361 NE 102 St (3)Approved
Correction
Re- Insp'n Fee
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date Time
Type Insp'n
Permit No.
Name •
Address
Company CTIl1Wtn
Phone # ,
For Inspector: 16 ` I ` b "` - {'' Name
l4,
PROPERTY OWNER
Name
Address
1(0/ Ai& /oa St
Home Telephone
i n s 7 5 _ 7 _ S'y e) R'
Business Telephone 3 6 _ j 3/- 3. 7 D d
Fax
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'I Attachment
Other
Add'I Detachment
Other
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Step 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
K Job Address:
3(0/
Address
Folio Number
Lot Block
Subdivision PB PG
Current Use of Property
Proposed Use of Property
Tenant Information
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Other
Fe
Apt. City
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
escription of W
Master Permit No.
Subsidiary Permit No.
PERMIT APPLICATION
sA d ✓e5,
S
ORAL !
FL 3 3i35
Zip
Zoning Linear Feet
Square Feet Units Floors
4 alue of Work / /a C--O Bldg Value
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
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 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.
STATE OF ORIDA, COUNTY OF MIAMI -DADE
1- 7 C4 Sigttature wner
� /J
(°fin /7 ; 6ei,s
Print Name / Print Name
worn . nd subscribed before me thi2 b day , Sworn to and subscribed before me this day of
SEAL: SEAL:
PERMIT APPLICATION
STATE OF FLORIDA, COUNTY OF MIAMI -DADE
Signature of Contractor / Qualifier
Signature of Notary Public - State of Florida
Personally known OR, Produced Identification v r���'� �p Personally known OR, Produced Identification
Type of Identification Produced: S- )D 5 . y , j»pe of Identification Produced:
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 9/26/2002
Applicant: CONNIE
Owner: BENSON
JOB ADDRESS: 361
Contractor
Local Phone:
Parcel # 1132060135090
Signed:
NE 102
If there is no permit package accessible on the job -site for ins
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
ordinances pertaining thereto and with the understanding that the work will be perfor '``
and approved by the proper municipal authorities. This Permit may be revoked at ar"r
authorization. A further condition upon which this permit is granted is the understanr
ordinances and regulations pertaining to the work covered hereby whether shown of
by his agents, servants or employees.
(INSPECTOR)
In consideration of the issuance to me of this permit, I agree to perform the wo t
with the plans, drawings, statements or specifications submitted to the proper autt '.
myself, my agent, servants or employes.
Building Permit
Permit Number: BP2002 -1661
BENSON
CONNIE
ST
Contractor's Address:
Page 1 of 1
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 E1/2 LOT 19 & LOTS 20 & 21 BLK 37 LOT SIZE
Fees:
FEE2002 -5405
FEE2002 -5406
FEE2002 -5407
Description
Building Permit Application Fee
CCF
Notary Fee
Total Fees:
Amount
$60.00
$0.60
$5.00
$65.60
Total Fees: $65.60
Total Receipts: $0.00
Permit Status: Approved Permit Expiration: 3/25/2003 Construction Value: $1,000.00
Work: EXTERIOR PAINTING AS PER AGREEMENT
Connie Benson /
- P..Benson
305- 7 57 -5408
- 361, N.E.,102.d ST
Fl :33138 -
ORD ER '
� I i
^
FIRST UNION NATIONAL BAN' •_`
.j DOWNTOWN BANKING CENTE FLORID - -
ONE SOUTHEAST FINANCIAL CENTER ,
MIAMI,: FL 33731 539
O R ��
Unre
ANN
-
u!:06 7 0064 3 2I:
L6 5 3906
; 4 19
-i
e e will be no inspections. Re- inspection
11
3090
The Sunshine State
P1,11010r-h
B525-103-56441-0
• CONNIE CONTRATA BENSON
• 361 NE 162STREET
MIAMI SHORES, FL 331384128
BIRTH DATE SEX liar. REST, ENDORSE.
09,21-66 F 506
ISSUED EXPIRES DUPLICATE
00-00.00
084648 0921-04
ORGAN DONOR SAFE DRIVER
X06900006312S
at a motor vehicle constitutes consent to any sobriety test reqtaed by taw.
MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
DATE: Q f y—
OWNER'S NAME: e e, V - �_�;'� PHONE: 3o S 5 760 x 3.3 cc,
ADDRESS: 3c,/ /Lye /6 3
,e '1S6 ' S /- 1d '"es /PL.
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE: / AJ c j St
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME: PHONE:
********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted..
Walls o /c-e- 5 y (a/a // # � 3 V ae -°
Fascia Al 06 Fe rh 0-- 9[o / (a/o „5 radC 1.; n e) (
Drip Cap/Drip Edge
Soffit
Roof
Flower Bins
Shutters )J /
Awnings W
1,L) L;
Chimney 4 /1 o (AD
Doors and door jams wh.4.2”'
Garage Doors W
Railings C,J
Fences A //,1
Decorative Metal w
All brick (simulated or regular) OM-
Stucco Banding til/A-
Any other stucco features
Accessory'Buildings e //6 c,J
n)//A-
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
samp s.
APPROVED:
Building Official
6 /( 2 40/0.
Date
(x 1 ee.7
.P.
0
r
H
•
z
c
W
• rxi
z
nature of Owner Date Signature of Contractor Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
4/23/01
ELECTRICAL
TYI'P,
Minimum Fee
QTY.
'I'VI'E
Dryer
Q'I'1'.
TYPE
Outlet, Appliance
QTY.
T1'1'N.
Service Repair
Q'FY.
A/C Central 1 -3 Ton
Heating Strips, each
Fan
Outlet, Wall
Service, Temporary
Paint Booth
A/C Central 4 -7 Ton
Fire Pump
Outlet, Switch
Piping, Flammable Liquid
Signs
A/C Central 8 -15 Ton
Fixture - Fluorescent
Process/Pressure Piping
Oven
Space Heater (kw)
A/C Central 16 -20 Ton
Pressure Vessel
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
"1'YPE,
Minimum Fee
QTY.
INIT.
Condensate Drain
QTY. '1'V
Generator
QTY. '11 PE
Refrigeration, Tons
QTY.
A/C Central, Tons
QTY.
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
Pump and Abandon
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
Gas - Appliance
PLUMBING
TYPE
A/C Condensate
QTY.
TYPE
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
DATE
Zoning
/ee ' 6
p„Z
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
yb,-2 2-
Building Official
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
Metropolitan Dade County (C.C.F.) $ • 6 0
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)
PERMIT FEES
$ o
$
$
( x .6 x/1000
0)
(¢.005 /sq.ft.)
(¢.01 /sq.ft.)
PERMIT APPLICATION
O CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ v a
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
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
MIAMI SHORES VILLAGE, FLORIDA
Lam`
PERMIT IN? 13288
n Work to be performed under this Permit
t /
•
CONTRACTOR OR 13611d)I L .- - 1
t u r i
Subdi-
vision
Value of
Project
$
BY - . t •
DATE � / ' 4. 195
Contractor's
License No.
Amt. of
Permit $
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.
Signed: _ s, ...,,0 x BY 1...
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work done by either, mygelf, my agent, servant or employee.
AUTHORITY
Alp
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.
Date 67 /L , 19
. _
Owner's Name and Address _ V e ak - L L_ �__S No. 61 Street AIe.10 Z• b i
Registered Architect and /or Engineer. _
Name and address of licensed contractor__ L�7 0712
Location and legal description of lot to be built on: �j/ -
Lot 2 / gi 2. 1 Block 3 7 ^ Subdivision 1 4- 41 - 5
• / 127. /
4/ 11. re) 2... S /.
State worl be done and
pur ose of building by floors) _._ • .e' _�e¢.�
C I A. 4-1'_� f_ ee t•J_ d for no o her purpose.
No. of Stories
Street and Number where work is to be done
STATE OF FLORIDA,
COUNTY OF DADE. ss.
New Building Remodeling
To be constructed of Kind of foundativ Roof Covering
Estimated Total cost of improvements $ 2 S 00 .—
Addition Repairs I�
Amount of Permit $
Zone cubage required plan Cubage
Size of Building Lot
Distance to next nearest building
Maximum live load to be borne by each floor
I hereby mit all the lans and specificatio s for said buil ing. All notices. wi
be sent to__ ___ __ _ _
and has complied with the provisions thereof, and will require similar compliance fro
in the work to be performed under this permit; and will post or cause to be poste
or notices as are required by the Act. The undersigned agrees to employ only s
permit, as are licensed by Miami Shores Village.
Remarks ( Signed
reference to the building and its onstru ion •
e 4 4r )
1
The undersigned applicant for this buil ing 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,
all contractors or sub - contractors employed by him
nspectio : • the site o e works 1 1 l' t'
.- .c•ntra or
• r
•'
uci u�ic noi
. e P e� • r ry n• f ,
a
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
to me well known,
and who, being by me first duly sworn, upon oath deposes and says that he is the
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.
1 �
Permit No L_ ' Date Read, Sworn to and Subscribed before me.
Disapproved atg >_ J_
Notary Public, State of Florida
(Signed)
Build g I Spector My Commission Expires
PLANNING BOARD DATE
Chairman 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.