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
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PERMIT APPLICATION
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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)
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CHECKLIST
• • • ••• •••
❑ PROOF OF OWNERSHIP
(Attach)
•• ••• •• • • • ••
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• ❑
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
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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
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Master; Permit No..
8u%sidla:y firriit ?Zo.
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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
.. ..
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• 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
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• • ... • • • ...
VILLAGE MM US
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BUILDING DEP1RTME
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OWNER BUILDER DI,SCLOSURL STATEMENT
• • • • • •
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•• • • • • • ••• ••
•
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