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ME-03-143PERMIT APPLICATION Master Permit N Subsidiary Permit o. _003 IL/ 3 INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Srep 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 additional information. 1PI'I,1C ITION Job Address: 1271 - 1309 NE 105th Street Address Folio Number 11- 22 -32- 027 -0010 Lot A, A -1, A -2, A -3 Block Subdivision AN CO pH 53 pG 54 Zoning • Linear Feet Square Feet Units N/A Floors 1 Proposed Use of Properly Value of Work 119P 5 Oh Bldg Value Tenant Information Tax Assessed/Appraised Value Flood Zone Base Floor Blev. Apt. Miami Shores Florida 33138 City State Zip Description of Work Construction of 'Ronk / #7,Cjs `,,4 0 PI'ay . Current Use of Property Vacant PERMIT TYPE (✓.) Building Electrical Mechanical Plumbing C_- LPGX Roofing Fence Other PERMIT CHANGE (.r ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name ROGER PIPER License NDAR 13039/FL Address 20100 NE 21ST AVE., N.MIAMI BEACH, FL imePhm1305) 932 -5200 Fax (305) 932 -0025 PROPERTY O A N: BRIAN SCHEINBLUM Na/ILLAGE DEL MAR DEVELOPMENT GROUP, LLC Address 1655 NE 115TH ST. # 12, MIAMI, FL 33181 Some Telephone_ 5) 965 -5893 Business '305) 981 -4702 Fax (305) 675 -9221 TYPE OF MANAGEMENT (1 ) New Construction License No. Enclosure Telephone Alteration Exterior Repair A /� Name f b/Ubgt3 4t6 ecZ)Crg t /N a Alteration Interior Address 7( (2 ki ev . Cr 4 S I- M rdz t.r Pa 33166 Demolish Qualifier Name ' r2 ju ......3— / tf �✓ gLL Relocation of Structure Shell Only Foundation Only Add'l Attachment Other Add'I Detachment Other ENGINEER Name License No. Address Telephone Fax CONTRACTOR A /� Name f b/Ubgt3 4t6 ecZ)Crg t /N a "mesa No. C 4 c 0 4-7,814 Address 7( (2 ki ev . Cr 4 S I- M rdz t.r Pa 33166 p Telephone0©S Q 2 - /1/35 —Fa (.(7jQ��) l Z ° 43 8g Qualifier Name ' r2 ju ......3— / tf �✓ gLL v-3-.rlb MIAMkIMRES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Dat Type Insp'n Permit No. Na e Address Compan Phone # Inspection Date 3 / 23 / o 1 Approved III Correction 74- Re- Insp'n Fee cot- ktzei f / 2 APP-torm-C P' + Page 2 PERMIT APPLICATION ............................ ............................... ICI I >t:)Ir'c:1 r N(? Ti c L S • I. DO NOT BEGIN ANY WORK wrrHOtyr 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 am. 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. Ali 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. SWAT PS 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 S'T'ORED 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 (MI)WASD) approval is required for applications involving sewers. II1)AV 1. Please read care tttI1L. 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 S2,500 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. STAI'E OF FLORIDA. COUNTY OF MIAMI -DADE Signa re of Owner Irian So_heinbILt► i Print Name Sworn subscribed before me this 31z4 . day of .__ Tul_y Signatu of No ry Public - State of Florid 44.;4,,, Luvyanka Se queira Commission #DD219113 .'e Expires: Jun 02 2007 i�ss4 Bonded Thu Personally known t&gliwfication SEAL: Type of Identification Produced: STAFF OF FLORIDA, COUNTY OF ,MIAMI -DADE Signature of Contractor I Qualifier C nU Print Name Sworn to and subscribed before me this ►r12-v Signature Notary Public - SEAL: State of rn•ida day of _Zy Luvyanka Sequeira ��` ' . Commission #DD 19113 ' 't'` ; Expires: Jun 02, 2007 Bonded Um a Personally kno4teitrrra` Atlanfi ldWlfrcation Type of Identification Produced: PL 1 i ��l/ .31J - O 11,03 MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Da %Z Type Insp'n Permit No. Name Address Company Phone # Inspection Date Approved Correction Re- Insp'n Fee gcrzeov-, , moth ii^, t3,OR,44 �5 motammatauw;. Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies in the space provided below. ,1C'FR I CAL ,pp, QIV, 11 Pi, Minimum Fee Dryer Outlet, Appliance Service Repair A/C Central 1-3 Ton Fan Outlet, Wall Service, Temporary 1 A/C Central 4-7 Ton Fire Pump Outlet, Switch Signs A/C Central 8-15 Ton Fixture - Fluorescent Oven Space Heater (kw) A/C Central 16-20 Ton Fixture Light Parking Lot Lights Spas/lint Tubs A/C Central 20+ Ton Flood Lights Phiginold/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 ee Low-volt, Fire Renew - Temp Service . Demolition Low-volt. Intercom/Teleph. Repair Circuits Dishwasher Low-volt. Television Service, Number of Amps 14li,C,F1,1,,NIC 11, 1\1,1 Q Mininiuin Fee A/C Central, Tons A/C Wall/Win. Tons Air Handler, Tons Barbecue Bath Fan-Vented, # 3 Condensate Drain Cooling Tower Dryer Vents, Number of Q'l TYPI, Ductwork, Cost of Fire Sprinkler System Fireplaces, Number of Generator Heating Strips, each Paint Booth Piping, Flammable Liquid Process/Pressure Piping Pressure Vessel Refrigeration, Tons Vent Hood, Cost Ventilation, Cost Periodic Inspections ql Y. YPI. A/C Condensate Bath Tub Bidet Drains, Roof Drinking Fountain Filter Replace Miscellaneous Fixture Miscellaneous Repairs Pool Piping Soakage Pit Solar Water Heater Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Catch Basin Clothes Washer Dental Chair Gas - Natural Gas - Propane Pump, Fire Stand Pump, Re-circulate Temporary Toilet Temporary Water Closet Gas Piping Grease Trap Discharge Well Ice Maker Pump, Replace - Pool Pump, Sprinkler Pump, Sump 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 Drandield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re-pipe Drains, Floor Drains, French Minimum Fee Miscellaneous Equipment Shower Sink Water Service Well, Supply RECEIVED AND REVIEWED BY: DATE: Page 4 PERMIT APPLICATION OFFICE USE ONLY U OWNER - BUILDER FORM (Attach) U FIRE DEPARTMENT APPROVAL (Commercial / multi-family) U CONCURRENCY (New Construction) U OTHER (Specify & Attach) U PROOF OF OWNERSHIP (Attach) U FIRS / DERM APPROVAL (Septic / Sewer) U IMPACT FEE (New Construction) U OTHER (Specify & Attach) U 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 C.) $ = x/I000 x OM) (0.005/sq.ft.) (e.01/sq.ft.) TOTAL REVIEWED AND PREPARED BY: DATE: SECTION BY DATE Zoning Electrical Mechanical ff.94f 1.1'f'°> Plumbing Fire Public Works Structural Building Official C()ND1'1-1( ()I 1..11)1Z()V,k1, Revised July 2001 10050 N.E. 2" AVE., MIAMI SHORES, FL • (305) 795-2207 • FAX (305) 756-8972 • http://www.miamishoresvillage.com