1160 NE 102 St (8)MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date Tim
Type Insp'n
Permit No.
Name //
Address // N
Company
Phone #
For Inspector: /n Name &
Approved3l 7'
'DP CD ()
Correction ❑ ioh'� cf
Re- Insp'n Fee ❑
CONTRACTOR
Name �Jy ! � " � / .44... 74, 6
Name
/'/
License No. .. g ,
!
4, b0 g
t
Address 7a � � re- 0
,�ua o 2� 3 To /4
Telephone /a 4
- 6 $,70ax
Qualifier Name 7
��
// p ` s��
PROPERTYOWNER W
Name �Jy ! � " � / .44... 74, 6
Address it: o
Al /40.
Home Telephone
Alteration Exterior
Business Telephone
Repair
Fax
Alteration Interior
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'l Attachment
Other
Add'l Detachment
Other
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Step I.
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
Address Apt. City
Folio Number /7 5.3-0 ®/9 . 6 /t Descript of Work
Lot Block
Job Address:
Subdivision PB PG Zoning Linear Feet
Square Feet Units Floors
V Value of Work ) 7 9 '
Current Use of Property
Proposed Use of Property
Tenant Information
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.
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
Master Permit No.
Subsidiary Permit 0
State
Bldg Value
PERMIT APPLICATION
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
ENGINEER
Name
License No.
Address
Telephone
Fax
Zip
v
Page 2
I\11'OR'I'.1NT NOTICES
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 C • ' . • ctor.
tary ' bile - State of r orida
Print Name
Sworn to and subscribed before
Signature of
SEAL:
Personally known
IAMI -DADE
■
J::i `:) MA :ZS
0 CC 9213m
! 1;' RES. June 4, 2009
OR, Produced Identification
Type of Identification Produced:
ST OF FLOR
Signatur actor / Qualifier
Name
Sworn to and subscribed before me this
Signature
SEAL:
PERMIT APPLICATION
Y OF MIAMI -DADE
:of Florida JULIO „Oi')
CC?■MISSIUU 0 CC 921872
EXPIRES: Jung 4, 2004
9c;;4�J Tl:ti t&-j F¢b:ic Undre
Personally known OR, Produced Identification
Type of Identification Produced:
PAY
TO THE
ORDER OF
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 9/26/2002
Applicant: CHRISTOPHER
Owner: RUSSO
JOB ADDRESS: 1160 NE 102
C ontractor BRINKS HOME SECURITY INC
Local Phone: 305 - 558 - 6625
Parcel # 1132050190160
Fees: Description Amount
FEE2002 -5394 Building Permit Application Fee $60.00
FEE2002 -5395 CCF $0.60
$60.60
Total Fees:
Total Fees: $60.60
Total Receipts: $0.00
Permit Status: Approved Permit Expiration: 3/25/2003
Work: BURGLAR MASTER 1 DEVICES
BRINK'S HOME SECURITY
5765 N.W. 158TH STREET
MIAMI LAKES, FL 33014
RUSSO
CHRISTOPHER
ST
Legal Description: 5 53 42 MIAMI SHORES SEC 8 REV PB 43 -67 LOT 6 BLK 176 LOT SIZE
If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection
c u r i f y e n h a n c e d d o c u m e n t . S e e b a c k for
Bank of America.
Customer Connection ��
FOR e-fr /
"00 388411' •: L L 10000 L 21: L 5.9 56 L 4a L
Electrical Permit
Permit Number: EL2002 -310
Contractor's Address: 5765 NW 158 ST
Construction Value:
DATE
f
$199.00
/7oa --
DOLLARS 8 n
Page 1 of 1
tion herefor in strict compliance with all
ations that may have been submitted to
)r if the plans are changed without
nsibility for a thorough knowledge of the
at he assumes responsibility for work done
pertaining thereto and in strict conformity
iponisibility for all work done by either
4
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
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
PERMIT FEES
$ 4
Metropolitan Dade County (C.C.F.) $ 0 (sq.ft. = x/1000
P Y
x4.60)
Inspector State Educational Fund $ (¢.005 /sq.ft.)
State DCA (Radon) $ (4.01 /sq.ft.)
Code Enforcement Fine $
Zoning Review
REVIEWED AND PREPARED BY:
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)
TOTAL $ h � h C�
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
TYPE
Minimum Fee
QTY.
TYPE
Fze,/,-+< �,a, i
QTY.
Typi.:.
Outlet, Appliance
QTY.
TYPE
Service Repair
QTY.
A/C Central 1 -3 Ton
4 11114 ‘4,4e &i —
1
Outlet, Wall
Service, Temporary
A/C Central 4 -7 Ton
mp 1 �' 4
Tice -Fn �1
-
Outlet, Switch
ns
Signs
A/C Central 8 -15 Ton
Fixture - Fl . I rescent
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
PLUNII3INc
TYPE
A/C Condensate
QTY.
TYPE
Drains, Roof
QTY.
TYI'E
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
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. I
RECEIVED AND REVIEWED BY: DATE: