1230 NE 102 St (3)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
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 Contra .r.
Signature of S ier
STATE FLI'IDA,
Print Name
Sworn to and subscribed before me this tO day of 0 r
0
gnature
SEAL:
Notary
Iic ta • o Florida
OF MIAMI -DADE
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
PERMIT APPLICATION
p:.1FItL'
r pU e� AMGELd SEAL:
i
Z k C073yZ97
Personally known C F F'- OR, Produced Identification �
n ification L/ Personally known OR, Produced Identification
\
Type of Identification Produced: )--- VV l'1 b7 • , 37"Cype o9 Identification Produced:
PROPS TY OWNER
New Construction
�
Name A VV �DIr
�
Enclosure
Address 1-2,30 N 6 (o).-
Au fiMI *tto�2�∎ eF1 3 31
38
Home Telephone 3 . 7 ifc
Repair
Business Telephone . 0y0 - i )•Ari s
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'l Detachment
Other
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
tep 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
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
Address
Ap
Folio Number
Lot Block
Subdivision PB
Current Use of Property
Proposed Use of Property
Tenant Information
ARCHITECT
Name
License No.
Address
Telephone
Fax
escription of Work
City State
- PA ( f- oet. F--
PG Zoning
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
PERMIT APPLICATION
Master Permit No.
Subsidiary Permit No. c ' is 05
Zip
Linear Feet
Units Floors
4 6 D • Bldg Value
Square Feet
A' \ alue of Work
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
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 10/21/2002
Applicant: DENNIS WOOLFOLK
Owner: WOOLFOLK DENNIS
JOB ADDRESS: 1230 NE 102 ST
Contractor
Local Phone:
Parcel # 1132050250020
Fees: Description Amount
FEE2002 -5940 Building Permit Application Fee $60.00
FEE2002 -5941 CCF $0.60
FEE2002 -5942 Notary Fee $5.00
Total Fees: $65.60
Total Fees: $65.60
Total Receipts: $0.00
Permit Status:
APPROVED Permit Expiration: 4/19/2003
Work: PAINTING AS PER AGREEMENT
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 mb of this psnnll, I apron to Ilrnbum Ills wino 0I0 Ilu►r,llluhll 111 1dnnldhHllu I/I111 r111 'mllnn►u,1iH loin i d /i/bllbllill ini i /llllh/ I N illrll/ mill 0 /.111111 I//lll
with the plans, drawings, str lottiorns or slnr';Ilicrrti'ns auh►nhb,'l hi 1110, p►'r11u► 1IIII1000111 iri 0d 14 /'11111 I illrnrtli 'ill/oil'', Ill ll /./'1111 //// 11 /N- //r/////// H!• /•1 //l /lr /lrr // / /III» 11i11 /J/ //g 1/11 /// //I 111/1./, b/ /4 //
myself, my agent, r' :rvant ; or rrrntibiyos.
Signed: (INSPECTOR) IIY:
ii
Building Permit
Permit Number: BP2002 -1805
Contractor's Address:
Legal Description: 5 53 42
II .0111 I I 11 '1
Construction Value:
$500.00
Page 1 of 1
PB 42 -25 BAY BREEZE SEC MIAMI SHORES LOT 2 BLK
1111,1 111 111,''1111' 1 / 1)1 IIIII 111 /11111 I i11 /'h,
MIAMI sitio_RESVILLAGE
Paint Color Approval and Agreement
DATE: 0 :1 - L5
OWNER'S NAME: VA P./ R A- W COL- POL-ge...._ PHONE: 305: 75 4 3
ADDRESS: 1)-3 c) ME lo 67—
************************1
ADDRESS OF SITE: 12- 1Je (0 57
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME: PHONE:
****************************************************************
All Elements on the site must be listed and indicate the color to be painted.
l
Wals 0
Walls
Fascia
:
Drip Cap/Drip Edge
Soffit
v■iti T
Roof
SAA.4? LC Dv
ci)
Flower Bins
Shutters
Awnings
Chimney
Doors and door jams rk
vj
Garage Doors fMi
Railings
Fences
En
Decorative Metal
All brick (simulated or regular)
Stucco Banding
Any other stucco features
Accessory'Buildings
Other
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 wt stated. Furthermore , the paint colors will be as per the attached
sa 1
Signature wner Date Signature of Contractor Date
******** ***********************************************g!*******
APPROVED: WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
Building Of 1 Date
•
4/23/01
'1
ELECTRICAL
TYPl.
Minimum Fee
QTY
.1.x,1,1,,
Dryer
QTY.
TYPE,.
Outlet, Appliance
tin'.
.
Service Repair
Q . 1 . v
A/C Central 1 -3 Ton
Dryer Vents, Number of
Fan
Ventilation, Cost
Outlet, Wall
Ductwork, Cost of
Service, Temporary
Periodic Inspections
A/C Central 4 -7 Ton
Fire Sprinkler System
Fire Pump
Outlet, Switch
Fireplaces, Number of
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
TY Q'FY.
Minimum Fee
TYPE
Condensate Drain
QTY. TYPE QTY.
Generator
TYPE Q'I'Y.
Refrigeration, Tons
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
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
PLUMBING
TYPE
A/C Condensate
QTY.
TYI'I?
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 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:
SECTION ,
BY
DA E
iO /
Zoning
9 ji
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
Page 4
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi - family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
PERMIT FEES
$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
Notary
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
- (New Construction)
‘❑ OTHER
(Specify & Attach)
$ L
► �" �/ (sq.ft. = x/1000
x ¢.60)
$
(¢.005 /sq.ft)
(¢.01 /sq.ft.)
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ 43
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
PERMIT APP, CATION FOR MIAMI SHORES VILLAGE
Date j / - / i Job Address (2,30 ilk 1 • , /07. .. Tax Folio
[(13 R
ti
Owner/Lessee / Tenant < M Pt R 1. Master Permit #
Legal Description
Owner's Address l Z ,SO ' V "l 4 (f� Z• rp 1AA S 4 o Rea
Contracting Co. k ??Th f CI�L. /44. g, s'"
WORK DESCRIPTION
Sign e of owner and/or Condo Pisident Date
Notary as to Owner and/or Condo President Date
, P4/ OFFICIAL R'OTARr SEAL
(i SANDRA C^ C 'O:d81FL
{ COt L91SSIOC� cJi�Cman
't`` CC401231
- 7. rs; •rttP.
F
Co7i1
Or FN.-0 C.; �. 1`;7 .•ir'
FEES: PERMIT / 1 D • RADON
Building
My C
C.C.F. I. NOTARY
Historically Designated: Yes No
Address
Phone
Qualifier SS# o/ D ` ? 92- Phone
State # _ Municipal # Competency # Ins. Co.
Square Ft. Estimated Cost (value) X
(/B CIAL NOTARY SEAL
e SANDRA FA nONTIEL
* COF<7IISS',ON Ni;RCDER
CC4O123
9 RrY COPt:FAISSIONd .EXP.
OF F L 0 AUG 17,1
Electrical
3 RI' t`/
G5 - 77y S
62 /V D
Architect/Engineer Address / 92. ? 1V.1' 3 3 1-'
Bonding Company ldress
Mortgagor Address
Permit Type (circle one): BUILDING ' ELLECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN errJ" ,111;Z) to ‘A//-/
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY OF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I
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, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
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. Furthermore, I authorize the above -named contractor to do the work stated.
Signature of Contractor or Owner- Builder Date
??-2
Notary as to Contractor or Owner - Builder Date
TOTAL DUE
•
Qa
APPROVED:
Zoning
Mechanical Plumbing Engineering