ROOFINGMIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Time
Date
Type Insp'�°`j �LaC. cop ow\
Permit No. C f�,�;�
• fir
Name
"' Address
® Company
Phone #
For Inspecto
vL ii\ Appro 6 \
Correction
Re- Insp'n Fee
73C ATF /0/S1.
\-k
CONTRACTOR
Name L" e - N6 pea', tle1r vfai
Address
7 ? lie- el .r
Name
fr ii o °tr. , .., 4 ( )ci/,;i,,,
Business Telephone
Fax
License No.e e .. e , d ( 6 et — r
Repair
Address
e ,f ,;i _t/, Ar i'5,;(
Demolish
Telephone (le ;1 f4 l..Lil y Fax
�;
'.y.
Qualifier Name ��,
Foundation Only
PROPERTY OWNER
Name L" e - N6 pea', tle1r vfai
Address
7 ? lie- el .r
Home Telephone ( r) 7q� -70
t T
l 7 /724
Business 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'l 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 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
7 \Job Address: 7 g r
Address
Folio Number
Lot Block
Subdivision PB
Current Use of Property
Proposed Use of Property
Tenant Information
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
, Odf&
Apt.
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Aozze/
Telephone
Fax
Master Permit No.
Subsidiary Permit No.
Ravi nloge5 t czd&e >
State Zip
fo// L &l4 /I et/
n
City
Description oWork
�aZlet'y r `Yine Feet
PG Zoning
Square Feet
)Value of Work
/ \ Tax Assessed/Appraised Value
Units
` 3 2
e .00
Flood Zone Base Floor Elev.
ENGINEER
Name
License No.
Address
Telephone
Fax
PERMIT APPLICATION
Floors
ldg Value
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.
STATE OF FLORIDA, COUNTY OF MIAMI -DADE
ignature of Owner
M 1/45 1 e; d1 A
Print Name
Sworn to and subscribed before me this a of
of
Signature of o .1 blic - State of Florida
ANA B. PUJOL
t
SEAL: .c. >ire.5 MY COMh1ISStON # CC 930328
EXPIRES: Al .r 20, 2004
F; c•Ni,;n R [1G!'. nj, Ino.
;s,
4; 0'
1- 000-3 - NOTARY
Personally known OR, Produced Identification
Type of Identification Produced: ,D.4 %tJ 0'i 2. . 1 Le tv S-e
ST CIF FLORID , C N OF MIAMI - DADE
� t
ignature of Contractor / Qua 'tier '
Print Name
Sworn to and subscribed before me this apv day of
SEAL:
Personally known _ OR, Produced Identification
Type of Identification Produced: -ARID
PERMIT APPLICATION
ANA B. PUJOL
MY COMMISSION # CC930328
1 4• 0 " EXPIRES: Apr 20, 2004
1 -&703- NOTARY Ft_' !:.y .^..rnv e & Bonding, Inc.
Page 4
OFFICE USE ONLY
CIIECKI. 1ST
❑ 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
Code Enforcement Fine
Zoning Review
Notary
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
Metropolitan Dade County (C.C.F.) $ 4 0 (sq.ft. = x/1000
x0.60)
Inspector State Educational Fund $ (¢.005 / sq.ft.)
State DCA (Radon) $ (0.01 /sq.ft.)
SECTION
Zoning
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
BY
DATE
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
PERMIT FEES
TOTAL $ to.
6
ISSUING OFFICIAL
REVIEWED AND PREPARED BY: 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
ELECTRICAL
. ypE
Minimum Fee
Q'I'V
TV,I,I;
Dryer
QTY.
TYI,I,,
Outlet, Appliance
(Fry.
TN pi.:
Service Repair
QT 1'.
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
()Ty.
TypE
Generator
()Ty.
.LVpl.
Refrigeration, Tons
()Ty.
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
QT'Y.
'I'1'r!
Drains, Roof
Q"I'1'.
Tl'1'I{
Miscellaneous Fixture
QTY.
'I'1'I'I':
Soakage Pit
Q'I'Y.
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:
Application is hereby Linde for the approyal of the detailed statement u► rite plans and specifications herewith submitted for the build
inc or other structure herein described. This application Is made in compliance and conformity with the Building Ordinance of Miami
Shorts Village, Florida. and all provisions of the Laws n( the State of Florida, all ordinances of Miami Shores Village and all rules and
regulations of the i3t►ilding 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.
Owner's Name and Address Irene Johnson
Registered Architect and /or Engineer
Name and address of licensed contrgctor Biscayne Rgo f ng.... Q,.. „... ...... a
Location and legal description of lot to be built on:
Lot 3 .14 .E 1 / (1 Al /.
......... Block. subdivision ..4t0 PL /x
( f/ Ja d /7 oza -00J
Street and Number where work is to be done 730 N.E. 101St S t r g t „ _ „____�_
State work to be done and purpose of building (by floors)....._ RE -ROOF: Remove existing & Gravel
roofs. Slope: Tin cap ... .1 3 _.f elz a _.. me .p...1 -9. QS s.laxe_. &..ins.tall Gnry....t.il.e...._
Flat: Apply 1 -434 & 3 15# ,_. &_ • Cravee.' our. ac.e.e 3.3.._Squ.r.e.a. and for no other purpose.
New Building Remodeling Addition Repairs.. RODE.. No. of Stories 1
To be constructed of Kind of foundation Roof Covering.. & Gravel _
Estimated Total cost of improvements Amount of Permit S. ...3
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 BISCAYNE ROOFING CO. 5180 E. 11 Ave. H� F] 33013
The un dersigned 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 5966, Compiled General Laws of Florida, Per►n:tncot Supplement,
anti h.ts complied with the revisions 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 work such public notice
or notices as are required by the Act. The undersigned agrees to employ only suc bcontractors, on work to be rformed under this
pcnnit, as are licensed by Miami Shores Village.
• Remarks (Signed)
e?
STATE OF FLORIDA, 64-36-4704
„,, �atttes T. Laing
COUNTY OF DADE.
SS.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared James T. Laing
._. to me well known,
and who, being by me first duly sworn, upon oath deposes and says that he is the. Ro.afing....C..n.tract.or•
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 p are
,/ true.
. { 1
Permit No tQ 1 _ Date ( 1:1.
. ._ Rea • _ ' • . Ail” • .. P. fore me.
Disapproved Date. ._...._..— ,�
Notary Pub' ,State oI#pti s .,, y .r 1 ri.
(Signed) I ,,
Building Inspector My Commission Expires..._ . —.,,,. 7. 1 .0 A ,......7.6._,....,./..0:1..I.:____
PLANNING BOARD DATE
Chairman Member
Mcrraber 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 51.00 will be charged when such re- inspection is made necessary by improper notice for inslsealwrn at faulty
materials and/or workmanship.
.. No.... 7.3.Q _..... Street... E 101_ S t
I} }} H .•• .....
}}. }}.}}! }.,M!•tt } }}HIl Y•••}
RC 0021338
•
1,493 Sq. Ft.
Application is hereby made for the approyal 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.
Owner's Name and Address... Bernard_ Gasser_ No 730... Street_ N E.,. 10151
Registered Architect and/or Engineer.
Roo -.-dtme and address of licensed contractor. Adams & Beagles Roofing Co., Inc.„ 4021 N.W.28th.St•
Miami, I42.
Location and legal description of lot to be built on:
Lot Block Subdivision.
Street and Number where work is to be done 730 N._ E_.__ 10_1st_ atr_eet.,. Shor_
State work to be done and purpose of building (by floors)__ Rear Gravel Roof: Remove existing roof.
Apply __1/30 ._ and...gravel....
and for no other purpose.
New Building .. Remodeling Addition Repairs._ R.e 0 0 f No. of Stories 1
To be constructed of Kind of foundation__ Roof Covering.. Gravel
Estimated Total cost of improvements $ 1,495,00 Amount of Permit $ 5 ,00
Zone cubage required _Plan Cubage._
Distance to next nearest building._ Size of Building Lot
Maximum live load to be borne by each floor___
, roofing
hereby submit all the plans and specifications for said building. All notices with reference to the building and its fronstruction may
be sznt toAdams_&___B_eagles Roofing Co., _Inc...., 4021 N.W. 28th St. Miami,Florida,
3142.
The undersigned applicant for this building pennit doc hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen s Compensation Act, being Sec:ion 5966, Compiled General Laws of Florida, Pennanent 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 work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks ( Signed
e-P r es
Adams & B,1eskioofing Co•, Inc.
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me,
peared
undersigned authority, a notary public, duly authorized to administer oaths and take a.',:owledgments, personally ap-
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 sttej1 arktrueo 7
7
Permit No / Date_2:::
e—
_____ _ - --:
1 Read, Sworn to and Subscribed before me.
Disapproved ____ Date__ / '
- A. I
I L (
(Signed) — 1— - -- )
Building Inspector
PLANNIN BOARD_ DATE
Chairman
Member
Member
Council Approved
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT ---ttOOF
Date May 8
Notary Public, State of Florida
y Commission Expires._
to me well known,
Member
Member
Member ......
_Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has hecn obtained from
the Planning Board.
A re-inspection fee of 51.00 will be charged when such re-inspection is made necessary by improper notice for inspection or faulty
materials and/or workmanship.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
MIAMI SHORES VILLAGE. FLORIDA
DATE ❑ PERMIT N° 2501 Contractor's 195
License No.
0-
❑ Work to be performed under this Permit
Lot
Bl.
CONTRACTOR OR BUILDER BY
Subdi-
vision
Value of
Project $
Amount of
Permit $
This permit is granted to the contractor or builder named above to construc 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.
Signed. BY
INSPECTOR
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 and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac-
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
AUTHORITY .
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approyal 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.
Date , 19
Owner's Name and Address < t No Street
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done
State work to be done and purpose of building (by floors)
and for no other purpose.
New Building
� t Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation 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 5966, 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 work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)
STATE OF FLORIDA,
COUNTY OF DADE. j 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.
Permit No ` t/) Date � Read, Sworn to and Subscribed before me.
Disapproved Date
Notary Public, State of Florida
( Signed)
Building Inspector My Commission Expires
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 -ins on fee of 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials a /or workmanship.