270 NE 101 St (6)MIAMI SHORES VILLAGE 5
BUILDING DEPARTMENT
305- 795 -2204
Bui din. Inspection Request
Date .e''
r
Type Insp'n u ' D fj t}. e c..
Permit No. 69
Name- -CA I l
Address D--10 (NYE 10 , 34-
Company S
Phone #
Inspection Date c9-1q 10 4
Approved
Correction
Re- Insp'n Fee ❑
MIAMI SHORES 'VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Reques,tyv
Date ,-�, � l
Type Insp' n 1- CC, , `l 1�p 01(c-(l.
Permit No.
BP2OCU3 - 1qO2
Name Sc.. c Cfj‘Y15 c 1
Address .1C ` NE. ) 0 J t T
Company�r� l �J�C•
Phone # i J L 42$ .
Inspection Date 140( 04
Approved
Correction
Re- Insp'n Fee ❑
Type Insp'n
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Requests
3
Date
al
Permit No. 'BP ` `O a
Name
Address 2�? 0 NJa `o t
Company WI11X Y!! SiCa
Phone # C0 — 1 r
=�`a
Inspection Date a /3 )
Approved
, (14
Correction ❑
Re- Insp'n Fee ❑
BUILDING
PERMIT APPLICATIO
FBC 2001
Is Building Historically Designated YES NO
Type of Work: ❑Addition
Describe Work: �-- ant-NO
(Continued on opposite side)
Total Fee Now Due $
Miami Shores Village
Building Department
10050 : - d A e..!,P_ . l�!t ami Shores, Florida 33138
VE443 5) 756.8972
❑Alteration ❑New
C6-7-1cA, t
Permit No.
Master Permit No.
L_13A 0 L3
Mechanical Roofing
Permit Type (circle): uildingj Electrical Plumbing
Owner's Name (Fee Simple Titleholder) 4 1 1A R 6coGGin 6 Phone # "76 - li gcR 5
Owner's Address a 70 n e 10( •
City M i , S hores State cr 1 Zip 331 3g
Tenant/Lessee Name Phone #
Job Address (where the work is being done) a 7D n 10 1 S-€
City Miami Shores Village County Miami -Dade
Contractor's Company Name S � S & - v - . t L Phone #
Contractor's Address 5,9014 5..3 1 34 C*
City 1 6...)r14-Z State (E-Q. Zip 31'7 S
Qualifier (.) s Q-'Y\zo
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Permit Square Footage Of Work:
* * * * * * * * * * * * * * * * * * * * * * * * * ** *F * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $ CCF $
Notary $
Scanning $
Code Enforcement $ Structural Plan Review. $
Training/Education Fee $
Radon $
Zip 3 3 {
❑ Repair/Replace ❑ Demolition
a oo3 -- . 9 0 .
Technology Fee $
Bond $
?a\ci Ct K3qzt- .
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
C f 70 /
Signature Signature s
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of , 20 _, by , day of , 20 by
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: Print:
My Commission Expires: My Commission Expires:
*********************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
6 � - //i y j3
Chc 10/14/03
* * * * * ** ** * * 1 4 * * * * * * * * * * * * * * * * * * * * * * * * * **
Plans Examiner
Engineer
Zoning
.6- • ,,,zee-y
LOT OSTAKS
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 with att Federal. State,
County. Vittage rtes and regulations. Village mums
no responsibility for accuracy oflor resutts from
JOB ADDRESS �l 0 / 0 / 1 . )
APPLICANT C C7 GCpl N S �
5 V)
\ � \I
PHONE f#
APPUCATION
SHEET OF
MISCELLANEOUS
CRITIQUE SHEET
( 64106 wAy /5 Fe) m6-0 Muir
-'� Too W ID E
4L4tiV v sI- these plans,
a -C ° 1- 141 4 )40-
2. Thls copy of plans must b. available on
building site or no Inspection Mil be conducted.
DATE ZONING ' COMMENTS INITIALS
0 . - /V / W +1.ft f s )- Q.1 w , C` T d C (kJ(' t,),x 4--t J
.-, o 1
BUILDING
PERMIT APPLICATION
FBC 2001
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Permit No. AP 03 - �qd�
Master Permit No.
Permit Type (circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) Phone #
Owner's Address
City State Zip
Tenant/Lessee Name Phone #
Job Address (where the work is being done)
City Miami Shores Village County Miami -Dade Zip
Ls Building Historically Designated YES NO
Contractor's Company Name Phone #
Contractor's Address
City
Qualifier
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Permit
Type of Work: ['Addition ['Alteration ['New
Describe Work:
Submittal Fee $ ‘6 Permit Fee $ / ) V
Notary $ Training/Education Fee $ / A K)
Scanning $ 3 Radon $
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $ "7 o S S
(Continued on opposite side)
State
Square Footage Of Work:
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Zip
k re;air/Replace ❑ Demolition
CCF $__AERS93. 45
Technology Fee $ q, 73
Bond $
Bonding Company's Name (if applicable) r .•
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of , 20 _ , by day of , 20 _, by
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: Print:
My Commission Expires: My Commission Expires:
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY: Plans Examiner
Engineer
Zoning
Chc 10/14/03
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305- 795 -2204 Permit Number: BP2003 -1902
Printed: 12 /8/2003
Applicant:
Owner: SCOGGINS BILLY
JOB ADDRESS: 270 NE 101 ST
Contractor SUPER STAMPED CONCRETE Contractor's Address: 5204 S. W. 134 CT.
Local Phone: 305 - 220 - 1163
Parcel # 1132060134610
Building Permit
Legal Description: 1 53 41 6 53 42 MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 4 & E1/2 LOT 5 BLK 34
Fees: Description Amount
FEE2003 -8035 Building Fee $110.00
FEE2003 -8036 CCF $3.60
FEE2003 -8037 Training and Education Fee $1.20
FEE2003 -8038 Technology Fee $2.75
FEE2003 -8039 Scanning Fee $3.00
Total Fees: $120.55
Total Fees: $120.55
Total Receipts: 0:00
j am . . , 7 o _ s
Permit Status: APPROVED Permit Expiration: 6/2/2004 Construction Value: $5,080.00
Work: STAMPED CONCRETE DRIVEWAY AND WALKWAY
Signed: (INSPECTOR)
Page 1 of 1
DFC 15 P4/
0
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict
conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
/- o7 y
c • .
27 D
Vi6
7. 3 4
rgls-6eA
7 / • <4.e/to,- e
„e"
d! •
LOT IMAM strut ?" •
.as 101 3N oLt
• •
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
WHEREAS, ,er / /c� 4' /464 g") r„- hereinafter referred to as the Owner of the
/ (owner)
following described property:
Legal description/folio #:
Lot 1/AfeePieFof Z Block 3 Subdivision /4,4A6 �,Clf.eP,S
Tax Folio #: 40," / lye 20
requests permjssion to install:
Asphalt, concrete, brick pavers
[ ] Landscaping
[ ] Other' -
within the public road right of way of � /(/- j(*,/s'/
(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.
?. 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 day of
SIGNED, SEALED AND DELIVERED in the presence of:
7Y h ami ShoreJ i e
10050 N.E. SECOND AVE.
MIAMI SHORES. FLORIDA 33138 - 2382
Telephone: (305) 795 -2207
Fax: (3051756 -8972
Marola Franco
� �iSaI13
'.E+? gommtssion # CC 925828
Expires April 6, 2004
Atlanli Bonding Co., Inc.
DK Welt) ft
y
f PPRo ice
Witness(sign and print)
(date of survey)
Affiant is personally known to me,
AFFIDAVIT
STATE OF FLORIDA)
COUNTY OF DADE) //�
The undersigned Affiant,6/' e G(�,�1�6�v /,75 , does hereby attest that the
' property owner)
attached survey, performed by 5/.2.4/ C�C�
n ame of surveyor's company)
performed on , is an accurate representation of the existing conditions and
locations of all structures on the property as of this date.
The purpose of this Affidavit is to induce Miami Shores Village to 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 perm. � `` �1111I//�� '
o�p� YPG�4� M Franco
m ans ,:,'' =Co �Sarls
Further, Affiant sayeth naught. i _ . ; ,, _ mmission # CC 92582
�! �: ?� Oe Expires April 6, 2004
�0 MIant Bonded m
O
ink! Co., Inc.
Affiant/Property owne
SWORN TO AND SUBSCRIBED before me this day of T2G., 2003
L e as identification.
Witness(sign and print)
1111111111111111111111 1110111111111111111111
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECT1ION
PERMIT NO. TAX FOLIO NO. (I 30.06-013-9(01o:
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 is provided in this Notice of Commencement:
1. Legal description of property and street address: 270 Ng 101 5' 1 AMI 6 k) U+ZS
f L 33 t39 . Lot 5 1 blil 3% M 4.1-ti Senores Sec 1 P6 Jo 1 (G 10
2. Description of ' prov men': S' C 34,9c pS l
3. Owner (s name and address: #&l/ 6.9
1 /v
Interest in property: 0 (/74
Name and address of fee simple titleholder: 1
4. Contractor's name a d address: 6 V P� c 10- 4 AM p h cr' fie. ,Itr1G
5ao4 134 ek MiAL4i t Vi 33175
Persons wit the State of Flo
a ovided by Se 'on 713.13 (1) (
In additi. - to himse , Owner desi
in Section 7
ddress:
a designated by 0
Florida Statutes:
er upon whom n
So
ates the following p- on (s) to receive a
13 (1) (: 7., Florida atutes.
it nd County rts
D.C.
• 1
ces
other documents m
,tc
STATE OF FLORIDA, COUNTY OF DADE
5. Surety: (Payment bond required by owner from
{ f�c ,I,i iraPyr)st this is a true opy of the
7ripmal filed rhrjbo�thce on
Name and address:
Amount of bond: $
6. nder's name an
7.
served
prove
e and addres
Name and add
9. Expiration date
unle . • . ifferentdate in
17.
Signature of Owner
o' . is Notice
specified)
" "TN1iSS my hand and Of
•IARVEY RUVIN, CLERK,
Print Owner's Name
Sworn to and subscribed before e this 1 day of.LAC, 20 03
Notary Public�J',C:4
Print Notary's Name 1, 4M 0(1 Taal Ca /6etAIS
My Commission Expires: 4 I m' 04
CFN 2003R08
OR BI: 2187E Ps 2091►
RECORDED 12/05/20)3
HARVEY RUVIN, CLEO,
MIAMI -DADE COUNTY ► F
LAST PAGE
D 20
da
C7
y of the Lienor's Noti
ommencement (th- -xpiration date is 1 year from the date of
t ,`�iPAYP{����i� > Marola Franco /Sans
'T.:Commf sion # CC 925828
*�• aQ B Expires April 6, 2004
on d Thna
,,,,+fn„,,, Atlantic Bondin
g Co„ Inc.
ecording
Prepared byi C/• A /9 /114
Address: /0 je f e A
97494
1Ps)
12:19:03
OF COURT
LORIDA
as
ELECTRICAL
TYPE
Minimum Fee
QTY.
i 1'E
Dryer
Q'F''.
TYPE.
Outlet, Appliance
Q"I'1'.
"I'YI'I':
Service Repair
Q"I'V.
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
rs'IECHANICAL
T1'PI:
Minimum Fee
QTY.
TYPE
Condensate Drain •
QTY.
TV
Generator
QTY.
'11YPE
Refrigeration, Tons
QTY.
A/C Central, Tons
Cooling Tower
Heating Strips, each
Vent Hood, Cost
A/C Wall/Win. Tons
Dryer Vents, Number of
Paint Booth
Ventilation, Cost
Air Handler, Tons
Ductwork, Cost of
Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
Process/Pressure Piping
Supply, AC Well
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
Temporary Toilet
PLUMBING
TYPE
A/C Condensate
QTY.
TYPE
Drains, Roof
Q"I'Y.
'nil:
Miscellaneous Fixture
QTY.
TYI'I
Soakage Pit
Q"rY.
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
❑ 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
❑ IMPACT FEE
(New Construction)
SECTION
8 2003
Zoning
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
BY
DATE
DEC
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ OTHER
(Specify & Attach)
(s .60) x/1000
x (¢.005 /sq.ft.)
(¢.01 /sq.ft.)
PERMIT APPLICATION
CHECKLIST
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
PERMIT FEES
1 LS
S 4o, 00
—61 lcb
TOTAL $
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 a http : / /www.miamishoresvillage.com
Page 2
IMPORTANT NOTICES
DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant
the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m.
to 5:00 p.m. No inspections will be conducted on weekends or holidays.
2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris.
3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS.
4. , SWALES MUST BE PROTECTED FROM BEING DAMAGED 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.
. t .
Application is hereby made to obtain a permit to do work and installation as i nd i cate d . I, th 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, rFENCE, :DRIVEWAY,
ROOFING and SIGNS and therm may be additional required from other governmental agencies.
I, the OWNER of the property, have disclosed "aid' n fon iation related to any work at the property - petformed in the prior twelve
months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and
any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the
present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business
under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must
conform to the current code requirements of the Building Code.
WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for
improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with
your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at:
22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in
accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and
Choosing a Contractor.
STATE OF FLORIDA, COUNTY OF MIAMI -DADE
l7ure Owner v
S
Ad
Print Name
wom o and subscribed before me this day of Vac-
/
a(4, ! L4119 1 e -
Signature of Notary Public - State of Fl
Marola Franco /Sans
YP
''o= Commission # CC 925828
Expires April 6, 2004
, Atlantic Bonding Co
Personally known OIl�')'oduced Identific
SEAL:
Type of Identification Produced:
Bc ui Thru
D
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/LIB
Signature of Contractor
�illi am S•
Print Name �,,
om subscribed before me this day of - 24.•
Signature of Notary Public - State of Florida
SEAL:
PERMIT APPLICATION
A, COUNTY OF MIAMI -DADE
• yr i7 YELINE SANS
1, MY COMMISSION # DD 209288
�oF boa EXPIRES: June 3, 2007
TARY FL Dis , nt Ass. .
rson
fication
pe of Identification Produced:
CONTRACTOR
Namec�
a/ 4-
Licen N e ° e9/ O 0.
Add ress
��yew / 3 , c /
13/7 /22/, 3 3/ oZ/
Telep e /) o//63 Fax
Name Ow die( '44.5
PROPERTY ONER
New Construction
Name e/1/ i '›
, //J,$
Address /
79 'V a /s
/` /Zt '/ S
X 3%3?
Home Telephone 6 , j/ 1 77
y x2-4-
Business Telephone
Alteration Interior
Fax
Demolish
ENGINEER
New Construction
Enclosure
Name
Alteration Exterior
Name
Repair
License No.
Alteration Interior
Demolish
Address
Relocation of Structure
Shell Only
Telephone
'
Address
Add'l Attachment
Fax
Other
•
% -,'`
ARCHITECT
New Construction
Enclosure
Alteration Exterior
Name
Repair
Alteration Interior
Demolish
License No.
Relocation of Structure
Shell Only
Foundation Only
Address
Add'l Attachment
Other
Add'I Detachment
Telephone
Other
Fax
b
. 0- ;
•
'
z • • .
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
_MC 0 , 5 Ha
Step 1.
AlritAlk
INSTRUCTIONS - The followirng, steps must be taken f.9 obtain a permit from the Miami Shores Village:
Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please
print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submit-
ted along with this permit application.
Step 2. Submit the completed 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
, /, /> ic/i & S , -,-6_s
Address Apt. City
Folio Number
it— 3 O �o — O 3 ' 46 O /Description of Work f ,e_ ,.... _,,
Lot 5 Block 34 .� • A/.i�/ 1
Subdivision M • S1IDP€S Sc I PB 10 PG 7 0 Zoning Linear Feet
Current Use of Property IDi3'/4,504A 569C6/2.5 SS''are Feet 1 I So Units 1 Floors I
Proposed Use of Property QES • " Value of Work it 6080 O O Bldg Value
Tenant Information Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
Job Address:
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
s o, b O � 11 �
•
Master Permit No.
Subsidiary Permit No.
State
PERMIT APPLICATION
3 3/3
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
Architect
Contractor
or Builder
Legal Lot Bl.
Description
Address of
Building
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N9 2929
Work to be performed under this Permit
Subdi-
vision
Value of
Project
DATE
Contractor's
License No.
/ 194
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 drawings or in the statements or specifications and
that he assumes responsibility for work done by his agents, servants or employees.
Signed• 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 conforrhity 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. �.
CONTRACTOR OR BUILDER BY AUTHORITY