640 NE 101 St (9)MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date 1 P. Time 11
TypeInsp'n � * "FG)n7
Permit No. 6P co y 5S,
Name 6 undV oPd
Address & 4O
Company " I S l_L.)l l '+-
Phone #
For Inspector: I a. 109 Name & Date
Approved
Correction
Re- Insp'n Fee ❑
Village of Miami Shores
JOB .,
ADDRESS
INSPECTION
TIME READY A
REMARKS
INSPECTOR DATE
N° '202
Village of Miami Shores
JOB
ADDRESS ifs
INSPECTION ( ' j
TIME READY
A )
REMARKS
INSPECTOR
N? 3890
DATE
Villcjje of Miami Shores N° 4024
JOB 4_ 1 ,t7 7 -7- y , J c -
ADDRESS �� " - /e' .S 77
INSPECTION -. `'l e" w.
_�
// TIME READY � "'"` ' � ` Y 0
REMARKS
INSPECTOR DATE
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.
f ,
Owner's Name and Address... .._. ..__ .. _�:J._ ^_i�.t
Registered Architect and /or Engineer... -. ..._x _f_...S 1 .'__ ...____ is rf' •
Name and address of licensed contractor C € - >�.„4___ ._ '
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done _ . ,,,r' fv =__L ;_L._4 4
State work to be done and purpose of building (by floors)
and for no other purpose.
New Building Remodeling Addition I— " Repairs No. of Stories
To be constructed of - Kind of foundation__ e;`.E _. g t ��____ _ :6.� x _ " 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 5968, 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 workisUch public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on *irk to be:prmed under this
permit, as are licensed by Miami Shores Village. � - r -
Remarks -
ned :..
L
�
Date / __- t� r+ , 19
No Street
Permit No Date Read, Sworn to and Subscribed before me.
Disapproved Date Notary Public, State of Florida
(Signed)
Building Inspector My Commission Expires
STATE OF FLORIDA,
COUNTY OF DADE. 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.
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.
Page 2
IMPORTANT NO'T'ICES
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, P' 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.
�STA OF O
/2"--41' Si tune of 0 e
O .
SEAL:
Personally kno
Signal a of Notary Public - State of Fl rida
G K a: i) 14.5 Ot.
Print Name
Sworn to,And subscribed before me this Aq day of
"t'
ROXANA C. ALVAREZ
Notary Public, State of Florida
My Comm. Exp. MAR. 25, 2003
Chit iiss on I Q.CC 14177
op Irahnn
ture of Contractor / Quali
Sign
Print ame
worn to and subscribed before me
Si ature of
SEAL:
SATE F FL A, CQ // Y OF MIAMI -DADE
.o & AI ! rJ�
otary i t . - State pf
•
•
PERMIT APPLICATION
Personally known OR, Produced Identification
Type of Identification Produced: Type of Identification Produced:
CONTRACTOR ,
Name l 4NT l N t7
License No. 9 J £ t
Address
a 44 D �� , s 5 L�
Telephone 717 _.716 ax
Qualifier me 4,0,,,h---
PROPERTY OWNER
New Construction
LL�1�����
Name / f �/e 7 6104�y
' /
& N➢A& SC-R
Address 6�4 , . g- /0/57---
A/ i ''�r � _ ito RE5 77
Alteration Exterior
Home Telephone 7
b Z
Business Telephone
Alteration Interior
Fax ..�
Demolish
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
INSTRUCTIONS - The following steps must be taken to obt
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.
A PPLICATION
Job Address: 6 a AZ
Address Apt.
Folio Number Description of Work
Lot Block
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Telephone
F
Master Permit No.
PERMIT APPLICATION
Subsidiary Permit No. op ' 69G9a . 55
in a permit from the Miami Shores Village:
Sdeg g- 33/3
City
Subdivision PB PG Zoning_ Linear Feet
Current Use of Property Square Feet Units Floors
Proposed Use of Property Value of Work 7 ine> Bldg Value
Tenant Information Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
PERMIT CHANGE (✓ )
State
7kJi eF r 'oPN
Zip
ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPE
Dryer
QTY.
TYPE
Outlet, Appliance
QTY.
TYPE.
Service Repair
QTY.
A/C Central 1 -3 Ton
Fan
Dryer Vents, Number of
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
Drains, Area
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
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
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 CIoset
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
D TE
:e,
Zoning
r :.
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
2
Page 4
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi - family)
L CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
$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)
PERMIT FEES
$ 6 a-
$ (0.005 /sq.ft.)
$ (¢.0 / sq.ft.)
ISSUING OFFICIAL
( sq.ft. = x/1000
x0.60)
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ ' -
REVIEWED AND PREPARED BY: DATE:
DITION OF APPROVAL
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com
ROBERT S. VISCOUNT, JR.
640 GRAND CONCOURSE
MIAMI SHORES, FL 33138
y Q4.X, exAcsid x.
BankofA erica.
ACH H/r 083100277 ��
- ADO, gSS _ _ ok-� k
Pay to the
order of
1:063 LOO 2 ? ?1: 00350801,33 L611' 249?
Date
Dollars
2497
63-27/631 FL
988
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 5 /3/2002
Applicant: JOHN
Owner: GRUNDHAUSER
JOB ADDRESS: 640 NE 101
Contractor VISCOUNT PAINTING & DECORATING
Local Phone: 305 - 751 -7164
Parcel # 1132060172090
Fees:
FEE2002 -2483
FEE2002 -2484
FEE2002 -2485
Permit Status: Approved
Work: EXTERIOR PAINTING AS PER AGREEMENT
Signed:
Building Permit
Permit Number: BP2002 -855
GRUNDHAUSER
JOHN
ST
Contractor's Address: 640 GRAND CONCOURSE
Legal Description: AMD PL MIAMI SHORES SEC 4
Description
Building Permit Application Fee
CCF
Notary Fee
Total Fees:
Permit Expiration: 10/28/2002
PECTOR) BY:
/1 i l: /, i;1 i
Amount
$60.00
$1.80
$5.00
$66.80
Construction Value:
$2,475.00
Page 1 of 1
PB 15 -14 LOT 3-4 & E1/2 OF 5 BLK 103
Total Fees: $66.80 r
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.
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 in 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.
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto aril in sire r./nforrnity
with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibilrty fcr ar •wee ax*: ., r e-
myself, my agent, servants or employes.
MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
DATE: 't- Z.�• D?�
OWNER'S NAME: �,� , � �,c.4, .R PHONE: (3o?) 75F-J- o -
ADDRESS: CO i /O/ s
********************************** * * * * * * * * * * * * * * * ** * * * * * ** * * * * * **
ADDRESS OF SITE: o (( 7
CONTRACTOR & LIC SE (if a plicable) qii-.?.5004.071 /
COMPANY NAME: tSCovk fnl/i PHONE:( 'jam- ry /6 T
************************ * * * * * * * * * * * * * * * * * * * * ****** * * * * * **
All Elements on the site must be listed and indicate the color to be painted.
Walls h/C -
Fascia WC- /9t
Drip Cap/Drip Edge //C - 9'
Soffit /Ji
Roof
d/A.-
Flower Bins Al/A- hiA-
Ni/A
Shutters
Awn ings
Chimney
Doors and door ja' ns W - IN'QTE
Garage Doors CFFrrf h td
Railings
Fences
Decorative Metal
All brick (simulated r egular) / _ Lfg-
Stucco Banding t ,( A -
Any other stucco f atures
Accessory Buildings 5'4 n/ / (✓v -G/�r�/L Were
Other _ , ,� . ,. 5c? 1 50) .
.mp s
APPROVED:
(V 4 � -� �� /
Building Of
3a o
3 oh -
Date
China White 74
H
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. I authorize the above -named contractor, if applicable, to
do the work stated. Furthermore , the paint .. s will b9 as per the attached
9.2r
Signature of Contractor Date
Signature of Owner Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
4/23/01