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53 NE 101 St (5)MIAMI SHORES VILLA R-90 \ BUILDING DEPARTMENT 305- 795 -2204 B 'Wing Inspection Request �/ Date 1 � C . Time Type Insp'n r 1 C fi�� 1e I) 634) rev Permit No. by aco3 - - 6s1 Name r `'. V\Ck VC1 Address 53 NE. (O t J T Company n�(r _ U c Phone # ` (� 1U ^ - �1 � J l J For Inspector: 1 113 Name & Date Approved Correction Re- Insp'n Fee ❑ Oa him rnu ne cull 02. t►rfK, asa p ELECTRICAL TYPE. Minimum Fee QTY. TYP• Dryer QTY. • •1')"1".. • OutktJrlpplient . - – - • QTY. •1,N,1'L; Service Repair QTY. A/C Central 1 -3 Ton Fan • • Outlet, Wall Ventilation, Cost Service, Temporary Air Handler, Tons A/C Central 4 -7 Ton - Piping, Flammable Liquid Fire Pump Outlet, Switch Fire Sprinkler System Signs A/C Central 8 -15 Ton Bath Fan - Vented, # Fixture - Fluorescent Pressure Vessel 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 ()Tv. T1'PI' Condensate Drain Q'I'Y 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 Solar Water Heater Air Handler, Tons Ductwork, Cost of - Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Cap - Fixture Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Pump and Abandon PLUMBING TYPE A/C Condensate QTY. TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture Q"I'y. 'rm.: Soakage Pit QTY. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinlder 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' perforfne4 attd qi adtitj(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) • • • • • ••• • ••• • • • • • • • • ••• • • • • • • • • • • • • • • • • • • • • • • CHECKLIST • • • ••• ••• ❑ PROOF OF OWNERSHIP (Attach) •• ••• •• • • • •• • • • • • • • • • • ❑ 1111S %•11EU AriROVAL • • • • (Septie / Stwet) • • • ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) PERMIT FEES $3.00 per page (Scanning Fee) Miami Shores Village Bond $ 2s Metropolitan Dade County (C.C.F.) $ 3 0 a (sq.ft. = x/1000 x ¢.60) Inspector State Educational Fund $ State DCA (Radon) $ Code Enforcement Fine $ Zoning Review $ Notary ISSUING OFFICIAL REVIEWED AND PREPARED BY: DATE: SECTION Zoning Electrical Mechanical Plumbing Fire Public Works BY DATE Structural Building Official • • (¢.005 / sq.ft.) (¢.01 /sq.ft.) PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ 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 Page 2 IMPORTANT NOTICES DO NOT BEGIN ANY WORK WITHOUT IIAi✓InlatECEIVID YZ)UR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CbNSTRUCTIO14 are li?r ted 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 SIIA KE FRED F DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEI DAMAGED 13Y lailM4FINTY 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. 1. 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: Signat e 22 N.W. 1st S accordance w Choosing a C ST • O •' ID• " • JO OF A Print Name Sw SEAL: wner t, Pl Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and tractor. vsl An 0 5 • CAA subscribed before me this . day `Ll '■ ature of No Public - S . - of Flon 0 0 Angela M Becker bt = • My Commission DD1500413 or o. Expires November 15, 2006 • • • • • . ••• • • • • • • • • I -DADE PERMIT APPLICATION STATE OF FLORIDA, COUNTY OF MIAMI -DADE Signature of Contractor / Qualifier Print Name Sworn to and subscribed before me this day of Signature of Notary Public - State of Florida SEAL: Personally known OR, Produced Identification - Personally known OR, Produced Identification "1 Type of Identification Produced: F4101.` .����� 9��9'+� Type of Identification Produced: PROP TY OWNER rk <<.M A- T. Cn►c.-e—RAtt-1 e. Name Enclosure Address 34 L ,4 6- AM( 6, FL t l 1 5T 35)6 Home Telephone `I if t...i �3 ` S — 7 - 7 Business Telephone Fax 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 Step 1. Folio Number Lot Block Subdivision PB PG Current Use of Property Proposed Use of Property Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical t umbing GX Roofing Fence Other PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax • • • • • • • •.. • • • • • • • • .•.•.. • Master; Permit No.. 8u%sidla:y firriit ?Zo. • • • • • • •.•. • .. . . . • •.. ... • • • 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 theeiopesty owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of yotl‘arli :atIkn; IPrpbfiag work 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. PERMIT APPLICATION --- 5 fv( Jo/ s r ✓" I,q,4 t' S.1.2) f 33/3 Address Apt. City State scription of Work t rc-Ore .� iTel - 20 Zip Zoning Linear Feet Square Feet Units Floors value of WorA 4 O 4 - 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 .. .. • • • • • •• • • • • 0000 • • • • 0000 • • • • • • • • • • .. • •••• • • • • • • • •• M... •• • • • • • •• • • • •r•••• • •I • • •I • • • 7- Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 3 /3/2003 Applicant: KATHRYN Owner: BROWN JOB ADDRESS: 53 Contractor Local Phone: Parcel # 1132060131530 NE 101 Building Permit Permit Number: BP2003 -351 BROWN KATHRYN ST Contractor's Address: Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 18 & E1/2 LOT 17 BLK 11 LOT SIZE Fees: FEE2003 -1286 FEE2003 -1287 FEE2003 -1288 Description Building Fee CCF CCF Total Fees: Amount $85.00 $3.00 $3.00 $91.00 Total Fees: $91.00 Total Receipts: $0.00 Permit Status: APPROVED Permit Expiration: 8/30/2003 Construction Value: $5,000.00 Work: KITCHEN BATHROOM REMODEL If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection fee is $50.00, which must be paid in advance before calling for another inspection. This Permit is granted to the contractor or builder named above to construct the I ordinances pertaining thereto and with the understanding that the work will be perfo and approved by the proper municipal authorities. This Permit may be revoked at a authorization. A further condition upon which this permit is granted is the understan ordinances and regulations pertaining to the work covered hereby whether shown of by his agents, servants or employees. Signed: (INSPECTOR) In consideration of the issuance to me of this permit, I agree to perform the work c with the plans, drawings, stat ments or specifications submitted to the proper author myself, my agent, servants o employes. Signed: (Contractor or B aN 99090 MOWN 0L9/£Y9 Sig OG area 5i706 °q 540;x 01113t1E434600t01: Page 1 of 1 51)x^+ - �� 4'+ - Lc- ) „IN £"S 101 ZEV900L901H H3V VIAOHDYM � 3o is C V2$J S• aMt o� /"t Jo astwvxxvD f UUVHD111 • • ... • • • ... VILLAGE MM US • • • • • • •••• BUILDING DEP1RTME • • • • • • • • • • • • • • • • • • • . • • • • •••• ••• ••• • • • OWNER BUILDER DI,SCLOSURL STATEMENT • • • • • • • •• • • • • • ••• •• • o 7S. • C—A " •tit 4 AL being the legal property owner, for the property Located at: S A E S N\ ` AM S (40 Legally described as Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S. 489.103(7),,nd I have read and understand the following disclosure Statement, which entitles me td fork as my own contractor, I further understand that I as the owner must appear in person to complete all applications. DISCL OSURE STATEMENT State law requires construction to be done by licensed contractors. You have applied for a permit under an exemption to that law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two - family residence or a farm out - building. You may also build or improve a commercial building at a cost of $25,000.00 or less. The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is completed, the law will presume that you built it for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as your contractor. It is your responsibility to make sure that people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A. and with- holding tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, building codes and zoning regulations. Proof of ownership provided ( ) initial of reviewing clerk. The foregoing instrument - Was acknowledged before me this 2. day.o , 20 03 By p;, hc1 rc1 Ca C' C4' % c ho is personally known to me or who has Produced a Owner Owner 0 0 as identification and who did take an oath. � o� P\ Angela M Becker �` My Commission DD150048 /4 0 d" Expires November 15, 2008