289 NE 102 St (13)Owner's Address ?( r1z 9 ' S 1.-
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 4/ 28 / 9 9 J o b Address 289 N. E. 102 S t . - Tax Folio) r ` 3 2- - 0 (o -- C (3 -- e/ 170
Legal Description (4, (A M 1 S Siic. I Historically Designated: Yes No
Pa, o - a Low a 1- -tic 3 , _____
Owner/Lessee / Tenant David & Nancy Dawson Master Permit
Contracting Co. Owner / - l(0 u/ 14-17 a10 Address
Qualifier 4 U/' Ito L .✓V ``J ss#
State # (6 C ' " Municipal # Competency #
Architect/Engineer Charles C. Mitchell P. E. Address 15490
Bonding Company Address
Mortgagor Address
Permit Type (circle one) BUILD II ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
2,400.00
Square Ft. Estimated Cost (value)
40 sq. ft.
Extend front porch •f- pa-
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YO!,
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF 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.
OWNERS 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 : o ' g. Furthermore, I authorize the above -named contractor to do the work stated.
Signature of>HISIar and/or Condo President Date
APPROVED:
Zoning
Mechanical
Notary as to Owner and/or
My Commission Expires: PO49-- _ anCil NOTARY SEAL
0 'l�' (iY er STEVE TRICE
Z
11�` CI COMMISSION NUMBER
c CC683996
$ Q � MY COMMISSION EXPIRES
OF F a0 'Q i'T. 25,2001
FEES: PERMIT 1 /0. RADON / 1 10 C.C.F.
Building
Phone 9aC --5:5-3 —94174
Signature of Contractor or Owner - Builder
8 NOTARY
Phone ( 305) 757-0140 r/
Electrical
N.W. 7 Ave.
J022/
H ; =30V - s C3
Ins. Co. 3 3 `r
i / 2 ASS
Date
,01.k
Notary as to Contractor or Owner - Builder ) Date
My Commission Expires:
NOTARY PUBLIC - STATE OF FLORIDA
LOIS E. LINDLEY
COMMISSION # CC601852
EXPIRES 12.15.2000
BONDED THRU ASA 1- 888- NOTARY1
BOND • 3x.7
TOTAL DUE 9 1 7 / 0 1 i e2
Plumbing Structural Engineer /
umg Engrn ?5/
otin Xtt
LAiZDU RVEYOAS
4151111111•1111111015111•51115V
j Usertw.71, STREET, SUITE 202
,MAK RAMO,. 331E6
IELEPPIONE; (305) 220.3 7 I
FAX: L305)5347622
AA/00
BOUNDARY SURVEY
.e‘oCpe-
0.
/Pr
• 4:50o
(my /0.427/
1........ 1 •• ••••.M•FOMM•■•••■
Scale 1" -
Z 27 /
e-Aw
SURVEY NO. 97- 2
SHEET NO. 2! OF 2.
6e 707We....
(
g •
f !
MIAMI SHORES VILLAGE
EUILDING AND ZONING DE2ARTNEY
10050 N. E. and AVENUE
(305) 795 -2204 FAX: (305) 75i - 2972
BUILDING PERHIT /CONTRAL ORS REGISTRATION alEOCLIST
C:,py of STATE OF FLORIDA CERTIFICATION (DPER) :r STATE REGISTRATION
AND DADE COUNTY COMPETENCY LICENSE.
Copy of current OCCUPATIONAL LICENSE from county or municipality where
business is located.
Certificate of Insurance for LIABILITY (addressed to Miami Shores
Village)
Certificate of Insurance for WORKER'S COMP (addressed to Miami
ShoresVillage) or if exempt.
State of Florida LES Form BCf-204, Construction Industry Notice of
Election to be Exempt.
PLEASE SUBMIT EVERYTHING CHECKED OFF
V Permit Application (signed by person performing the work, licensed
contractor and the property owner, both signatures notarized).
Two sets of plans /drawings signed and sealed by registered architect or
engineer. Occupancies by Group Classification must be on plans and
perit application. All plans must include folio number and property
address. Amended plans, in addition to the above, must also include the
permit number.
_ Structural Calculations signed and sealed by architect or engineer when
applicable.
Current survey of the property.
Certificate of Elevation signed and sealed by Surveyor.
Substantial Improvements Checklist (contractor or owner).
Two sets of energy calculations.
1
DADE County or State of Florida Products Approvals for roof materials,
sheds, windows, exterior /garage doors, aluminum: carports, screen
enclosures, shutters awnings, skylights, french doors and etc.
Approvals from HRS, DADE County Impact Fee Section, Fire Department &
Health Department (when applicable). DERM
Warranty Deed or Other Proof of Ownership if necessary.
Structural Review fee
Flood Elevation
Owner's Name and Address
State work to be done and p se of buildin
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersi
peared
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.
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
ss.
(by floors)
Date 2� /
. 41-9
/ No Street_
19 •�
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of fo on Rolf Covering
Estimated Total cost of improvements $___ �c Amount of Permit $ SC)
Zone cubage required Ian Cubage
Distance to next nearest building Si a 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)_ —Yl j+ s ` t
, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
to me well known,
and who, being irst duly sworn, up i' oath deposes and says that he is the
of the above desc ibed onstruction, that h has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him sta -d ar: true/
Permit No _ • ate ,! ___ 0 and Subscribed before me.
Disap
Notary Public, State of Florida
( S •
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chair - 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.
S7eP /7aWis/ 5 / E lv A'-E-
O F wArra oo 4
)4 :at tvcii
;11 Sr
A ppv», coorr
3 . G 6 _: AO -./ QNr 7foPeRrr
: »
< V2
o Ri¢ +)
«
•
JOB: / :r �� , AD
BUILDING
•
•
ELECTRICAL
PLUMBING ,
•
•
•
Inspector's Report:
•
•
• WORK
• • DONE BY
•
• REQUESTED
•
• •
•
•
•
•
The following is ready for Inspection:
i
WILL BE READY
•
JOB:
BUILDING •
ELECTRICAL
PLUMBING , •
•
Inspector's Report:
•
•
• • WORK
• • DONE BY
•
REQUESTED
The following is ready for Inspection:
AD: ,
WILL BE READY
r_.
JOB:
BUILDING
ELECTRICAL
PLUMBING
t
•
•
•
•
r r
Inspector's Report:
•
• WORK
DONE BY
•
•
The following is ready for Inspection:
c
•
�iI i ff
AD : 6 e, ixi a .. -4
•
REQUESTED WILL BE READY