361 NE 102 St (9)MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date Z 0. Time
Type Insp'n /
Permit No. P 'au / b k J
Name
Address
Compan
Phone# ^ .--Sj 0
For Inspector: 9 13° D `kN ame & D t e
Approved
Correction ❑
Re- Insp'n Fee ❑
I��
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Datei7 ��T /im
` ✓ ( d Ci( /
Type Insp'n
Permit NOT — OO
Name
Company
Phone #
For Inspector:
Approved
Correction
Re- Insp'n Fee ❑
) 1?
CONTRACTOR
{�
Name A r r�S...� 1 1) ? hc.-. ` 'I' 4- EY/ Cf t /1020
License No.
Address I ( 4 - 7 1 6 l lbw ! I7 6 J2
I - t :`a_c...k et-
Telephone 3(i „ � .. 54:. ,,s V7
Qualifier Name
PROPERTY OWNER
\Name E. (` C >.3 vt5u..
` Address
3C r p . E l ea 3 t In S .FL-
Home Telephone 3 OS _ -7 ,7 , 9 g
Business Telephone 3 OS - 3 J L F . - 2 ? s
0 /
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'l Detachment
Other
INSTRUCTIONS - The following steps must he taken to obtain a permit from the Miami Shores Village:
Step 1.
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
/Job Address:
Folio Number
Complete the attached permit application which must be si ng ed by the p r ope r ty owner and q ualifie s Both signatures must b e 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.
Lot
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
3� ( M I S S4-
Address
Aat.
Block
escription of Work
Subdivision PB PG Zoning Linear Feet
Current Use of Property Square Feet Units Floors
Proposed Use of Property alue of Work D- OULl Bldg Value
Tenant Information Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
Master Permit No.
Subsidiary Permit No - aODa • 1 to I
■(; -.'".. SIAA re
City
PERMIT APPLICATION
State Zip
ENGINEER
Name
License No.
Address
Telephone
Fax
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.
ST OF FLORIDA, COUNTY OF MIAMI -DADE
Signature of Owner
x :13 1,
Print Name
S (.YiL to and subscribed before me this 1
tate of Flonda
I
.r
• ature of rt ary Public -
OFFICIAL NOw .V''" I. -J
•
pttV PV eI/ ANGELA M 6r1,
2 " /tt i3 p COMh1SCi4 i1'.'.
T. ., 'III - cr cc/ t ., c
SEAL:
PERMIT APPLICATION
ST E F FL IDA, CO NTY OF MI I -DADE
Signature of Contractor / Qualifier
I fl C m c z _ I 1 giv. A✓ 7 ' C_
Print Name
and subscribed before me thi
SEAL:
lie te'j M
N 1 r ,; * COMIt!JSO :J Nume.-.i l.+
( jr CC786697
si N1Y COQ
r „:i C.
CF FLC NOV. `:J,' ^ R u
P onally known OR, Produced Identification
Type of Identification Produced:, &DL 3.54s--R )S 9i 1.4 1 Type of Identification Produced: /—iJ)L PS 3 D
Miami Shores Village
10050 NE 2nd Avenue
Building Permit
Phone: 305 - 795 -2204 Permit Number: BP2002 -1621
Printed: 9/26/2002 Page 1 of 1
Applicant: CONNIE BENSON
Owner: BENSON CONNIE
JOB ADDRESS: 361 NE 102 ST
Contractor ARROW ASPHALT & ENGINERING INC Contractor's Address: 14799 NW 117 AVE
Local Phone: 305 - 556 -5702
Parcel # 1132060135090 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 E1/2 LOT 19 & LOTS 20 & 21 BLK 37 LOT SIZE
Fees: Description Amount
FEE2002 -5391 Building Permit Application Fee $60.00
FEE2002 -5392 CCF $1.20
FEE2002 -5393 Notary Fee $5.00
Total Fees: $66.20
Permit Status: Approved Permit Expiration: 3/19/2003 Construction Value: $2,000.00
Work: Resurface driveway
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.
Total Fees: $66.20
Total Receipts: $0.00
Signed: (INSPECTOR) BY:
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity
with the plans, dr ings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either
myself, my a t, s an or employes.
Signe
(Contractor or Builder)
REG 001 092702 0925 MC #Dl M1472 EZDC. "CaIc6.2Q
BY:
STATE OF FLORIDA)
COUNTY OF DADE)
) horeo e
UL��
AFFIDAVIT
The undersigned Affiant, l•r e'�� -m. '1 ; does hereby attest that the
(property owner)
attached survey, performed by
(name of surveyor's company)
performed on 5 is an accurate representation of the existing conditions an
(date of survey)
locations of all structures on the property as of this date.
The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the -
property without first providing a survey less than six (6) months old. The Affiant, as property owner, further
agrees to remove or obtain permits for any structures which now may exist on the property which are not
permitted or which may violate zoning or building code regulations. The Affiant further understands that the
existence of any such structures may affect final inspections as applicable to this or other permits..
Further, Affiant sayeth naught.
Witness(sign and print)
•
Affiant/Property owner
Witness(sign and print)
SWORN TO AND SUBSCRIBED before me this day of 20c),
Affiant is personally known to me, Li/'"
produced 1 _ j I• L _ fiI de
OFFICIAL NO Y '' _ 1.
. - 1 PO AVMGELA M BEG r
Z 1 iii. iO commlsootl Pilltairll
N I , CC766697 • O MY COBS: /i '3" "')id ;']!?IFl .2
411 1
...
-
ARROW ASPHALT & ENGINEERING, INC.
14799 NW 117 Avenue
HIALEAH, FL 33018
Dade (305) 556 -5702 froward (954) 963 -9034
Fax (305) 556 -0288
Lk, #E97200 CC#98-1608-X
PROPOSAL SUBMITTED T
C n e. 2t\CO 1
PHONE
3 0 7,57 �
DATE
7 / �
STREET . /0 z ..S1--
-
JOB NAME
cIT j STATE and ZIP CODE
JOB LOCATION
ARCHITECT / 97//�
DATE OF PLANS
JOB PHONE
We hereby submit
..,....... ... .......__•
4
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C-ct.
-r
/4-ek)
AI Y.
specifications and estimates for.
vim _.. .._a5- __._. /09S � 'fi - - ..._6 _..
C
cl _ i p :e.gf5s• _._._...y" Q - 4ii_.f,. oth.e.46.
4 4ese t' ,t1- ..... l vl�./ /i ` 6j. e.� k
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w., 5.4..L.A,•4. S 4.0....a,.
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-
M 2 ft 1
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1
2 -f -- c..-
310•600,
14) 1,._,.,,x,
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iii P hereby complete specifications, C TQ GSP hereb to furnish materlal and labor — com late in accordance with above s for the sum of:
dollars ($ 6 0 0 q..
.�
Pa men wbe . =_ / /
All material Is guaranteed to be as specified, All work to be completed In a workmanlike
manner according to standard practices, Any alteration or deviation from above epecillcadons
Involving extra costs will be erceculad only upon written orders, and will become an extra
charge over and above the estimate. All agreements contingent upon strikes, accidents
or delays beyond Our control. Owner to carry fire, tornado and other necessary Insurance,
Aim wnrknre_ !!r.% 1.111... A..ww,rl 1... 1,11..x........4 r•.._ ... 1 —..__
Autholiz 1
Signature /�
1
Note: This proposal may In
withdrawn ht, Ha if not ar,rnnfnrf within J......
co'cfT • -1
[UJJuzru1
Atrrpthrtre of Proposal —The above prices, specifications
and conditions are satisfactory and are hereby aCCepted. lbu are authorized Signature
to do the work as specified. Payment will be made as outlined above.
Date of Acceptance: Slgna re
t7ra • as 7rtra7 -MT --.Mc
VISIONS
4 9. •
•••••---- 0 2'
20 •
ED. 1/2" IRON isi .' t V'''' .,--.0 .0. 1 -- ,,, N..,',
PIPET
_ 1.8 irkla1Vci-..;7,p5.66,(k &
_
• 4
ID. DRILL HOLE..
IN CONC. WALK
1.11
•• •
buutilimiri ourii v
CCiJC.
SL
\B\
10
LO
GRAPHIC SCALE
01
co
BY
20• 40
( IN P'EET )
1 inch 20 ft.
1
1- 56.15'
16.15'
, 5 T. OtIC! S'IBEWAt •°,,
S 90'00'o,akti oo'
ASPHALT
CO
04
•R4,;740 .,001it■
N.E. 102ND ST.
11•4•1111
1....■■■•■■•■•
56.60'
.4 ,,
0 • •
FD. 1 /2" ;RON N( / CA C A P
.
— 0.2'
7
. 4
4 /
FO. 1 /2" IRON PIPE
NO CAP
5 5ct
•••
75 FT fe /14
CY & ASSOCIATES
Land Surveyors / CIvL Structural & Environmental Engheer
4694 Pan Avenue o Suite 203
titaleth Florida 33012
`" ir '2R 0 Fax 11051 R" '7.''-
Tax Folio #:
requests pen to install:
Lot Block Subdivision
1' Asphalt, concrete, brick pavers
[ ] Landscaping
(J Other
SIGNED, SEALED AND DELIVERED in the presence
tami ShoNeJ (/iClag
10050 N.E. SECOND AVE.
MIAMI SHORES. FLORIDA 33138 - 2382
Telephone: (305) 795 - 2207
Fax: (305)-756 -8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
WHEREAS , hereinafter referred to as the Owner of the
(owner)
following described property:
Legal description/folio #:
within the public road right of way ( � 9 � ( }ril S FL
(address)
IN CONSIDERATION of the approval of this permit by the Village, the Owner agrees as follows:
1. To maintain and repair, when necessary, the above - mentioned item(s) installed within the dedicated right
of way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said
items within public right of way including restoration of street by reason of the Owner's failure to do so,
such expense shall be paid by the Owner or shall constitute a lien against the above described property
until paid.
2. The owner does hereby agree to indemnify and hold Miami Shores Village or dade County harmless from
any and all liability, which may rise by virtue of permitting the installation of these items within the public
right of way.
3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days
notice by the Village to do so. Failure to comply with this notice will result in the Village causing the
item(s) to be removed and a lien being placed on the property and/or assessed against the Owner for all
costs incurred in the removal and disposal of the item(s).
4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and
shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such
time as this obligation has been canceled by an affidavit filed in the Public records of Dade County, Florida
by the Village Manager of Miami Shores Village (or his fully authorized representative).
I
SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE malls 1 ( day of .) e '0
f� Pf o4cf-}
•
ELECTRICAL
'rvi'i:
Minimum Fee
()Ty.
ivI
Dryer
Q
.i'i'i:
Outlet, Appliance
(fry.
.LITE
Service Repair
Q.LY.
A/C Central 1 -3 Ton
Cooling Tower
Fan
Outlet, Wall
Service, Temporary
A/C Central 4 -7 Ton
Paint Booth
Fire Pump
Ventilation, Cost
Outlet, Switch
Air Handler, Tons
Signs
Ductwork, Cost of
A/C Central 8 -15 Ton
Fixture - Fluorescent
Oven
Space Heater (kw)
Process/Pressure Piping
A/C Central 16-20 Ton
Fixture Light
Bath Fan - Vented, #
Parking Lot Lights
Fireplaces, Number of
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. "I'm
Generator
QTY
TYPE
Refrigeration, Tons
Q'fY
A/C Central, Tons
Bath Tub
Cooling Tower
Heating Strips, each
Vent Hood, Cost
A/C Wall/Win. Tons
Dryer Vents, Number of
Paint Booth
Filter Replace
Ventilation, Cost
Pool Piping
Air Handler, Tons
Sprinkler Repair
Ductwork, Cost of
Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
Process/Pressure Piping
Cap - Water
Gas - Appliance
Bath Fan - Vented, #
Pump, Domestic
Fireplaces, Number of
Pressure Vessel
Cap - Sewer
PLUMBING
TYPE
A/C Condensate
QTY.
TYPE
Drains, Roof
QTY.
TYPI?
Miscellaneous Fixture
QTY.
'I'YPIi
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
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)
PERMIT FEES
, a°
(sq.6 x/1000
x
(¢.005 / sq.ft.)
(¢.01 /sq.ft.)
REVIEWED AND PREPARED BY:
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File).
TOTAL $
ISSUING OFFICIAL
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
BY
Zoning
Zoning
�
� �-
"
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
•
�� q /
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.) $
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
, a°
(sq.6 x/1000
x
(¢.005 / sq.ft.)
(¢.01 /sq.ft.)
REVIEWED AND PREPARED BY:
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File).
TOTAL $
ISSUING OFFICIAL
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