465 NE 102 St (11)MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Dat Mme
Type Insp'n ,oc AA V .ec4 Att
Permit No. P 0 Ll
Name
Address 6 5 11 , e,
Correction
Re-Insp'n Fee
Company (7:3M)JY\x-A-/
Phone # 3o<- T J ( C? J - `ic9 /
1 D
For Inspector$ )3 0 / Name & Date
PROPERTY OWNER
� a11e C - 1• 4.1 . 5 4- L 's c,... (lea-Liz
Address
y i`&t. ..i S L s c 4A -
Home Telephone 3ov. 9.-S -4-5 b t g
Business Telephone 3 os' q q C • -'tf s- s 7
Fax 36 5 3-5-41 — (4 S"
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 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 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.
APPLICATION
Job Address:
(-16 c- h(.E .
Address
Folio Number
Lot Block
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
Co a-
PERMIT CHANGE (✓ )
Chg.'Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
/►1 r' a ti..t'
City
c f_
Apt.
Description of Work
Master Permit No.
Subsidiary Permit No.
<-e
PERMIT APPLICATION
State
p0„0,+ C- X'd'i
33 ? 0
Zip
o-c kvn u T--C
Subdivision PB PG Zoning Linear Feet
Current Use of Property . Square Feet Units Floors
Proposed Use of Property / Value of Work I i S-(23. - Bldg Value
Tenant Information ax 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
IN'IPORTANT 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 0 • FLO IDA, COUNTY OF MIAMI -DADS STATE OF FLORIDA, COUNTY OF MIAMI DADS
Signature of Contractor / Qualifier
Ignature of Owner
41 A- Irk.- L
Print Name
orn to d nd subscribed before me this
Print Name
Sworn to and subscribed before me this day of
0
I
gnature o./ otary Pub , State nda a -; ' B . t, , : .• . �4 `I Signature of Notary Public - State of Florida
Z % n cL . ';.:9'e SEAL:
r : : i.,
Personally known OR, Produced Identificati Personally known OR, Produced Identification
Type of Identification Produced: /26— Dom° 3 'c 5 b5a [ - 6 I ^ Type of Identification Produced:
D( — 'd
SEAL:
PERMIT APPLICATION
uv i 1 1 l v= VY
unique L,nvmg 3cnooiiterrannJ Je
Parry Real Estate (Mgt. Agent)
Henry Everett (Owner)
155 N.E 96 Street
PZ01 -11 18 -05 Scott & Marcy Orth
9376 N.E. 9 Place
PZ01- 1118 -06 Ronald Temkin Sec. 523: Pai,
9935 N.E. 4 Avenue Road
PZ01- 0621 -01 Brian Scheinblum(agent) Sec. 604: site!
PZ01- 1018 -04 M &M Trading (owner) Sec. 400 : vari;
xxx N.E. 105 Street requesting .66
.5 is allowed
New Business: Discussion of paint colors
IV NEXT MEETING — December 20, 2001
Sec. 52s
requestinc
where 15 °A
1 ,
ct-yucAJD
p\-QA-
► 0 %% !�:
A rdS Zecz4
CHRISTOPHER C. HERBERT
USA A. HERBERT
465 N.E. 102 ST.
MIAMI, FL 33138
PAY TO THE
ORDER OF
W Waslfington Mutual
DATE
Washington Mutual Bank. FA
Miami Beach /Alton Road 1742
1801 Alton Road 1- 800-768 -7000
ml Beach. 9.��`3 31��_3 9 20 hour Customer Service
1:26 7084 L 3 L1:13 3 log. 280 29411101' 24 2 7
NOTES
63- 8413/2670
8312802940
2427
DOLLARS 8
n.om F.r...
Ijoisfig
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 4/12/2002
Applicant: CHRIS &
Owner:
JOB ADDRESS: 465 NE 102 ST
Contractor
Local Phone:
Parcel # 1132060170820
Fees: Description Amount
FEE2002 -2159 Building Permit Application Fee $60.00
FEE2002 -2160 CCF $1.20
FEE2002 -2161 Notary Fee $5.00
Total Fees: $66.20
Total Fees: $66.20
Total Receipts: $0.00
Permit Status: Approved Permit Expiration: 10/9/2002
Signed:
Building Permit
Permit Number: BP2002 -749
HERBERT
Contractor's Address:
Legal Description: 6 53 42 PB 15 -14 MIAMI SHORES SEC 4 AMD PLAT LOTS 20 & 21
Construction Value:
Work: EXTERIOR PAINTING AS PER AGREEMENT (OWNER BUILDER PERMIT)
$1,500.00
Page 1 of 1
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 hown on the plans or • . , 'rigs or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees.
SPECTOR) BY:
In consideration of the issuance to me of this permit, l agree to perform the 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 responisibihty for all work done by either myself, my agent,
servants or employes.
Signed: (Contractor or Builder) BY:
MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
DATE: -( I /o)
OWNER' S NAME: (-kJ- PHONE: -4-c _ 4 -8
ADDRESS:`16sN•F. foai-
********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE: 967 - (oa s
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME:
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted.
Walls
Fascia
Drip Cap/Drip Edge
Soffit
Roof N
Flower Bins
Shutters
Awnings
Chimney
Railings
Fences
Decorative Metal
APPROVED:
Doors and door jams
aV .1 o Wo
Navq 1 4 to
l` t
1---) 0--
N
Garage Doors ►� a-
i' II
All brick (simulated or regular) r,, w * \,
Stucco Banding
Any other stucco features
Accessory Buildings
Other
lna
A\ 4)
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accu ra t
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
.\ sample y/9 b
Signature of Owner Date Signature of Contractor Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
_q/7/dd,
Building Off ial Date
r
\11)l);fie
Oaf
PHONE:
CG 0 L C ]OCCQSt'J 3 -776'
H
$J
CJQVQda TIE P -922"
460,e-
_
.r wu
/ r�
k
0
2
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
4/23/01
\ �
ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPE
Dryer
QTY.
TYPE
Outlet, Appliance
QTY.
TYPE
Service Repair
QTY.
A/C Central 1 -3 Ton
Fan
Dryer Vents, Number of
Outlet, Wall
Ventilation, Cost
Service, Temporary
Air Handler, Tons
A/C Central 4 -7 Ton
Piping, Flammable Liquid
Fire Pump
Outlet, Switch
Fire Sprinkler System
Signs
A/C Central 8 -15 Ton
Bath Fan - Vented, #
Fixture - Fluorescent
Pressure Vessel
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
TYPE
Minimum Fee
QTY. TYPE
Condensate Drain
QTY. TYPE
Generator
QTY. TYPE
Refrigeration, Tons
QT1'.
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
Solar Water Heater
Air Handler, Tons
Ductwork, Cost of
Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
Process/Pressure Piping
Cap - Fixture
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
Pump and Abandon
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
Drainfeld, 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
LI OWNER - BUILDER FORM
(Attach)
U1 FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
CONCURRENCY
(New Construction)
® OTHER
(Specify & Attach)
El PROOF OF OWNERSHIP
(Attach)
m HRS / DERM APPROVAL
(Septic / Sewer)
® IMPACT FEE
(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
$ a 9
$
(sq.ft. = x/1000
x0.60)
(¢.005 /sq.ft.)
(¢.01 /sq.ft.)
REVIEWED AND PREPARED BY:
SECTION
Zoning
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
BY
PV0
PERMIT APPLICATION
El CONDO ASSOCIATION APPROVAL
(Attach)
BPR APPROVAL (Restaurants)
® CONTRACTOR REGISTRATION
(On File)
TOTAL $
DATE:
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL ® (305) 795 -2207 m FAX (305) 756 -8972 a http : / /www.miamishoresvillage.com
•
PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
Datet q /' , Job Address /O / .9y/fi (5
Tax Folioll .Jola / 7 Iwo/
Legal Description/ 'roZ I/ Mt p4 7) .5'
Owner / Lessee / Tenant 441 Master Permit ii,fil *- %
Owner's Address 445 '1 t /4r (5 - 7 1---
Phone
Contracting Co. tJA/ /f7/4)J �/} /A/r //J6 Address /..�,39 f . P.4 i /- io4 /14
QualifieiT /77/aA/ //vN /ij Phone � 9 ? 3/;-
State # Municipal 1 Competency # 0,040 /` /ins.Co. / 24///f/f �eArA / / /NG
Architect /Engineer
59
Bonding Company
Mortgagor 79 ).( a a 0
Signat r
Date: 6
tar yf as to Owner and/krintCondOstitINSidefitotary Public
pi? ''-fa,4/
Commission Expires: Personally known ❑OK Produced I.D.❑
Type and number of I.D. produced:
APPROVED:
Jo
� /9## owner and/
0/
Address
Square Ft. Estimated Cost(value) R20,690
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 1 p�J/vr /}ou
Address
Address
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 (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.
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 abov- -name1 rnnrractor to do the work stated.
0" "`e4:: JOSEPHINE CHURCH .
:Notar Pusli • •nda
• ! ± � . F iId ntExp. April 30, 1996
•. orn� No. CC197545
'', A o:. ( , NE CH
Ap,a ... No. CC197545
,GPI
T otlry as to Con�'fiiiht�froro�4'" 3. S i
My Commission Exres known ■ ro lice
ypc anti number of I.D. produced:
lic
** * * * *❑ Dii) rake an o h, or * * * * * ❑ DO rake an oath, or
❑ DID OT take an oath. * 0 DID NOT tan oath.* **
/
FEES: PERMIT l'7,5 RADON C.C.F. S �/ NOTARY �l 8 t' . TOTAL DUE 7 3 °P,
Fire Other
Zonin: Buildin_ Z ''l3v A Electrical
Mechanical Plumbing Engineering
4 , 9 •