301 NE 102 St (8)PROP ER
N
Addr „ 46 f i ex ,
A ,I Arsh WcsAiwa
,, V)
Home Telephone r . 30 f p 7S1 e Go'
Business Telephonefor. fag WO
Fax
410
TYPE OF MANAGEMENT ( i )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'I Attachment
Other
Addl Detachment
Other
Step 1.
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
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.
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.
Folio Number 1 -"'Icription of Work
Lot Block
Subdivision PB PG
Current Use of Property Square Feet 1. Units Floors
Proposed Use of Property LArgue of Worn. I s a Bldg Value Zdt0 OW ?
IMP
Tenant Information Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
PERMIT TYPE (/)
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
ddress Apt. City
PERMIT CHANGE (/)
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
Master Permit No.
Subsidiary Permit No.
411
State
Zoning Linear Feet
PERMIT APPLICATION
Zip
•
ENGINEER
Name
License No.
Address
Telephone
Fax
CONTRACTOR
Name
License No.
Address
Telephone Fax
Qualifier Name
Page 2
IMPORTANT NOTICES
1. 1)0 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.
ST O - • • IDA, COUNT •
4 01111 A.
i \
S
gn
eofOwn -r
Print Name
Sworn to and subscribed before me this
day .f
c
0 e ° 2 Al i `C. OM d sgON NU0.16aR
w• Q :c786697 I
Q MY COru?LSSS.ON EXPiRas
OF F'P NOV. 5,2002
SEAL:
Personally known
F MIAMI - DADE STATE OF FLORIDA, COUNTY OF MIAMI - DADE
OR, Produced Identification
Type of Identification Produced: f LS 1 I S 115 • f l
Signature of Contractor / Qualifier
PERMIT APPLICATION
Print Name
Sworn to and subscribed before me this day of
Signature of Notary Public - State of Florida
SEAL:
Personally known OR, Produced Identification
Type of Identification Produced:
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 4/1/2002
Applicant: GEORGE
Owner: SAUVIGNE
Contractor Address:
Local Phone: Cellular:
Parcel # 1132060135050 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 13 & 14 BLK 37 LOT SIZE
Job Address: 301 NE 102 ST
Fees: Description Amount
FEE2002 -1856. Building Permit Application Fe$60.00
FEE2002 -1857 CCF $0.60
FEE2002 -1858 Notary Fee $5.00
Total Fees: $65.60
Permit Status: Approved Permit Expiration: 9/25/2002
Work: EXTERIOR PAINTING AS PER AGREEMENT (OWNER BUILDER PERMIT)
If there is no permit package accessible on the job -site for in
fee is $50.00, which must be paid in advance before calling for
This Permit is granted to the contractor or builder named above to construct the t
ordinances pertaining thereto and with the understanding that the work will be perfo
and approved by the proper municipal authorities. This Permit may be revoked at a
authorization. A further condition upon which this permit is granted is the understar
ordinances and regulations pertaining to the work covered hereby whether shown c
by his agents, servants or employees.
Signed: (INSPECTOR)
In consideration of the issuance to me of this permit, I agree to perform the wort
with the plans, drawings, statements or specifications submitted to the proper aut
myself, my agent, servants or employes.
Building Permit
Permit Number: BP2002 -657
SAUVIGNE
GEORGE
Construction Value:
PAYTOTHE
ORDER OF
FOR
Signed: (Contractor or Builder)
$1,000.00
GEORGE A. SAUVIGNE
301 N.E. IO2nd Street
Miami Shores, FI 33I38
BY:
rat Union National Bank
firstunion.co
Or 003 R/T 067006432
a T 1
Page 1 of 1
Total Fees: $65.60
Total Receipts: $0.00
DATE
x:0 6 700 6 4 3 21: 16 7 7008 488 2 2 10
HARIAJ D rgyp 2 6 3
-D/
24 63
6 3-643/670
BRANCH 00770
sods 40
DOLLARS
NP
VDATE:
MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
0 2-
***************************************************************Mr
-"ADDRESS OF SITE: 301 Nei az sr
CONTRACTOR & LICENSE (if applicable) ,J/
COMPANY NAME: PHONE:-
-'OWNER'S NAME
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Element on the s e must be listed and indicate the color to be painted.
Walls g it
Fascia
Drip Cap/Drip Edge
Soffit \n j k
Roof
Flower Bins f).-
Shutters
Awnings
Chimney �e nvO
Doors and doo jams
Garage Doors
Railings
Fences
Decorative Metal
All brick (simulated or regula
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 work stated. Furthermore , the paint colors will be as per the attached
sa
APPROVED:
Building Offic
ate
0
r
rn
s
kg-
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
4/23/01
Signature of Owne Date Signature of Contractor Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ELECTRICAL
TYI'l
Minimum Fee
QTY.
TYPE;
Dryer
QTY.
TYPE
Outlet, Appliance
QTY.
TYPE,
Service Repair
QTY.
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
'rvpi.:
Minimum Fee
OTC.
nil.:
Condensate Drain
()Ty.
TN IT
Generator
OTT'.
•Tvii;
Refrigeration, Tons
QTY.
A/C Central, Tons
Cooling Tower
Heating Strips, each
Vent Hood, Cost
A/C WaWWin. Tons
Dryer Vents, Number of
Paint Booth
Ventilation, Cost
Air Handler, Tons
Ductwork, Cost of
Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinlder System
Process/Pressure Piping
Supply, AC Well
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
Temporary Toilet
PLUMBING
TYPE
A/C Condensate
QTY.
TYPE
Drains, Roof
Q't'y.
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:
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
$ 01
Metropolitan Dade County (C.C.F.). $ / 0 (/ ( sq.ft. = x/1000
x ¢.60)
Inspector State Educational Fund $ (¢.005 /sq.ft.)
State DCA (Radon) $ (¢.01 /sq.ft.)
Code Enforcement Fine $
Zoning Review $
ALait`
ISSUING OFFICIAL
REVIEWED AND PREPARED BY:
SECTION
Zoning
Electrical
371-7(e)
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
DAT
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ ‘c, b 0
DATE:
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2"° AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date y' t / ' 9 ( Job Address 3U i ' r�l/� S� Tax Folio // 3 Q 6 — 0/3 - 3
Legal Description 11 P4 - Historically Designated: Yes No
Own se / Tenant Cr,PE r ,;(5,1/5
% (j r1/G= / Master Permit # 9 P S 3/
owner's Address J/ t/L / 2 5f
Contracting Co. Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co. }'
Address
Architect/Engineer
Bonding Company Address
Square Ft. _
WARNINC
RESULT
Application
certify that
permits are 1
'V ire
Phone )3-J • ?Si l i U
r--
Mortgagor Address
Permit Type (circle one)
WORK DESCRIPTION I � — /` (UiL( �/I L
ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
fated Cost (value) ' ' > i 1
'OMMENCEMENT AND YOUR FAILURE TO DO SO MAY
NJ UR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING,
ECORDING YOUR NOTICE OF COMMENCEMENT.)
ti
as indicated above, and on the attached addendum (if applicable). I
® Igulating construction in this jurisdiction. I understand that separate
)FING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the o e r rmanolTIsiccnrate and that all work will be done in compliance with all applicable
laws regulatin! cons ction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
atlf. / 1 . L / / C V ?
. do "esident Date Signature of Contractor or Owner - Builder Date
•
,.
Notary as to r and/or ondo President Date Notary as to Contractor or Owner- Builder Date
" 4 y Commission Expires: My Commission Expires:
sY k COLEEN 0. HENDERSON
, : � , COMMISSION #E CC 660927
" " EXPIRES JUL 1, 2001
^' BONDED ?11RU
OF R ATLANTIC BONDING CO., INC.
FEES: PERMIT RADON C.C.F. 6 t, NOTARY BOND
TOTAL DUE
APPROVED:
Zoning Building ' 'J % < Electrical
Mechanical Plumbing Engineering
Owner's Name and Address
New Building
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 building 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 I ,, / L
Name and address of licensed contractor �/t C& pp L {� _ 4 ' 1 —. 70/� 4440.5 0 < ' /7 ` 7 7 —
57 /F •
Location and legal description of lot to be built on: Lei J `, ✓ �f B6 ( -� j � t
Lot /2 s 4 1 Block J / Subdivision � bdivision •V Q kleJ / Ame // 2 0 S` 5 b /
Street and Number where work is to be done 3 ub
O/ 72 e / Q eZ , i)-
State work to be done and purpose of building (by floors). state exterior colors Is bmit amples)
hzi i ,,,,
�""L� o and for no other purpose,
Addition Repairs No. of Stores
Remodeling
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements S . 6 O Amount of Permit S • 3 7 50
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 plans and specifications for said building. All notices with reference to the building and its construction may be sent to
'4 3 31 O
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatons 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 y bcontractors, on work to be performed
under this permit, as are licensed by Miami Shores Village.
Remarks (Signed
STATE OF FLORIDA
COUNTY OF DADE.
} SS.
Date Z 19S(f��
No. 30/ Street
/2 ( ?-T
Before me, the undersigned authority. a notary public. duly authorized to administer oaths and take acknowledgments, personally appeared
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. 9 / 5 —/
Disapproved
(Signed)
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved
Date
Read, Sworn to and Subscribed before me.
Date
Notary Public. State of Florida
Date Disapproved Date
NOTE: A charge of $25.00 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 $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.
BUILDING
ELECTRICAL
PLUMBING
Owner o
Building
Architect
Contractor ' /,
or Builder
Legal Lot Bl.
Description
Address of
Building ,U 1 1 U
This permit is granted to the contractor or uilder named above to construct the building or to install the equipme .r devi described in the appli-
cation 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 respo
sibility for work done by his agents, servants or employees.
INSPECTOR
In n 'deration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance withrdinances an
peitainin the eto and in strict conformity with the lans, drawings, statements or specifications submitted to the proper authdaliA of Miami Sh
In accep g s i assume responsibilit for 1 work done by either myself, my agent, servant or employee.
4✓
CONTRACTOR OR B
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N? 4980
Work to be per,9rmed under this Permit
Signed.
Subdi-
vision
Value of
Project
BY
DATE
Contractor'
License No
AUTHORITY
194 7_