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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: