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390 NE 101 St (15)PROPERTY OWNER Name ( (L.lr �. 0 —(ei '"' ' li�- \ A ddress S-0 / K 0 5 G ti (/\cL/l' - 1 5 7. -0 — a— Lcgc c -Home Telephone Business Telephone . ✓�6— / '3/ 6 -' -36363 Fax u it TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'l 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. A Job Address: � ° 1/0 . E 1 c ( 6 f /0 . nvLI),_4 City State Address Apt. Folio Number Description of Work Lot Block Subdivision PB PG PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Master Permit No. Subsidiary Permit No. PERMIT APPLICATION Zip � V '- Zoning Linear Feet Current Use of Property Square Feet �r Proposed Use of Property V e of Work CA_ (� 1�1 t 4 V. ue Tenant Information Tax Assessed/Appraised Value Flood Zone Base Floor Elev. nits . Floors ENGINEER Name License No. Address Telephone Fax CONTRACTO Name License No. Address Telephone Fax Qualifier Name 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. AFFIDAVI'1' - Please read ca refully. 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. f Owner 1 i ((jj / signature off Contractor / Qualifier Print Name / and subscribed before m this L ( day of S gnature of No ;Public Sta a of Florida SEAL: SEAL: Personally known Type of Identification Prod ORIDA, COUNTY OF MIAMI -DADE STA 0 DA, COUNTY OF MIAMI -DADE /O l O � P ttY PUe E OFFICIAL r'OTAiV Sri.L e, ANGELA BECiKER II 2 .)';' C+ coca as aumsar. n .7x669 N • MY C .' : 1 '• . • . a 11 f P Print Name Sworn to and subscribed before me this Signature of Notary Public - State of Florida day of Personally known OR, Produced Identification PERMIT APPLICATION Type of Identification Produced: Bank of America Advantage'" JOHN DORSCHNER OR KATHLEEN MARTIN 305 - 754 -4969 390 N.E. 101ST ST. MIAMI SHORES, FL 33138 -2425 ,, n '<tc,2_,D6 ( Pay to tf/iorder of !� �j \ tg ( Bank ofAmerica. ACH FUT 063100277 Date Memo �r/ GLC i ` a.-e' v►l 1:0631.00277d 103SL313,962311' 3970 3970 (6.0.• O 63 27!631 FL 988 "°itzt .. tlbllars a ,. ,,, tVe MIAMI SHORES VILLAGE Paint Color Approval and Agreement %DATE: � 0 - I 0 o VOWNER'S NAME: �Gc l/L-( HONE: 3c) 3' — '754 -c(qb / //ADDRESS: p4 > • (c7 ********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** `ADDRESS OF SITE: q0 C91 CONTRACTOR & LICENSE (if applicable) r/1 OMPANY NAME: ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Walls Fascia Drip Cap/Drip Edge Soffit Roof Flower Bins 1/1 rt kkDt Shutters vl Awnings M / Cv �' Chimney Q �, Doors and door jams Garage Doors fr/ Railings Fences vi Decorative Metal All brick (simulated,or re Stucco Banding Any other stucco features All Elements on the site must be listed and indicate the color to Building Offi a Date C, l "lam' �d ONE: `1a. 3663 Mo�jj Latex House Paint H 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. I authorize the above -named contractor, if applicable, to do the work stated. Furthermore , the paint colors will be as per the attached gnature of Owner Date ignature of Contractor Date ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED: `t bo 4 ' HEN PAINTING IS FINISHED, ��d ®' 4� ,a 4 CALL FOR FINAL INSPECTION 4/23/01 — Odessa Pink ' -59 �' 0 ft 4'4 CC a 64 C)C_ oV/ Queen Anne Pink HC -60 3 ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. TYPE Outlet, Appliance QTY. TYPE Service Repair QTY. A/C Central 1 -3 Ton Heating Strips, each Fan Outlet, Wall Service, Temporary Paint Booth A/C Central 4 -7 Ton Fire Pump Outlet, Switch Piping, Flammable Liquid Signs A/C Central 8 -15 Ton Fixture - Fluorescent Process/Pressure Piping Oven Space Heater (kw) A/C Central 16 -20 Ton - Pressure Vessel 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. 'rvPE Refrigeration, Tons QTY. A/C Central, Tons QTY. 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 Pump and Abandon Bath Fan - Vented, # Fireplaces, Number of - Pressure Vessel Gas - Appliance PLUMBING TYPE A/C Condensate QTY. 'TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. TYPE. Soakage Pit QTY. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet •+ Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: SECTION BY (),0A DATE __-_)--/b) Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official y_ � ° f$ -d Page 4 OFFICE USE ONLY CHECKLIST U OWNER - BUILDER FORM (Attach) U FIRE DEPARTMENT APPROVAL (Commercial / multi- family) U CONCURRENCY (New Construction) U OTHER (Specify & Attach) O PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) O 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 $ e l t/ (sq.ft. = x/1000 x 0.60) $ L J 1 ISSUING OFFICIAL (7 c) (¢.005 / sq.ft.) (¢.01 /sq.ft.) REVIEWED AND PREPARED BY: PERMIT APPLICATION O CONDO ASSOCIATION APPROVAL (Attach) O BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ L � v DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2"° AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com Date / Job Address 3 qO C ©/ - 5 Tax Folio 11 Jq' 13 Legal Description '° �- Lessee / Tenant Cc� ( � 2 ' " ` a L ' �. Master Permit # - / frt 0125 Owner's Address 3Y O 1 4-E tot Sf-' Phone - 7 60 4q (e 1 Contracting Co Cam" �� 21 1 ( Address / `2. o E `7 7 . Qualifies ) ©✓' Q, Qt (7 2i I Z5Phone - 7 5 7 - 3 3 c e ( ^2 57 1z v71 o� s State (� 55 `84 - 3 Municipal �� � $ Competency 4� Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN WORK DESCRIPTION � _ " — / ; 4 : 1 1 - - - "t Q©Cn Square Ft. Estimated Cost(value) I WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT). Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accura and that =11 work will be done in compliance with all applicable laws regulating construction a zoning. rthermore, I autho ize - "e above -named contractor to do the work stated. 4 Signatur owner and /or Condo President Date: /� / 7 11 /1 10 144iii. /4 6 a 11.4. e.;•. JOSEPHINE CHURCH lr; :li D i m ar has to �' a n .. —� r • . y M � �cr °; No. CC197545 My Commission Expire FEES: PERMITg /. SC) RADON C.C.F. /° 0 D NOTARY . < Oe TOTAL DUEiJ, APPROVED: Zonin PERMIT APPLICATION FOR MIAMI SHORES VILLAGE * * * Mechanical Plumbing r • to y as to C y Commission S (0 c90 gnat ate' / Contractor or Owner- Builder LAO * ** Other Electrical Engineering