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400 NE 101 St (5)PROPERTY OVOER New Construction Nam n V Alteration Exterior Address L4I 101 S i7v Home Telephone 3 s' ( c T / IIJJ jo Business Telephone Relocation of Structure Fax Foundation Only TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'l Attachment Other Add'l Detachment Other INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step I. 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 K Job Address: 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. 1400 OE 101 St' r tok m 1 S$10 - Z 3 3(g Address Apt. City 1 St 1 at te e (e3(41 Zip Description of Work ?Oki f io� Folio Number Lot Block Subdivision PB PG Current Use of Property Proposed Use of Property Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax PERMIT APPLICATION Master Permit No. ' Subsidiary Permit No. P ' C T 6 . Zoning Linear Feet Square Feet Units Floors fn Value of Work °„ 2Thr4 Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. Address Telephone Fax Qualifier Name %?( Page 2 'PERM, IT APPLICATION 1N1 I'ORTA NT 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 n 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Signa of 0 e is Sta o accordance wi Ch .. a C i ntractor. et* ry s� • > C Y OF MIAMI -DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE Print Name to and subscribed before me dit i Signature of otary Pub Signature of Contractor / Qualifier Print Name day of , Sworn to and subscribed before me this day of Signature of Notary Public - State of Florida �Ptty Po tr...",; . At. SEAL: O • t !� G1Nf ci_ 1 i_, e.. �i l 'O h:. Gri6d.=.., Personally known nt 01V, Produ�Cdldentfl#eaN6 Personally known OR, Produced Identification --)) • Type of Identification Produced: � ). 9 iS I) 1)-43 -,:).4.--- b n ►ype of Identification Produced: SEAL: Village of Miami Shores 10050 NE 2nd Avenue Miami Shores, FL 33138 Phone: 305 - 795 -2204 Printed: 3 /5/2002 Applicant: CARL Owner: SAIA Contractor Local Phone: Parcel # 1132060170480 Job Addr s: 400 NE 101 ST Legal Description: 01 V \/ Address: Cellular: Permit Status: Approved Permit Expiration: 8/28/2002 Building Permit Permit Number: BP2002 -440 PAULSEN BRIGID Work: PAINT EXTERIOR AS PER AGREEMENT (OWNER BUILDER PERMIT) Page 1 of 1 AMD PL OF MIAMI SHORES SEC 4 PB 15 -14 LOTS 11 & 12 BLK 90 41-4}7 Construction Value: $2,000.00 0 Total Fees: $0130 Total Receipts: $0.00 If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection fee is $50.00, which must be paid in advance before calling for another inspection. /CI e CitiLW UI e Al' ii0r1' �'r•..A: A iii''.uli u .�Ea�4T.i Vi a+.: >�.wcVxa•v..... ...-. ._ -.- c¢vca.�r. -_ .. _ _vr....f This Permit is granted to the contractor or builder named above to construct the I ordinances pertaining thereto and with the understanding that the work will be perfo and approved by the proper municipal authorities. This Permit may be revoked at E authorization. A further condition upon which this permit is granted is the understar ordinances and regulations pertaining to the work covered hereby whether shown o by his agents, servants or employees. Signed: (INSPECTOR) In consideration of the issuance to me of this permit, I agree to perform the work with the plans, drawings, statements or specifications submitted to the proper authc myself, my agent, servants or employes. Signed: (Contractor or CARL F. PAULSEN MARIA A. PAULSEN 271 N.E 101ST STREET MIAMI SHORES, FL 33138 -2422 NaLionsBank, N.A. ACHR/700 47 63 -4/630 Fl 254 DATE;— —C2 1 THE 1'n 1�U�1 C f1�c�,►�— (1 la I $ Coto ?k7 O RPE (5A S O,-\ Z'°A d a DOLLARS NationiBank FOR 1:0 6 30000 4 71: 00 L L9756989 20 2861 2861 0 CI. on wnnln AVfi I Fn* Village of Miami Shores 10050 NE 2nd Avenue Miami Shores, FL 33138 Phone: 305 - 795 -2204 Printed: 3/5/2002 Applicant: CARL Owner: SAIA Contractor Local Phone: Address: Cellular: Parcel # 1132060170480 Legal Description: Job Addr s: 400 NE 101 ST -6 O. O d I( V \17 Permit Status: Approved Permit Expiration: 8/28/2002 Work: PAINT EXTERIOR AS PER AGREEMENT (OWNER BUILDER PERMIT) If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection fee is $50.00, which must be paid in advance before calling for another inspection. Nom- ',:-. •:pia. ` '�.e= .Ck'Ya' Fit• - -�_. - �.:..c �mm�li�nrawith,.all This Permit is granted to the contractor or builder named above to construct the r +�'`�slF�3S"d.. -:d czs . •rte; -� � = ,,.�. -.:� . - ��,�� � �� ordinances pertaining thereto and with the understanding that the work will be perk and approved by the proper municipal authorities. This Permit may be revoked at authorization. A further condition upon which this permit is granted is the understa ordinances and regulations pertaining to the work covered hereby whether shown by his agents, servants or employees. Signed: (INSPECTOR) In consideration of the issuance to me of this permit, I agree to perform the wort. with the plans, drawings, statements or specifications submitted to the proper autl myself, my agent, servants or employes. Signed: (Contractor c Building Permit Permit Number: BP2002 -440 PAULSEN BRIGID AMD PL OF MIAMI SHORES SEC 4 Construction Value: I , CARL F. PAULSEN 63 MARIA A. PAULSEN 2861 271 N.E. 101ST STREET MIAMI SHORES, FL 33138 -2422 1 () tom- Nation Bank: NationsBank, N.A. - ACH Rif OO O 7 FOR ' - 1 $2,000.00 s -0 0 ':OP, RiflflnnL 7,' Page 1 of 1 PB 15 -14 LOTS 11 & 12 BLK 90 Total Fees: UM Total Receipts: $0.00 1(14. la 'Par ono ]■ DATE. ;- -02 3 n r 1 ■v MIAMI SHORES VILLAGE Paint Color Approval and Agreement DATE: a.. -D 7, a OWNER'S NAME: SeAIN PHONE: '7SY 17 ADDRESS: 400 Kl€ IO 1 ********** *** * * * ** *** **:k*?k* ** ** * **** **# k?k?k *** ADDRESS OF .SITE: X00 1 10 CONTRACTOR & LICENSE (if applicable) COMPANY NAME: d • the wor stat: d. Furthermore , the pain ******** * * * * * * * * * * * * * * * *o * * * * * * * * * * * * * All Elements on the site must be listed and ind Walls moor (IS 1 2 1 Fascia �.-O S C Fa l�f � �.- - 7 Drip Cap/Drip Edge it Soffit c f ac_P, (1101,, Roof 'A G � Flower Bins Sa, I : Shutters Awnings N IA Chimney Sall Cla`i° Doors and door jams LN'SIDu - Garage Doors &A i oile■ Railings Sam, e (- t Fences kilt) 6- Sat i Cl o - Decorative Metal w X44zz.) All brick (simulated or regular) Sc,,t 1 C1644--. Stucco Banding dl 1J a r Any other stucco features Accessory Buildings Other 1 OWNER'S AFFIDAVIT: I certify that all th€ and that all work will be done in compliance NA constructio' . zoning. I authorize the abo (; 1 to t J3 * Sail Cloth 77 ture of Owner Date Signature of Contractor Date ited. 0 0 Si *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED: WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION Building Official Date 4/23/01 The Sunshine State — LICENSE NUMBER P425- 126 -63 -212 -0 CARL FRANCIS PAULSEN JR 400NE101STST MIAMI SHORES, FL 331384449 RtRTH DATE SEX HGT. REST. ENDORSE. 06 -12-63 M 6.00 A ISSUED EXPIRES 0S1.96 061202 DUPLICATE 11 -1301 SAFE DRIVER X660111190041 Operation of motor vehicle constitutes consent to any sobriety test requied bylaw. ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. TYPE. Outlet, Appliance QTY. TYPE Service Repair TY. A/C Central 1 -3 Ton Dryer Vents, Number of Fan Ventilation, Cost Outlet, Wall Ductwork, Cost of Service, Temporary Periodic Inspections A/C Central 4 -7 Ton Fire Sprinkler System Fire Pump Outlet, Switch Fireplaces, Number of 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 r' 1ECHANICAL TYPE QTY. Minimum Fee TYPE Condensate Drain Q TYPE Generator QTY. TVI'I: QTV. Refrigeration, Tons 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 Bath Fan - Vented, # Fireplaces, Number of - Pressure Vessel PLUfIBING TVI'I•; A/C Condensate QTV TYPE Drains, Roof QTY TVI'I•' Miscellaneous Fixture QTY TVI'I? Soakage Pit Q 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 DATE/ /'�s Zoning /�� � Electrical Mechanical Plumbing Fire Public Works Structural ��_ Building Official >1 Page 4 OFFICE USE ONLY U OWNER - BUILDER FORM (Attach) U FIRE DEPARTMENT APPROVAL (Commercial / multi - family) U CONCURRENCY (New Construction) U OTHER (Specify & Attach) $3.00 per page (Scanning Fee) Miami Shores Village Bond Inspector State Educational Fund $ State DCA (Radon) $ Code Enforcement Fine Zoning Review ❑ IMPACT FEE (New Construction) $ Metropolitan Dade County (C.C.F.) $ / ' ° 0 $ ❑ OTHER (Specify & Attach) CHECKLIST ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) PERMIT FEES (sq.ft. = x/1000 x ¢.60) (¢.005 / sq.ft.) (¢.01 /sq.ft.) REVIEWED AND PREPARED BY: PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) O BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ a 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 Owner of Building I Architect Contractor or Builder CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA BUILDING Ig-• / i DATE ELECTRICAL PERMIT 'NA 12251 Contractor's PLUMBING (i License No ROOFING ❑ Work to be performed under this Permit Legal Lot II BL Subdi- Description vision Address of r' E Value of - / 1 Amt. of / y Building S ► Project $ f' % f ',. / Permit $ j 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 n 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. A l Signed• f — INSPE B Y a In consideration of the issuance to me of this permit I agree to platform 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 responsibility for all work done by either, myself, my agent, servant or employee. /0 - BY AUTHORITY °"�`� Owner's Name and Address (2 Registered Architect and /or Engineer Name and address of licensed contractor Location and legal description of lot to be built o Lot Block Street and Number where work is to be done State work to bed nd purpose of building (by floors ) __ MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the•Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and ,specifications must be kept at building during progress of the work. Subdivision_ Permit No 1 / Date Disapproved Date ( Signed) Date / 0 ` a V . / , 19 �+ No Street JAL 1 f and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $___ Amount of Permit $ Zone cubage required _Plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on .work to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) X STATE OF FLORIDA, COUNTY OF DALE. f ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction,.that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Read, Sworn to and Subscribed before me. Notary Public, State of Florida Building Inspector My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member / Member Council Approved — Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.