EL-03-225PERMIT APPLICATION
Master Permit No.. 2D3'
Subsidiary Permit No.
INSTRUCTIONS - The following steps must he taken to obtain a permit front 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 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 add tional information.
APPLICATION
Job Address: 1271 - 1309 NE 105th Street
Address
Apt.
Folio Number 11- 22 -32- 027 -0010
Lot A, A -1, A -2, A -3 Block
Subdivision ANCO PB 53 PG 54
Current Use of Property Vacant
Proposed Use of Property
Tenant Information
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
Miami Shores
City
Florida 33138
State
Zip
Description of Work Construction of Pool Equipment/Trash Room
Zoning Linear Feet
Square Feet Units N/A Floors 1
Value of Work Bldg Value
Tax Assessed/Appraised Value .
Flood Zone Base Floor Blev.
PERMIT CHANGE ( 1 )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT .
Nan* ROGER PIPER
T icense N°AR 13039/FL
Address
20100 NE 21ST AVE., N.MIAMI BEACH, FL 33179
ePhO7305) 932 -5200
Fax (305) 932 -0025
PROPERTY OWN7TN: BRIAN SCHEINBLUM
Naw,ILLAGE DEL MAR DEVELOPMENT GROUP, LLC
Address
1655 NE 115TH ST. # 12, MIAMI, FL 33181
Home Telq I1(jb5) 965 -5893
usl
Bneas TdePh° (305) 981 -4702
Fax (3051675 -9221
1
TYPE OF MANAGEMENT (✓ )
Name
New Construction
Address
Enelosdre
•
Alteration Exterior
t
`?) e ■4:
Repair
vaz Telephone si. c° 7r, ..?
S ci- `i 3
Alteration Interior
Qualifier Name
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 Lo C° H6-=1NC ' e„ :0_ ° a e__ i4
License No. 9 6 0%0 �
. y Z.
Address -y ..z._ c ,y ,,,,ai / t
ire; «-ice ;''' (,,r
t
`?) e ■4:
vaz Telephone si. c° 7r, ..?
S ci- `i 3
- c .91
Qualifier Name
Page 2
PERMIT APPLICATION
II4ZPOR';I ANT lit? I IC• S .
1. DO NOT BEGIN ANY WORK wiTInour RAVING RECEIVED) YOUR VALIDATED PERMIT AND Pt-RMJTCARD. 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 SIIALL 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 RFS1DENT'IAI, CONSTRI ICl'ION SITES. Other cnrrstruclto n may have a railer
which requires a separate Permit_
6. PORTABLE TOILETS fora construction sit require a separate pertnit.
7. DO NOT DISC.TIARGE WATER INTO TIIE RIGHT OF WAY OR STORM DRAINS without approval from the Building. Planning and Zoning Department.
8. EQUIPMENT AND MATERIALS SHALL BE S'T'ORED 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- Department of Environmental Resources
Management (DERM) and;or Miami -Dade Water and Sewer Department IMDW ASD) approval is required for applications involving sewers.
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 pennits 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. 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 Commencement must be recorded at:
22 N.W. 1st Street, 1" Floor, (305) 679-1078. Once recorded, the Notice of Comtencetnent must be POSTED ATTIIE 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.
S'T'ATE OF FLORIDA, COUNTY OF MIAMI -DADE
Sienat Owner
' 'ricxn $4.6inblum
Print Name
Swom to and subscribed before me this ig
y of - arktle
vezt
Sign ture of Ndary„i lit, S a e
queue
..
Commission #DD219113
y, Expires: Jun 02, 2007
.' Q;$ Bonded Urn rr r r +0 Atlantic Bonding Co., Inc.
Personally known v OR, Produced Identification
Type of Identification Produced:
SEAL:
STATE OF FL , .OUNT
Signature of C
Print Name 4
. om to and subscribed before the this ICI 4h day of e e
ANTI -DADS
r / Qualifier
Sig` :wre of
l y
otary Public - Stine of F rids
` 1"rre
SEAL: ' °'- un'anka Sequeira
# Commission #DD219113
IN; gitss
Expires: Jun 02, 2007
Bonded Tiro
+prN Atlantic Bonding ., Personally known OR. Identification Flori(�g PL. Type of Identification Produced: D L + 14 355 -- I1-a.'S 4--tW 'b
Page 3
PERMIT APPLICATION
INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below.
` }^� J rah
T!2� 1
„'?•, M1. ii.5 ,7
'
); Y
S}T�yi`
'} 4
,T :. f4 PS .p
"`4 ✓ge(,''4,;�ai' 1
I,linnnum Fee
Bath Fan - Vented, #
Dryer ;
Outlet, Appliance
Pressure Vessel
Service Repair
A/C Central
1 -3 Ton
Fan
'
Outlet Wall
Service, Temporary
4-7 Ton
Fore Pant
Pump
A/C Central
---____-
___- --- ; _- ---'_- ---- -- _._------_ -- --
Outlet Switch
--- -_-_ --
Signs
_---_- --_
A/C Central 8 -1S Ton
Fixture - Fluorescent
Oven
Space Heater (kw')
AJC Central 16.20 'Ion
Fixture Light
Parking Lot Lights
Spas /Hot Tubs
A/4. Central 20+ Ton
Flood Lights
Plvgntold /Strip
Subfeeds, No. of Amps
AiC Window
FPI. - Load Central
- --
Posts
Swim Pool, Commercial
Air Conditioners
Garbage Disposal
Range/Range Top
Swish Pool, Residential
Chiller
Generators, etc-
Receptacles
Switchboards
Clear Violations
Heat Recovery
Refrigerator, Comm. (p /PI.I)
'temp Serv., Construction
Compactor —
Low -volt, Burglar +
_
Refrigerator,
Domestic
Temp for Test - 30 days
Deep Freezer
Low -volt, Fire +
Renew - Temp
Service
Demolition
Low' -`Olt, interconi/Teleph.
Repair Circuits
Dishwasher
Low -volt, Television j
Service, Number of Amps
Minimum Fee Condensate Drain
A/C Central, Tons - Cooling Tower
A/C Wall/Witt. Tons Dryer Vents, Number of •
Air Handler, Tons Ductwork, Cost of
Generator
Heating Strips, each
Paint Booth
Pipin Flammable I'
Refrigeration, Tons
Vent Hood, Cost 1
Ventilation, Cost
--j
Barbecue
Fire Sprinkler System
g, +..,iw..F
Process/Pressure Piping
i ea ivua: itimpl ;L U ES i
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
PLC .\I IN
'TYPE
A/C Condensate
Bath Tub
Bidet
Cap - Fixture
rk I'l
Drains, Roof
1't PI
Miscellaneous Fixture
QTY
Drinking Fountain
Cap - Water
Cap - Sewer
Catch Basin
Clothes Washer
Dental Chair
Filter Replace
Discharge Well
Dishwasher
Disposal
Fountain
Gas - Appliance
Gas - Natural
Gas - Propane
Gas Piping
Grease Trap
Ice Maker
Indirect Wastes
Domestic Well
Interceptor
Miscellaneous Repairs
Pool Piping
Pump and Abandon
Pump, Domestic
Pum, Fire Stand
Pump, Re- circulate
Pump, Replace - Pool
Pump, Sprinkler
Pump, Sump
Relay Repair
Roof Inlet
•1'1l'i<'
Soakage Pit
Solar Water Heater
Sprinkler Repair
Sprinkler System
Supply, AC Well
Temporary Toilet
Temporary Water Closet
Urinal
Utility - Sewer
Utility - Water
Vacuum Pump
Water Closet
Drainfield, The/Res.
Laundry Tray
Septic Connection
Water Heater
Lavatory
Drains, Area
Drains, Floor
Meter Set (Gas)
Septic Tank
Sewer Connection
Drains, French
Minimum Fee
Shower
Miscellaneous Equipment
Sink
Water Heater New
Water Re -pipe
Water Service
Well, Supply
RECEIVED AND REVIEWED BY: DATE:
Page 4
1 OFFICE USE ONLY
PERMIT APPLICATION
t
O OWNER - BUILDER FORM
(Attach)
O FIRE DEPARTMENT
APPROVAL (Commercial /
multi-family)
Ll CONCURRENCY
(New Constriction)
C! OTHER
(Specify & Attach)
01 PROOF OF OWNERSHIP
(Attach)
O HRS / DERM APPROVAL
(Septic / Sewer)
• IMPACT FEE
(New Construction)
.l
OTHER
(Specify & Attach)
0 CONDO ASSOCIATION APPROVAL
(Attach)
rJ
BPR APPROVAL (Restaurants)
O 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
Zor.ing Review
Notary
ISSUINtiG O FICI IL
$ J4/3—/ 00'
$
$
$
(sq.ft. = y'i000
x 0.60)
(¢.005 / sq.ft.)
(0- 01 /sq.ft.)
TOTAL $
REVIEWED AND PREPARED BY:
SECTION
BY
DATE
Zoning
—rill11111111■
Electrical
;�/ T1%
a
Mechanical
-
Plumbing
Fire
Public Works
Structural
Building Official
DATE: -2. x-Ym
CONDITION ()F APPR()V AI,
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756-8972 • http : / /www.miamishoresvillage.com