICAL STANDARDS AS SET FORTH BY
THE FLORIDA BOARD OF PROFESSIONAL LAND
SURVEYORS IN CHAPTER 61017.6, FLORIDA
ADMINISTRATIVE CODE PURSUANT
TO 472.027. FLORIDA STATUTES.
REVISED ON
Situated in Zone: X Community /Panel /Suffix: 120652- 00g3 -J
Date of Firm: 07/17/1995 Base Flood Elevation:
Certified to: RAUL LOPEZ JR.
COMMONWEALTH LAND TITLE INSURANCE COMPANY
EQUITY LAND TITLE, INCA.
RESOURCE BANK,' ITS SUCCESSORS ANT) /OII.V ASSIGNS AS THEIR INTEREST
MAY APPEAR
p
• •
• • • • •
. • •
• • • •
No. 10
+ Flo 4ida
• •
•• • •
•
/ OF
• Da't : "03 /26/2001
LEGEND TYPICA%,
WOOD FENCE.
CHAIN LINK FENCE.
C.B.S. WALL (C.B.W.)
EXISTING ELEVATIONS.
PROPOSED ELEVATIONS.
BY: ti,.� 3 -27 -U/
t7
•IBARRA (DATE OF FIELD WORK).
PROFESS' AL LAND SURVEYOR NO. 5 Zoy
STATE OF FLORIDA. (VAUD COPIES OF THIS SURVEY WILL
BEAR THE EMBOSSED SEAL OF THE ATTESTING LAND
SURVEYOR).
REVISEDON
5582 N.W. 7TH STREET, SUITE 202
MIAMI. FLORIDA 93126
TELEPHONE: ()06) 220.3171
FAX: (305) 554•7522
SKETCH OF SURVEY
.... • .. ... ..
•
• • • •
• • •
•
.. .. • . ......
• Muini SIzor ViLar
AFFIDAVIT
STATE OF FLORIDA)
COUNTY OF DADE)
The undersigned Affiant, *el ' 77Z • , does hereby attest that the
(property owner)
attached survey, performed by 4)0 V.4 Su'//Fl0lt15 / TIC_
(name of surveyor's company)
performed on 0} /d(p /DDO / , is an accurate representation of the existing conditions and
(date of survey)
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) Witness(sign and print)
SWORN TO AND SUBSCRIBED before me this L day ofLI 2_00 c i
Affiant is personally known to me,`Iproduced /-' ��, L �D /JaC�( lification.
CONTRACTOR
New Construction
/^� /_
Name c c. J Fit s }� L Sc. c. 1 Coo..-
1.
II
License No.
V.5 U1/4)0
Address / /_ /_ 1 06 / o / s 17 6 T
011, sihie s, l2
Address e I �O LI U S cJ 137 r4 f 17
/t, Ft. 33/77
Home Telephone (go S 1's1- r'7O
Telephone (30n 9. 022Fax
Business Telephone / \ 4./ ao
�
Qualifier Name F can M I lie t
Fax (106— -7.‘? - O' 0 (°
PROPERTY OWNER
New Construction
Enclosure
Name k46/4 y • j p Z i .
Address / /_ /_ 1 06 / o / s 17 6 T
011, sihie s, l2
3i - P
Home Telephone (go S 1's1- r'7O
Business Telephone / \ 4./ ao
�
Fax (106— -7.‘? - O' 0 (°
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 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:
/ “, 4/E /0/ sw irl
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
Address Apt.
Folio Number // 3 ?O(' 013 Mi O
Loup <I A 1 Block / S
ry�
Subdivision �/. I ✓�(`� 5 / 0 PG .10
Current Use of Property £6 2 1'C %oCC
Proposed Use of Property Q GS _r7)15:0C
Tenant Information OW 00
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
PERMIT APPLICATION
Master Permit No.
Subsidiary Permit No. 50 1
City State Zip
Descri lion of Work T e e .���a
Zoning Linear Feet
S quare Feet Units Floors
Walue of Work 51 4 , ' Z 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 Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and
Choosing a Contractor.
SEAL:
azure of No
gnatur of Owner
p ft z -ate
Print Name
Sworn to and subscribed before me this L i day oC2 (j '
0J
AP* ; I
■__t i - - it t b! -__i
'y T 2 tk .
ay ` P O O 1CkAL)ao,.i,bf;'
o' ' �, ANGELA M BEC.:E6t
-A,5,r 0 coMes.s.on wuuae::
� Q CC786697 ■
GF F,.G MC'I. 's ' :'r
Personally known OR, Produced Identification J�
Type of Identification Produced: 1 - . 1 0 . . . '7 --'17'
Y OF MIAMI -DADE STATE FL RIDA, CO Y
Signature of Contractor / Qualifier
tip, 1( 1 ('
Print Name
worn to a.d subscribed before me this da of
SEAL:
PERMIT APPLICATION
F MIAMI -DADE
ture of No'.ry k bt c -
1 m ay p a ICSAL ::07A, Of Ste . ^.L
p S. t ANGELA M BECiiSR
2 l \i, n CO�':'.JSS30CA NUMBER
ti ti t Q CC78S697
r op F.O NOV. i S, ^i,l')2
0 Personally known OR, Produced Identification
Type of Identification Produced:Fhh I 1 ed 53 OA] 1 - , SS-RPS -6
SECTION
BY
D4TE
Hi/ ,/U/
, Zoning -
atoeyt Gj
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
f in A
qj,r0
Page 4
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
PERMIT FEES
$3.00 per page (Scanning Fee) $
Miami Shores Village
Bond
Metropolitan Dade County (C.C.F.)
Inspector State Educational Fund $
State DCA (Radon) $
Code Enforcement Fine $
Zoning Review
$ o0
$30
b
S- op
(sq.ft. = x/1000
x ¢.60)
(¢.005 /sq.ft.)
(¢.01 /sq.ft.)
REVIEWED AND PREPARED BY:
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR
(On File)
TOTAL $ f4 5, b U
ISSUING OFFICIAL
DATE:
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com
ELECTRICAL
TYPE
Minimum Fee
QTV.
TYPE
Dryer
QTY.
TYPE
Outlet, Appliance
QTY.
TYPE
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
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
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: