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500 NE 102 St (6)
PROPERTY OWNER Name c i a u,K ravt, (a actvlI -r cir. d Address ✓ G , ,� [ I - ) Qs ` ©z, 54.... 'f / m i IC to% Home Telephone 7 / 7 �/ - 7y Q Business Telephone Alteration Interior Fax . �7 /_ !/"� /- (0 - L•?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'I Detachment Other Step 1. PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other 1 at KV■.1cs, PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax PERMIT APPLICATION Master Permit No. Subsidiary Permit No. 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. APPLICATION Job Address: 5z) )-)E_ kO — 5+ 1� t u 5 Address Apt. City Folio Number l O LT' 101 0 Description of Work Lot` - • ) a Block L Subdivisioi f\ 1) i \ PB PG Zoning Linear Feet Current Use of Property Square Feet Zi CO Units Floors u`xck Proposed Use of Property Value of Work 1000 • Bldg Value ...0 Tenant Information Tax Assessed/Appraised Value Flood Zone Base Floor Elev. rL 333 State u-�- e o Zip ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. Address Telephone Fax Qualifier Name Page 2 I MPORTANT 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 Contracto . STATE OF r • RIDA T OF MIAMI DADE Signal of Owner Print Name Swom to and subscribed before me this .. ?0 SEAL: Personally known ,S teof tida__ ___ AI!CELl1 Q OR, Produced Identification day of�, STATE OF FLORIDA, COUNTY OF MIAMI -DADE Signature of Contractor / Qualifier Print Name Sworn to and subscribed before me this day of Signature of Notary Public - State of Florida SEAL: PERMIT APPLICATION Personally known OR, Produced Identification Type of Identification Produced l l/ c I W 5 T L )' � �. (/3 0 Type of Identification Produced: MIAMI SHORES VILLAGE Paint Color Approval and Agreement DATE: OWNER'S NAME: S as 4 U.(.cwtc1, -i cJcJz 3PHONE: a.-5 75 NCO" ADDRESS: 5)6 kJE 10 2 5 . **** Ncx& xxxxxxxxxxxxx** *************** *****x******** ADDRESS OF SITE: 5 C— tQ Z 5+, 1AU S ✓� CONTRACTOR & LICENSE (if applicable) ° COMPANY NAME: PHONE: ****xcxtT,CY *****scx**x*******xxxxxxx** * * *x All Elements on the Walls ✓ Fascia Drip Cap/Drip Edge Soffit Roof Flower Bins Shutters Awnings Chimney Doors and door jams Garage Doors Railings Fences Decorative Metal All brick (simulated Stucco Banding Any other stuccg features Accessory Buildings Other tv) N 1� or regular) N ki9A-Ct—E- LAA) J J4 l� 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 wol. stated. Furthermore , the paint colors will be as per the attached sam Sig ature of Owner Date Signature of Contractor Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED: WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION Building Off xx*Xexxx e must be li and indicate the color to be painted. v\cA LO QAP () R t\Np r Date 51kL0 tvk ai -5o)wAb 4/23/01 MIAMI SHORES VILLAGE` Paint Color Approval and Agreement DATE: /v OWNER'S NAME: d cm A NkLVig, 41C6PHONE: - 755 -7116j ADDRESS: •c0c L)E _ Illy:Gw► ■ \noVe * * * * * * * * * * * * * * ** *****************. * * * *ac * * ** * *** * *'se * * * * * * * ** ADDRESS OF SITE: 500 . CONTRACTOR & LICENSE (if applicable) COMPANY NAME: PHONE: * * * * * * * * ** * * * * * * * * * * * * * *hc . ** ** * * * * * * * ** * * *xxxx *xC *x ust be listed and ipdicate the color to be painted. � y All Elements on the site r S u �G Walls �/ Fascia Drip Cap/Drip Edge qA Soffit k) ? (U r _ lec- Flower Bins (U In- Shutters PO A geri,,,,,e Awnings / l y Chimne / U ( ) Doors and door jams ✓ o,Axi e ibv4101 Garage Doors (b (1 Railings Fences " 44 Decorative Metal All brick (simulated or regular) Stucco Banding Any other stucco features Accessory Buildings Other 0 r 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 wor ated. Furthermore , the paint colors will be as per the attached samples. ture of Owner Date Signature of Contractor Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED: WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION Building Official Date I „0.LA 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 Q"I'Y. 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 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 DA E Zoning 4. c /U 4 Electrical /✓� Mechanical Plumbing Fire Public Works Structural Building Official /0 Z i. 2tuti `.. Page 4 OFFICE USE ONLY CHECKLIST O 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 Inspector State Educational Fund $ State DCA (Radon) Code Enforcement Fine Zoning Review i PROOF OF OWNERSHIP (Attach) ® HRS / DERM APPROVAL (Septic / Sewer) • IMPACT FEE (New Construction) ® OTHER (Specify & Attach) PERMIT FEES $ 0 ,o t) Metropolitan Dade County (C.C.F.) $ f 6 0 ( sq.ft. = x/1000 x t.60) $ (¢.005 /sq.ft.) (¢.01 /sq.ft.) REVIEWED AND PREPARED BY: PERMIT APPLICATION m CONDO ASSOCIATION APPROVAL (Attach) O BPR APPROVAL (Restaurants) ® CONTRACTOR REGISTRATION (On File) TOTAL $ S v DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL a (305) 795 -2207 0 FAX (305) 756 -8972 a http : / /www.miamishoresvillage.com 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. Owner's Name and Address Registered Architect and /or Engineer Name and address of licensed contractor Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done State work to be done and purpose of building (by floors) STATE OF FLORIDA, COUNTY OF DADE. } SS. MIAMI SHORES VILLAGE iRn ' ' /4 / `,, / 5 6 /- /7 No 3'6° O Street //E J a 2 — o f> to P4t9 iii o r � /Y /t �P '• �/1 /A ; T ,19 6 and for no other purpose. New Building Remodeling Addition Repairs k No. of Stories To be constructed of Kind of foundation Roof hovering Estimated Total cost of improvements $ Amount of Permit $ 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 the plans and specifications for said building. All notices with reference to the building and its construction may be sent to The undersigned applicant for this building 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, Pennanent 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 subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) 4:2-tcoo 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 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 (Signed) Date__ Disapproved Dat .fl Notary Public, State of Florida Building Inspector " My Commission Expires Chairman Member Member Council Approved Date NOTE: A charge of $1.00 will be made for the Planning Board. A re-inspection fee of $1.00 will be charged materials and /or workmanship. Read, Sworn to and Subscribed before me. PLANNING BOARD DATE Member Member Member Disapproved Date making corrections or changes to this application after approval has been obtained from when such re- inspection is made necessary by improper notice for inspection or faulty