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441 NE 101 St (4)CONTRACTOR0 , , A a PROPERTY OWNER / /� Name 1fC/c/�i CG (/f 2 e O A Address / / « 4/7 Wi2 /O/ j 7/1 j; -4 7 4 Eli � Home Telephone 0O� ✓ 751- 5/0g Business Telephon , ii v.. f2 3 y Fax TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'I Detachment Other INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted along with this permit application. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. APPLICATION Job Address: 4'4/ N. C. /D/ dr f Address / X'pt. Folio Number , ff � o `� 0 4 (� Lot l$' SA) L (O tel Block Subdivisio 15 PG Current Use of Property f;v El sill / C Proposed Use of Property f /v� wAL /e Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Zoning Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax /41;✓9't a ,)/9, Description of Work Master Permit No. Subsidiary Permit No. O 372, PERMIT APPLICATION City / State Zip ,eE�J ✓it ideil ;ft5 Linear Feet Square Feet Units Floors Value of Work / 7rd. O • Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT CHANGE (✓ ) ENGINEER Name License No. Address Telephone Fax TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'I Detachment Other INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted along with this permit application. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. APPLICATION Job Address: 4'4/ N. C. /D/ dr f Address / X'pt. Folio Number , ff � o `� 0 4 (� Lot l$' SA) L (O tel Block Subdivisio 15 PG Current Use of Property f;v El sill / C Proposed Use of Property f /v� wAL /e Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Zoning Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax /41;✓9't a ,)/9, Description of Work Master Permit No. Subsidiary Permit No. O 372, PERMIT APPLICATION City / State Zip ,eE�J ✓it ideil ;ft5 Linear Feet Square Feet Units Floors Value of Work / 7rd. O • Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT CHANGE (✓ ) ENGINEER Name License No. Address Telephone Fax 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: 4'4/ N. C. /D/ dr f Address / X'pt. Folio Number , ff � o `� 0 4 (� Lot l$' SA) L (O tel Block Subdivisio 15 PG Current Use of Property f;v El sill / C Proposed Use of Property f /v� wAL /e Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Zoning Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax /41;✓9't a ,)/9, Description of Work Master Permit No. Subsidiary Permit No. O 372, PERMIT APPLICATION City / State Zip ,eE�J ✓it ideil ;ft5 Linear Feet Square Feet Units Floors Value of Work / 7rd. O • Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT CHANGE (✓ ) 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. ST OF FLORIDA, COUNTY OF MIAMI -DADE ' r Signature of Owner Print Name SEAL: Personally known }(j)aLA M - Ck Z Salo\:# (1 COuksSSON NUMBER .L ; 2ar';: , CC786697 r ∎© MY COMPhSSION l' OF F P 61CV, 115,2.0)2 OR, Produced Identification STATE OF FLORIDA, COUNTY OF MIAMI -DADE ignature of Contra r / Qualifier , Z Print Name Sworn to and subscribed before me this day of Signature of SEAL: Personally known PERMIT APPLICATION - • io !, .00..k, ROCOLF0 JUNCO %,,,.": MY COMMISSION @ CC 852366 'a EXPIRES: July 6, 2003 z c.,.• Bonded Thru Notary Public Underwriters tit told OR, Produced Identification Type of Identification Produced: F4 AL. 01 Type of Identification Produced: 5 euo b12 I - If 10 11 q nl It ti i ll G 11 • 1 • S vatrp UNLESS EN.SCSSED WITH SURVEYOR'S SEAL REVISED: L 'sq f2. °, i uETfIL a 6 I �K 2 � u,,, i v co 1 2. No I v PO (P• u12 1 ' r 3 - 10.20' < 2 m c(\ N N X21 3.80'( 0 h• 4 ' 20,420 1 HEREBY CERTIFY That the survey represented hereon meets the minimum technical requirements adopted by the STATE OF FLORIDA Board of Land Surveyors pursuant to Section 472.027 Florida Statutes. There are no encroachments. overlaps. easements appearing on the plat or visible easements other than as shown hereon ADIS N. NUNEZ Regis :ere:ILand Surveyor No. 5924 State of Florida DATE: 10-30 - 00 SCALE: ' 1 20' DWN. BY: F.131,6,14 C0 JOB No. 00- r703 , 'Burt); C Au,F,Y ) 6 1 0, 00 l4 42 ,s- 42.80' • a . • • N • `? /O:Zo' 1,!e /-).(atz -ge , Ua. 40I-( 2o, go' BOUNDARY SURVEY I 'e 64 ' 1.3o : r: 4.c>0' N • F N D =Found .,_i1 & Disc ii , /, !_ L' w F. 4!4 P. 1 0 ZS.4o- 3.5 a, oo ' N 'e• • S &tpEcv,i. z- . 11.70 x ,. 33' A¢ , 3 ' 2.4 f pi2uJ Ati{ r 1.115 ., Ot 1 1 20' WI fAi11. Eit1V t% ) LEGEND : FIP= Found Iron Pipe_ S.P.0 = SET 1 /2 PIN & CAP LB4789 S.PCP= SET PERMANENT CONTROL POINT LB4789 CENTERLINE. P /L= PROPERTY LINE. 0 /L= ON LINE M.H.= MANHOLE. WM= WATER METER PP= POWER POLE F.C.= FENCE CORNER, R= RECORD, M= MEASURED CHAIN UNK OR WIRE FENCE= • - W000 FENCE= MASONRY WALL= CONCRETE= t:. :'• ••• • . • • • • • • **: M.A.D•rram E 6 MENAGE EASFJ r b . NOTES: UNLESS OTHERWISE SHOWN. THE FOLLOWING NOTES APPLY. i) Record and measured calls are In substantial agreement. 2) Bearings. if shown are based on Plat data 3) The lands shown hereon were not abstracted for Easements or other recorded emcumbrances not shown on the plat and :he same, if any may not be shown on this sketch. 4) Underground portions of Footings. Foundations or other improvEner.ts were not located. 5) Elevations are based on National Geodetic Datum. 6) Fence Ties are to the Centerline rline of the fens :e. 7) Wall Ties to the face of the Wall. 8 HFkR NG Sv'I' i SHOW ARE _ REFERED TO AN ASSUI`*:.•D 14117 SAID FB P?.GE E eva:IC'•5 be cr: Elev. r:GV t;_ty -. Locator Index pa 10, N o D ul k Q t - LOCATION S K E T C SCALE : N T S yiJ 14 15 II ll II tie lal 5 CERTIFIED TO: MICHAEL R. OBREGON, A SINGLE MAN, 441 N.E. 101ST ST., MIAMI SHORES, FLORIDA 33138., SCOTT R. JAY, ESQ., ATTORNEYS' TITLE INSURANCE FUND, INC., COUNTRYWIDE HOME LOAN, INC., ITS SUCCESSORS AND /OR ASSIGNS, ATIMA. LEGAL DESCRIPTION: LOT 18 AND THE W. 40 FT. OF LOT 19 BLOCK 91 OF AMENDED PLAT OF MIAMI SHORES SECTION NO. 4 SUBDIVISION ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 15 AT PAGE 14 OF THE PUBLIC RECORDS OF MIAMI -DADS (COUNTY. FLORIDA.' (305) 865 -1200 • Fax (305 865 -7810 FLOOD ZONE: . IG SINCE 1987 BLANCO, DANIAL & ASSOC. INC. Engineers • Land • Planners LB 1/ 4789 555 NORTH SHORE DRIVE MIAMI BEACH FL. 33141 00 20 LL Z7 STATE OF FLORIDA) COUNTY OF DARE) The undersigned Affiant, 1 gEj OA) , does hereby attest that the (property owner) 4 /1/r/ / A ,_ V ' rOc (name of surveyor's company) J , is an accurate representation of the existing conditions and attached survey, performed by performed on 70 /J (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) Affiant is personally known to me, Witness(sign and print) SWORN TO AND SUBSCRIBED before me this --j- day of (' . �� 0 roduCedf&bi--- ^556 ^S1 i2tificati.on. : ELA 1C1AL NOTARY SEAL P RY P M BECKER , f ,�, r i� OMMISS10N NUMBER CC78 r : 2 i u A". Q S$ION fc%PiRES NOV 9 5,2002 F O f F�0 ELECTRICAL TYPE, Minimum Fee QTY. TYPE Dryer QTY. TYPE Outlet, Appliance QTY. TYPE Service Repair QTY. A/C Central 1 -3 Ton Cooling Tower Fan Outlet, Wall Service, Temporary A/C Central 4 -7 Ton - Paint Booth Fire Pump Ventilation, Cost Outlet, Switch Air Handler, Tons Signs Ductwork, Cost of A/C Central 8 -15 Ton Fixture - Fluorescent Oven Space Heater (kw) - Process/Pressure Piping A/C Central 16-20 Ton Fixture Light Bath Fan - Vented, # Parking Lot Lights Fireplaces, Number of 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 . Minimum Fee QTY . l . YIE Condensate Drain Q. TYPE Generator Q - l ' Y . 1 . YP1.; Refrigeration, Tons Q A/C Central, Tons Bath Tub Cooling Tower - Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of - Paint Booth Filter Replace Ventilation, Cost Pool Piping Air Handler, Tons Sprinkler Repair Ductwork, Cost of - Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System - Process/Pressure Piping Cap - Water Gas - Appliance Bath Fan - Vented, # Pump, Domestic Fireplaces, Number of Pressure Vessel Cap - Sewer PLUMBING TYPE A/C Condensate Q.l.Y m i.: Drains, Roof QIN. 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 DATE >v ; J / /2 Zoning , / Electrical Mechanical Plumbing Fire Public Works Structural Building Official Y °' Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (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 ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) $ np (� $ f 1 ( (sq.ft. = x/1000 x 0.60) $ (¢.005 / sq.ft.) $ (4.01 /sq.ft.) ISSUING OFFICIAL _S tro REVIEWED AND PREPARED BY: PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ 3 b b :\O 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