511 NE 101 St (8)MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date 0 ime
Type Insp'n
Permit No.
Name
Address
Company
Phone #
For Inspector) I t'j / -3 Name & Date
Approved
Correction
Re- Insp'n Fee
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MIAMI SHORES VILLAGE
• BUILDING DEPARTMENT
305- 795 -2204
Bui din Inspection Request
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Date Time
Type Insp'n't 1 cCXnCite 0c •
Permit No. EI- x13 - 1
Name --- ronA \Cnn'
Address 51 ` V■CE 10 ` 5�
Company 16tQ Y1 C J
Phone #
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Re- Insp'n Fee
Name & Date
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No. 4
$30, o0
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1182
BUILDING
PERMIT APPLICATION
FBC 2001
- 7 W f 1J,0 P fI 130
Miami Shores Village
Building Department
Permit No.
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Master Permit No. 03 /0/0
Permit Type (circle): Building lectrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) Phone #
Owner's Address 5 i) NO- lb l 9
City
Tenant/Lessee Name
Job Address (where the work is being done) 54/►'-e_
Number of: Bays Stories Families
Type of Work: ❑A ition ❑Alteratjon
Describe Work: l" ' / c5 / Q/1i
State
Zip
Phone #
City Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES NO
Contractor's Company Name Phone #
Contractor's Address
City State Zip
Qualifier
. Phone #
Architect/Engineer's Name (if applicable)
Architect/Engineer's Address
City State Zip
$ Value of Work For this Permit Square Footage Of Work:
* * * * * * * * * * * * * * * * * * * * * * * ** Fees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Bedrooms Baths
['New ❑ epair/Replace Demolition
e A-
County Escrow Fee $ Permit Fee
Education/Training Fee $ Tech $ Scanning $
Code Enforcement $ Bond $ Struct. $
Notary $
Radon $
Minus Plans Check Fee $ Total Fee Now Due $ (Continued on opposite side)
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.
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 , day of ,20
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: / � JUL 14 2003 Plans Examiner
Engineer
Zoning
chc7/7 /03
MIAMIDADE
Imo
BUILDING CODE COMPLIANCE OFFICE (BCCO)
PRODUCT CONTROL DIVISION
511 IJE.. 101 s f - -
SP 2oCB° 1 O lb
NOTICE Or ACCEPTANCE (NOA)
MIAMI -DADE COUNTY, FLORIDA
METRO -DADE FLAGLER BUILDING
140 WEST FLAGLER STREET, SUITE 1603
MIAMI, FLORIDA 33130 -1563
(305) 375 -2901 FAX (305) 375 -2908
DAB Doors Inc.
12195 N.W. 98 Avenue
Hialeah Gardens, FL 33018
SCOPE: This NOA is being issued under the applicable rules and regulations governing the use of construction materials.
The documentation submitted has been reviewed by Miami -Dade County Product Control Division and accepted by the Board
of Rules and Appeals (BORA) to bc uscd in Miami Dadc County and other areas where allowed by the Authority Having
Jurisdiction (AHD.
This NOA shall not be valid after the expiration date stated below. The Miami -Dadc County Product Control Division (In
Miami Dade' County) and/or the AHJ (in areas other than Miami Dade County) reserve the right to have this product or
material tested for quality assurance purposes. If this product or material fails to perform in' the accepted. manner, .the
manufacturer will incur the expense of such testing and the AHJ may immediately revoke, modify, or suspend the us6 of such
product or material within their jurisdiction. BORA reserves the right to revoke this acceptance, if it is determined by Miami -
Dade County Product Control Division that this product or material fails to meet the requirements of the applicable building
code.
This product is approved as described herein, and has been designed to comply with the High Velocity Hurricane Zone of the
Florida Building Code. _
'DESCRIPTION: Sectional Garage Door16' 2" Wide.
APPROVAL DOCUMENT: Drawing No. 01 -19, titled "Sectional Residential Garage Door ", dated 04/06/01 with last
revision on 08/30/01, sheets 1 through 3 of 3, prepared by A1- Farooq Corporation, signed and sealed by H. Farooq, P.E.,
bearing the Miami -Dade County Product Control Renewal stamp with the Notice of Acceptance number and expiration date
by the Miami -Dade County Product Control Division.
MISSILE IMPACT RATING: Large and Small Missile Impact
LABELING: Each unit shall bear a_permanent label with the manufacturer's name or logo, city, state and following.
statement: "Miami -Dade County Product Control Approved ", unless otherwise noted herein.
RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no change in the
applicable building code negatively affecting the performance of this product.
TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in the materials,
use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of any product, for sales,
advertising or any other purposes shall automatically terminate this N(.)A Failure to comply with am section of this NOA
shall bc cause for termination and removal of NOA.
LIMITATION: This approval requires the manufacturer to do testing, of all coils used to fabricate door panels under this
Notice of Acceptance. A minimum of 2 specimens shall be cut from each coil and tensile tested according to ASTM E -S by
Dade County approved laboratory selected and paid by the manufacturer. Every 3 months four times a year, the manufacture
shall mail to this office: a copy of the tcstcd reports with confirmation that the specimen were selelad from coils at the
manufacturer production facilities. And a notarized statement from the manufacturer that only coils with yield strength of
39,000 psi or more shall be used to make door panels for Dade County under this Notice of Acceptance
ADVERTISEMENT: The NOA number preceded by the words Miami -Dade County, Florida, and followed by 1.1:
expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, then it shall be done in
entirety.
INSPECTION:' A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors and shall be
available for inspection at the job site at the request of the Buildin ial.
This NOA revises NOA # 01 -0626.01 consists of this page , 5 , , � e approval document mentioned above.
The submitted documentation was reviewed by Can s'do F P
NOA No 03- 0402.
Expiration Date: - October 04, 2006
Approval Date: April 24, 2003
Page 1
0(. 51G .03
CONTRACTOR
New Construction
Name el/ILJFaii boa- Co , Tide,
Address 0 g 6 , 66 8
,v.M tam l FL 33 2_6/
License No. op65 / Os./ 30_ id ' /6 Ob1
1
Address 3 , 3 q g {_ () .tom s r
Wes- Ft- 3313 $
1
T ele hone ( 0�) 70 _ c 113 Fax 76-7 _ t
P 11
r
� s
Qualifier N e op 1 n Lic
Demolish
PROPERTY OWNER)
New Construction
G
il N - (Iti0 mi e, K�/� L. 6 L
Name / '
Address 0 g 6 , 66 8
,v.M tam l FL 33 2_6/
Home Telephone 3 891 - Q 7 7
1
Business Telephone 3 S 9J 1 - 4 77
1
Fax 301 9 .5 - - 4 76 66
TYPE OF MANAGEMENT (✓ )
New Construction
/
Enclosure
Alteration Exterior
I/
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'l Attachment
Other
Add'I Detachment
Other
Step 1.
Job Address:
PERMIT TYPE ( ✓)
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
UN 2 3 2003
5// NC /0/ 57,
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Address
Name
License No.
Telephone
Fax
PERMIT APPLICATION
Master Permit No. 6P-2003 - 1010
Subsidiary Permit No.
INSTRUCTIONS - The following steps must be taken to 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.
APPLICATION
AI14 Shores fL 33 13 e
Address Apt. City la( Zip /�
Folio Number `I - 32 06 ' D eI 7 ' ago Description of Work V / 7P 5 l ( A e..44.) f a✓4 e DQ(� t� ,
'Lot 1 `Block (
i T /
Subdivision PB 1 PG ) Zoning / r 14 Linear Feet Aipt
Current Use of Property P.a(4&A UL.t Square Feet il,P 0 Units CO Floors a
Proposed Use of Property 'Sol-Mt Value of Work 9 " Bldg Value AVIA
Tenant Information id/k,
Tax Assessed/Appraised Value /VA
-
Flood Zone Base Floor Elev.
ENGINEER
Name
License No.
Telephone
F
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 Commencem
accordance with Section 713 -35 of Florida Statutes. Review the brochure at
Choosing a Contractor.
STATE OF FLORIDA,
(Signature of Owner -- 7
V E. REUEL
ST
Signa'' of Contractor / Qualifier
SEAL:
&a cid 1e--
Signature of Nota
•
PERMIT APPLICATION
st be POSTED AT THE JOB SITE in
Hall on Construction Lien Law and
A, COUNTY OF MIAMI -DADE
Print Name i /
Sw m to and subscribed before me this l t0 day of , ! �k- ,
_ 111111 dig
blic - State of Florida
J ENNIFER JOHNSON
us MY COMMISSION # CC 903127
1.a EXPIRES :Jan 18,2004
NOTANY Fie. Notary Service 8 Bon dng Co.
> Angela M Becker
_ My Commission D01500
(Personally known Of V I, gt, os fictfiti Personally known OR, Produced Identification
P t '< -a -�� v
(Type of Identification Produced:_ � pe of Identification Produced:
ELECTRICAL
TYI'E
Minimum Fee
QTY.
TyrE
Dryer
QTY.
TYPE
Outlet, Appliance
QTY.
TYPE
Service Repair
QTY.
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
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
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
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
Mete!' 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
Zoning
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
JUN 3 0 t
Page 4
OFFICE USE ONLY
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.) $ I
❑ PROOF OF OWNERSHIP
(Attach)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
PERMIT FEES
0
Inspector State Educational Fund $ (¢.005 /sq.ft.)
State DCA (Radon) $ (¢.01 /sq.ft.)
Code Enforcement Fine $
Zoning Review
Notary
ISSUING OFFICIAL
REVIEWED AND PREPARED BY: DATE:
003
(X .ft. = x/1000
a
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach) e
❑ HRS / DERM APPROVAL 0 BPR APPROVAL (Restaurants)
(Septic / Sewer)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ 6 b
r 1
Lts
ca
*-a
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