RC-07-263Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP -40020
Permit Number: RC -2 -07 -263
Inspection Date: 02/15/2007
Inspector: Grande, Claudio
Owner: DOWER, DANIEL
Job Address: 280 95 Street NE
Miami Shores Village, FL
Project: <NONE>
Contractor:
Permit Type: Residential Construction
Inspection Type: Re Occupancy
Work Classification: Re- Occupancy
Block:
Phone Number
Parcel Number 1132060133710
Lot:
Buildinu Department Comments
Wednesday, February 14, 2007
Page 1 of 1
FEB 152661
`
Passed
Inspector Comments
305- 694 -5358
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Wednesday, February 14, 2007
Page 1 of 1
Miami Shores Village
Building Department
RE- OCCUPANCY
APPLICATION
Date -Ls ► 4 q '2- i
FEB FVEEVICI
1 4 2007
BY:
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
Fax: (305) 756 -8972
Permit No. 126 1263
Loc iD
Contact Name /5c /Z-1 :4 Phone # 3 US 4-t
Buyer Seller Realtor ' Company Name LA), f C A tS
Property Address 2 't:^ hiE `(5 S
City Miami Shores State Fl Zip 33/36'
I hereby certify that I understand that the zoning of the property is for single - family residential use and
that it is unlawful for more than one family to reside therein. I also understand that any Certificate of Re-
Occupancy that may be issued by Miami Shores Village certifies only that the referenced property is
being used for single - family purposes and that such Certificate does not constitute any representation,
warranty or certification as to the condition of the dwelling or other structures on the property.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate.
Applicant Na /2 C —r
Signature
The foregoing instrument was acknowledged before me this 4 day of C_P 0 , 2007 ,
by , who is personally known to me or who has
produced as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commi ion Expires:
Building Officials Approval:
Rev. 10 /02/03)
[ i Mabel Vargas
• �.•' • • e`er = Commission #DD23I 984'
= Expires: Jul 13, 2007
Bonded Thru
H rraiitri71- )ndine Co.. Inc
Re -Occ. $60.00 IV
Notary $5.00
CCF $0.60 ,/
Total ( ®,.) • (00
PERMIT APPLICATION
Master Permit No.
Subsidiary Permit No., � , e� ''' ' Q g 5
"'
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:
Po
keE
9
14-1-4/
2
35
Address Apt.
}� (�o City
Folio Number I f C) ,6 '0 )3 '73) l l.� KDescription of Work
Lot
Subdivision
Current Use of Property Square Feet Units Floors
Yalue of Work �—
Bldg Value Proposed Use of Property
Tenant Information Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
Block
PB
PG
State Zip
IA) ,3 t oll (cerrT)
Zoning
Linear Feet
PERMIT TYPE (✓ )
Building
License No.
Electrical
Telephone
Mechanical
Business Telephone
Plumbing
Fax
LPGX
Qualifier Name
Roofing
Fence
Other
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
PROPERTY OWNER
Name pg-itj i 0— po e -
Address mj'
kV— ei rrt, cc - f
Home Telephone
"` ► 9— 9.-572
Business Telephone
1%x,'
Fax
ne
TYPE OF MANAGEMENT (✓ )
New Construction
License No.
Enclosure
Telephone
Alteration Exterior
Address
Repair
Telephone
Alteration Interior
Qualifier Name
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'I Attachment
Other
Add'l Detachment
Other
ENGINEER
Name
License No.
Address
Telephone
Fax
CONTRACTOR
Name
License No.
Address
Telephone
Fax
Qualifier Name
Page 2
PERMIT APPLICATION
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.
STA
RIDA, COUNTY OF MIAMI -DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE
Signature of Owner Signature of Contractor / Qualifier
pkiw e 2 101Aroe--
Print Name Print Name
S . and subscribed before me
kL
pS4Y Pt, OFFICIAL NM' = EA
_ Ge ANGELA 14N LORPKg.11
SEAL: — ( coMsnorr NUMBER
'9` R CC786697
4.• COMMISSION EXPIRES
OF FtD W03,9. 15,2002
Personally known OR, Produced Identification
gna "e of otary Public
Type of Identification Produced:
Sworn to and subscribed before me this day of
Signature of Notary Public - State of Florida
SEAL:
Personally known OR, Produced Identification
Type of Identification Produced:
Page 3
PERMIT APPLICATION
INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below.
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 Sere, 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
QTY.
A/C Central, Tons
QTY.
Cooling Tower
- Heating Strips, each
Vent Hood, Cost
A/C WaWWin. 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
RECEIVED AND REVIEWED BY: DATE:
DATE:
CONDITION OF APPROVAL
Page 4
PERMIT APPLICATION
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
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
(sq.ft. = x/1000
x 0.60)
(¢.005 / sq.ft.)
(¢.01 /sq.ft.)
TOTAL $
ISSUING OFFICIAL
REVIEWED AND PREPARED BY:
SECTION
BY
DATE
Zoning
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
�
' " i°
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com