EL-03-195ECEOVED
U 7 2003
Master Permit No
PERMIT APPLICATION
0 03
Subsidiary Permit No.
INSTRUCTIONS - The following steps rims: ire iai;en io obtain a "permit from. fiat li niii Shorcs''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 submit-
ted along with this permit application.
Step 2. NftulullesogagIggAgnatradog with all necessary documents to the Budding, Planning and Zoning Department for processing. During the
processing of your application, you may be asked to submit additional information.
APPLICATION
Job Address: 1309 NE 105th Street
Miami Shores
Address
Folio Number 11- 22 -32- 027 -0010
Lot A, A -1, A -2, A -3 Block
Subdivision ANCO PB 53 PG 54 Zoning Linear Feet
Current Use of Property Vacant Square Feet Units Floors
Proposed Use of Property Value of Work Bldg Value
Tenant Information Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
Apt. City
Florida 33138
State
Description of Work Temporary Electric
PERMIT TYPE (✓)
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT .
Name ROGER
Ljecille NoAR 13039/FL
Address
20100 NE 21ST AVE., N.MIAMI BEACH, FL 33179
TU`b fl 305) 932 -5200
Fax (305) 932 -0025
PROPERTY OWN .N: BRIAN SCHEINBLUM
NanT/ILLAGE DEL MAR DEVELOPMENT GROUP, LLC
Address
1655 NE 115TH ST. # 12, MIAMI, FL 33181
HomeTelephm5) 965 -5893
Busing 11e'h7305) 981 -4702
Fax (305) 675 -9221
TYPE OF MANAGEMENT (✓ )
Name
New Construction
Address
Enclosure
•
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'I Attachment
Other
Add'I Detachment
Other -
ENGINEER
Name
License No.
Address
Telephone
Fax
CONTRACTOR
/ �
Name .)e c ' ll e . E , /.m p
- .
License No.
Address .71 A G;c <L-� /1k- kl G=1 ,-=z:-
(404„ A v._ le Lf e I '374'2_6
T e l e p h o n e y5?)--)/ - -) Fax V ,I i e x 5/ 3
Qualifier Name a
C��2 ^UGC -� 4�t''�`t`,z-'7
4.7 a -717 7
MIAMI SHORES -VILLAGE
BUILDING DEPAR
305- 795 -2204
Building Inspection Reques
Date ID. >14"11 YTime
Type Insp'n P/1-1,,L 7.e, A xtoyt e6' ,
Permit No. Ok- - / �J
Name Vititgyy --! ' 04. JA le-72-
Address / Z11rl / ®5 $'✓
Company Pah V
Phone #
For Inspector: Name & Date
Approved
Correction ❑ 07 )Z 'Y S '
Re- Insp'n Fee ❑
�P ; ' pm7 (Jam /`tod
Page 2
PERMIT APPLICATION
NIFT)12.I,1NV f hi(?TIC S
1. DO NOT BEGIN ANY WORK wiTuoU't'HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit dries 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.nt.
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 SI (ALL 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 RF.SIl3ENTIAt, CONSTRUCTION SITES. Other construction may have a (miler
which requires a separate permit.
ri. PORTABLE TOILETS for a construction site 1-equirc a separate permit.
7. 130 NOT DISCIIARGE WATER INTO '111E 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 MRS) approval is required for applications involving, septic tanks. Depattinent of Environmental Resources
Management (DERV!) and /or Miami -Dade water and Sewer Department ! MDWASDt approval is required for applications involving scwe:rs.
r f ,
*"t1
Application is hereby (Dade to obtain a permit to do work and installation as indicated. 1, the OWNER of the property, certify that all
work will he 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 (nay he 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, 1 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. 1 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 Comtnencernent must be recorded at:
22 N.W. 1st Street, t'' Floor, (305) 679-1078. Once recorded, the Notice of Commencement must be POSTED AI' •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 .FLOR , COUNTY OF M1AM1 -DADS
Signal, of Owner
rian Seheinb lum
Print Name
Swom to and subscribed before me this J day of ..SWAC_ ,
S t mature
Vary Public -*ate f �
ot
oVtr,,,, LuvyftnlcaSe ueira
° ` � Commission #DD219113
Expires: Jun 02, 2007
"4". off'.` Bonded'Ihru
` Atlantic Bonding Co., Inc.
Personally known V OR, Produced Identification
SEAL:
Type of Identification Produced:
STAFB OF FL 'g3UNTYJOF MIAM1-DADE
Signature of Contractor
ualitier
9 t ifigtJ •
Print Name
Sworn to and subscribed before me this day of U1Y1e ,
Si ' a of N a�►r•y. Llivya
Sequea „1- - S to of Flora
• Commission. #DD219113
:* Expires: Jun 02, 2007
►`• ` Bonded 7hru
a,nt+` Atlantic Bonding Co., Inc.
OR. Produced identification fiCriCk PL.
SEAL:
Personally known
Type of Identification Produced: p L f 4-4(00-0
Page 4
OFFICE USE ONLY
PERMIT APPLICATION
:....::................
O OWNER - BUILDER FORM
(Attach)
O FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
U CONCURRENCY
(New Construction)
O PROOF OF OWNERSHIP
(Attach)
O CONDO ASSOCIATION APPROVAL
(Attach)
• FIRS / DERM APPROVAL BPR APPROVAL (Restaurants)
(Septic / Sewer)
• IMPACT FEE
(New Construction)
C I OT[ tER w3 OTHER
(Specify & Attach)
(Specify & Attach)
1_I CONTRACTOR REGISTRATION
(On File)
1? %I2RIfl IEEE
53.00 per page (Scanning 1-7ce)
Miami Shores Village
Bond
Metropolitan Dade County (C.C.F.)
Inspector State Educational Fund
State DCA (Radon)
Code Enforcement Fine
Zoning Review
Notary
ISSUINF; OFI ;ICIA
REVIEWED AND PREPARED B
SECTION
Zoning
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
(sq.ft. = x/I00J
x 0.fi(f)
( &A05Isq.ft.)
(4_01/sq.ft.)
TOTAL $ 60po
�
DATE
ATE: ) 7 C 1:,re
C()NI ?IT3(:)N ()I, APPROVAL,
Revised July 2001
10050 N.E. 2N° AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com