499 NE 102 St (4)Dat- 1 Time
1
Permit No.
Name
Address 1,-.)
l
Type Insp'n
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
a„(
Company C2)_A' 1itfv
Phone # —7_c l OS
For Inspector: ( Z/ t /D12)N
Correction
Re- Insp'n Fee
R
.Odm'M
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-�III►IV�CI_ SFORES VILLAGE
Paint Color Approval and Agreement
R'S NAME: . i'l7 `)L lvtal.
DATE:
Shutters
Awnings
DRESS: 4 1 6 ) o 1
COMPANY NAME:
* * ****** is***
Roof es
Flower Bins
Chimney �U
Doors and door jams
Garage Doors
Railings
Fences
Decorative Metal
icxxxx
is
✓ADDRESS OF SITE: '4 6 M WE loZ � Gu(.L(
CONTRACTOR & LICENSE (if applicable)
All Elements on the site must be listed and indicate the color to be painted.
Walls \po,S
Drip Cap/Drip
Fascia
Edge
Soffit
N
S
All brick (simulated or regular) N 14-- Stucco Banding I
Any other stucco features II IA
Accessory Buildings
Other w (A
OWNER'S AFFIDAVIT: I certify that all the foregoing information is aci`urate
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
pies.
Sign of * wner Date Signature of Contractor Dat
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
APPROVED:
Building Official 7 Date
* *
*x*
DA/6/
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ONE : 3
t ; .S-kw'‘eS 33 / 3 �
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PHONE:
X
x
xx x}CX
ca
0<■5 •'' ThI cola
, + s '00d
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
- 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
Tl'PE
Minimum Fee
QTY.
TYPE
Condensate Drain
QTY. Tl'i'E,
Generator
QT1'. 'I'1'1'E
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
Tl'1'E
A/C Condensate
Qi'Y
TYPE
Drains, Roof
cm'.
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
� ..c
/ yy jo/
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
i
Building Official
�
Page 4
OFFICE USE ONLY
,CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
® FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
m PROOF OF OWNERSHIP
(Attach)
HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
PERMIT FEES
$3.00 per page (Scanning Fee)
Miami Shores Village
Bond
Inspector State Educational Fund $
State DCA (Radon) $
Code Enforcement Fine
Zoning Review
Metropolitan Dade County (C.C.F.) $ t TD
$
S., o
r
(sq.ft. = x/100
x ¢.60)
(¢.005 / sq.ft.)
(¢.01 /sq.ft.)
REVIEWED AND PREPARED BY:
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
® BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ S 6 0
DATE:
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL m (305) 795 -2207 o FAX (305) 756 -8972 ® http : / /www.miamishoresvillage.com
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.
Bo'
orida
E OF FLO
IDA, COUNTY
ature .f Ow , Signature of Contractor / Qualifier
Otr nh- ( 00rvA
Print Nan Print Name
Sworn Ip nd subscribed before me thi _ day of
ignaturf of otary Public- =-Siat F,
SEAL:
MIAMI -DADE
0, . P/ O ,. C.O''uiY S'-Y.L
< /ANGELA R4 BE R
ii
�, `'.i.:,.',-,S. a CC7d5C97
G C ti� . i f rr 1'3
STATE OF FLORIDA, COUNTY OF MIAMI -DADE
Sworn to and subscribed before me this day of
Signature of Notary Public - State of Florida
SEAL:
PERMIT APPLICATION
Personally known 'O'R, Produced I eritificatioon— Personally known OR, Produced Identification
Type of Identification ProduceTi l ��v / / b Type of Identification Produced:
PROPERTY OWNER
Name
G 1U nwt F/ vl n t
, fila r
Address –/
' A kvE h SI -- 0 S -2 — 7
Home Telephone 2 0 C- /�� -as-2_ 7
J / 3
Business Telephone I i 5? b b - ,� ? -- e 0/
/ J
Fax
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'l Attachment
Other
Add'l Detachment
Other
CINSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Step 1.
3P. 01,
Master Permit No. _
Subsidiary Permit No.
PERMIT APPLICATION
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.
A PPLICATION
Kb Address: \ al/Q.
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
Address Apt. City
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
Tax Assessed/Appraised Value
V
State
3
Zip
Folio Number 'Description of Work I L ( / i / 1 ( '
Lot Block
Subdivision PB PG Zoning
Current Use of Property Square Feet Units Floors
Proposed Use of Property 3-S-7.51) e of Work 4 3 Bldg Value
Tenant Information
Linear Feet
Flood Zone Base Floor Elev.
ENGINEER
Name
License No.
Address
Telephone
Fax
CONTRACTOR
y � _ Sme
ense No.
Address
Telephone
Fax
Qualifier Name
14 wner's Name and Address
Registered Architect and /or Engineer
„/Name and address of licensed contractor
Distance to next nearest building
Maximum live load to be borne by
I hereby submit all plans and
STATE OF FLORIDA
COUNTY OF DADE.
} SS.
Permit No U
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.
H/P
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Date
Df--eft/tbeA-
/ 19 S g
No. 17 Street
Location and legal description of lot to be built on: //')� Q�
Lot E �. l Block�2� ubdivision AMP {�{ n l Y 1 (� L M s1 f tS 4
(Street and Number where work is to be done - T 1 ` I\J'E 10 Z
-State work to be done and purpose of building (by floors), state exterior cold (submit samples)
a
�j �1
' /' J / /� " 0. / O . # /A'
New Building Remodeling Addition
'lb be constructed of Kind of foundation Roof Covering
(Estimated Total cost of improvements S c2A-L D Amount of Permit S
Zone cubage required Plan Cubage
1/A
Date /
023
Remarks (Signed)
/tom.
Disapproved L ■, l ate
(Signed)
Building Inspector
Repairs No. of Stories
and for no other purpose.
Size of Building Lot
tices with reference to the building and its construction may be sent to
The undersigned applicant for this building �ti a , �. - '� t 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 agree to employ only c su.' tractors. on work to be performed
under this permit, as are licensed by Miami Shores Village.
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.
Pr Read, Sworn to and Subscribed before me.
Notary Public. State of Florida
My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved late Disapproved Date
NOTE: A charge of 525.00 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 525.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.
�Ua3