BP-03-785CEIVE
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PERMIT APPLICATION
t No.
't No.
INSTRUCTIONS - `1'he following steps must be taken In „�
I � t,erut►t truon the Miami Shores Village:
Step 1.
Complete the attached permit application which ,ust a signed byihe 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 submit-
ted 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.
aPPL.ICA.I'!ON
job Address; 1271 - 1309 NE 105th Street
Address
Miami Shores
Apt. City
Description of Work Construction of Pool Equipment/Trash Room
.Folio Number 11 -22 -32 -027 -0010
Lot A, A -1, A -2, A -3 Block
Florida
33138
State
Zip
. Subdivision ANCO PB 53 Pt; 54 Zoning Linear Feet
Current Use of Property Vacant Square Feet Units N/A Floors 1
Proposed Use of Property Value of Work $10,000 Bldg Valve
Tenant Information Tax Assessed/Appraised Value
Flood Zone • Base Floor Elev.
PERMIT TYPE (✓ .)
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other.
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name ROGER PIPER
License NeAR 13039/FL
Address
20100 NE 21ST AVE., N.MIAMI BEACH, FL 33179
it'lePhan305) 932 -5200
Fax (305) 932 -0025
PROPERTY OWNTABI I N: BRIAN SCHEINBLUM
Namt/ILLAGE DEL MAR DEVELOPMENT GROUP, LLC
Address
1655 NE 115TH ST. # 12, MIAMI, FL 33181
Home Telepho 05) 965 -5893
Business eP 05) 981 -4702
Fax (305) 675 -9221
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Telephone 740 -0020
Repair
QaalifierN H. TOD BERMAN
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'l Attachment
Other c�
Add'i Detachment
Other ! /.4�\
ENGINEER
N
License No.
ddress
Telephone
CONTRACTCALANTIC GENERAL CONSTRUCTION
Nan H. TOD BERMAN
License N°CGC 038392
Address
1541 SUNSET DR. STE 301, CORAL GABLES FL 33143
Telephone 740 -0020
165) 665 -9222
QaalifierN H. TOD BERMAN
Page 2
PERMIT APPLICATION
............... ...............................
lNIP( >It't 1\T \ i )11
C S
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 6:01) p.m., and Saturday from 8:01) 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 TOIL PITS for a construction site require a separate permit.
7. DO NOT DISCIHARGE 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 (I)ERM) and /or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers.
11 I' I1)AVIT - Pie ase re<ul carc(-ully
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 tneet 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 CO�MMENcEMENT 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, lu Floor, (305) 679-1078. Once recorded, the Notice of Comtencement 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 OF FLORIDA, COUNTY OF MIAMI -DADE
Sign re of Owner
s lF.Rd�.rte
Prins Name
Sworn to and subscribed lief v me this '.___ -- day of e' 1
-Si >n lure of Nota + Publie - State of Florida
.414. Lance Simon
-I: #DD181277
::; Expireess: Jan 30, 2007
Personally known fisinOV Atlailittilnitirdgaafication Vt.—
Type of Identification Produced: ?)L_' J s➢° 7- 7e,
SEAL:
SAFE OF F
COUNTY OF MIAMI -DADS
Signature of Contra or / Qualifier
// /30 d AA r
Print Name
Sworn to and subset.] . before this . - - -_ __ day of
or�
gnature of Notary ublic - State of Florida
SEAL:
Itsg Lance Simon
• �_ Commission #DD181277
Expires: Jan 30, 2007
Bonded mini
mt a' auw Int
a ocn .
Personally known
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.
1? 1 1 (.
................
1� PI;
'FR IC :111'.
......................
Minimum Fee
A/C Central 1 -3 Ton
A/C Central 4-7 Ton
Dryer
A/C Central 8 -15 Ton
Fan
Fire Pump
Outlet, Appliance
Outlet, Wall
Outlet, Switch
1.11'1. I \ l l
Service Repair
Service, Temporary
Signs
Fixture - Fluorescen
Oven
AMC Central 16 -20 Ton
Fixture Light
Parking Lot Lights
A/C Central 20+ 7bn
A/C Window
Air Conditioners
Chiller
Flood Lights
FPL - Load Central
Garbage Disposal
PlugmoldlStrip
1 Posts
Range./Range Top
Space Heater (kw)
Spas/Hot Tubs
Subfeeds, No. of Amps
Swim Pool, Commercial
Swim Pool, Residential
Generators, etc.
Receptacles
Switchboards
Clear Violations Heat Recovery
Compactor Low -volt, Burglar
Deep Freezer Low -volt, Fire
Refrigerator, Comm. (p /PH)
Temp Serv., Construction
—o-
rDemolition Low -volt, Intercom/Teleph. I
Dishwasher
Refrigerator, Domestic
Renew - Temp Service
Temp for Test - 30 days
Repair Circuits
Low -volt, Television
Service, Number of Amps
MI+C,H <1 \I(y, <1I
1`\ 11
Minimum Fee
Q1�. ��P1
Condensate Dram
Generator
Q Y.'
Refrigeration. Tons
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
Mr Handier, Tons
Ductwork, Cost of
Piping, Flammable Liquid
Periodic Inspections
narnecue
Fire Sprinkler System
Process/Pressure Piping
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
PLL1'71
.... ...............................
..... ...............................
1N Ph,
A/C Condensate
Bath Tub
Bidet
Cap - Fixtu
t1i1 X. IA PI:
Drains, Roof
Drinking Fountain
Filter Replace
Fountain
Miscellaneous Fixture
Miscellaneous Repairs
Pool Piping
Pump and Abandon
Soakage Pi
Solar Water Heater
Sprinkler Repair
Sprinkler System
Cap - Wat
Gas - Appliance
Pump, Domestic
Supply, AC Well
Cap - Sewer
Catch Basin
Clothes Washe
Dental Chair
Discharge Well
Gas - Natural
Gas - Propane
Gas Piping
Grease Trap
Ice Maker
Pump, Fire Stand
Pump, Re- circulate
Pump, Replace - Pool
Pump, Sprinkler
Pump, Sump
Temporary Toilet
Temporary Water Close
Urinal
Utility - Sewer
Utility - Water
Dishwasher
Disposal
Indirect Wastes
Interceptor
Relay Repair
Roof Inlet
Vacuum Pump
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
Drains, Floor
Drains, French
Minimum Fee
Sho
MisceIlaneous Equipment
Sink
Water Re -pipe
Water Service
Well, Supply
RECEIVED AND REVIEWED BY:
DAVE:
Page 4
PERMIT APPLICATION
OFFICE USE ONLY
(...,111 (.../LIS
LI OWNER BUILDER FORM
(Attach)
LI FIRE DEPARTMENT
APPROVAL (Commercial /
multi-family)
Li CONCURRENCY
(New Construction)
LI OTHER
(Specify & Attach)
UI PROOF OF OWNERSHIP
(Attach)
• HRS / DER M APPROVAL
(Septic / Sewer)
U IMPACT FEE
(New Construction)
• OTHER
(Specify & Attach)
LI CONDO ASSOCIATION APPROVAL
(Attach)
U BPR APPROVAL (Restaurants)
U CONTRACTOR REGISTRATION
(On File)
$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
.■•■••••••
q 0
$
6-, a (sq... v,000
,.60)
(0.005/sq.h.)
(0.01N.11.)
54-rudvra I fZe
TOTAL $
(111'1('I \I.
$
$
REVIEWED AND PREPARED BY:
DATE:
SECTION
BY
DATE
Zoning
1
Electrical
el"iii
— 'Ir'' 4
7,42720,•40,
41**
Mechanical
/
Plumbinz_
F
Fire
Imw'
Public Works
Structural
Building Official
CONDI'l I( )N 1PPR()V
,
Revised July 2001
10050 N.E. 2" AVE., MIAMI SHORES, FL • (305) 795-2207 • FAX (305) 756-8972 • http://www.miamishoresvillage.com
ARBAB ENGINEERING, INC.
CONSOLING ENGINEERS • 11900 BISCAYNE BOULEVARD, SUITE 508 • NORTH MIAMI. FLORIDA, 33181 • PH. N0. (305) 891-5048 • FAX : 891 -0504
PROECT NAME : 7
REPORT NO.
CONTRACT NO. :
DATE
WEATHER
r
'3 -7 $
"J TIME
GENERAL cON1RACT0R : REMARKS
FAIR
;T�
CLOUDY _
RAIN
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ACCEPTED
REINSPECTiON NECESSARY k '
INSPECTED BY •
ARBAB ENGINEERING, INC.
comma ENG(NEERS • 11900 BISCAYNE BOULEVARD, SUITE 508 • NOR1H AOMp. FLORIDA, 33181 • PH. NO. (305) 891-5040 • FAX : 891 -0504
PROJECT NAME
CONTRACT NO. :
DAZE
WEATHER
Z12g/o"5
REPORT NO. •
TIME • t ° ; V A ,,,/j -
FAIR Z'"'----CLOUDY --- _ RAIN
E8azeg- S
ACCEPTED
REINSPEOTION NECESSARY
INSPECTED BY :
ARBAB ENGINEERING, INC.
CONSOLING ENGINEERS • 11900 BISCAYNE BOULEVARD, SUPIE 508 • NORTH WA HL FLORIDA, 33181 • PH. NO. (305) 891-5049 • FAX : 891-0504
PROJECT NAME • 11•4■"Aref F.. 1)E-1,/ M f1 ij
CONTRACT NO. • 61 2, on 3 R 7 p
DA1E
FATHER
REPORT NO. :
TIME
FAIR
ie..".. CLOUDY
RAIN
0
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t-tE.. OF 5 A •
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Fe a- ow )Ts ThA AT RT__4'v»'z.�s o E-
FIt.-L w In - C_.n Ai tom. 7 110 \G. s
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AccEPTED v AS & d 7 .p
REINSPECTION NECESSARY INSPECTED BY •