PL-03-196oplire
PERMIT APPLICATION
Master Permit No. �i -2. 003,1i 5-
Subsidiary Permit No.. f'2. 2_00 3 4 ) q y
INSTRUCTIONS'- Tie following stet s must be taken to obtain a permit from the 'Miami Shores Village:
Step 1.
Complete the attached permit application which must he sinned by the property owner and qualifier. Both signatures must he 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 witin 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.
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
Miami Shores
City
Florida
33138
State
Zip
Description of Work Construction of Pool Equipment/Trash Room
Subdivision ANCO PB 53 PG 54 Zoning Linear Feet
Current Use of Property Vacant Square Feet Units N/A Floors 1
Proposed Use of Property Value of Wo (r O) ®„ Bldg Value
Tenant Information Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
PERMIT TYPE ( ✓.)
Building
\.
Roofing
Fence
Other
PERMIT CHANGE (,/ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT .
NameROGE'R PIPER
License NOAR 13039/FL
Address
20100 NE 21ST AVE., N.MIAMI BEACH, FL 33179
ItielthanT305) 932 -5200
Fax (305) 932 -0025
PROPERTY OWNFAIIf..rN: BRIAN SCHEINBLUM
N/ILLAGE DEL MAR DEVELOPMENT GROUP, LLC
Addrrzss
1655 NE 115TH ST. # 12, MIAMI, FL 33181
HameTdephaape„ (.1()5) 965 -5893
Business Thlephaste.
(305) 981 -4702
Fax (305) 675 -9221
I
TYPE OF MANAGEME ✓)
New Construction
V
Enclosure •
License No.
Alteration Exterior
Address
Repair
Telephone
Alteration Interior
Fax
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'l Attachment
Other
Add'l Detachment
Other • -
ENGINEER
Name
License No.
•
Address
Telephone
Fax
CONTRACTOR
Nameg7 m' f _ /9N, )L sue' C-1 License Na C,F 60 3. c[� P5
Address / /d.' tiAL /AP y 7
if tt i F I 3 3' be y
Tek'Ph'SoSt / -00i 7 F-33,-68 tL" 6
Quainter Name ` ,1-e S d
Page 2
PERMIT APPLICATION
MPOR AINT f4OTtCV$
i. DO NOT BEGIN ANY WORK WH'HOt"r 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 11:00 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 front 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 CONSTRIJC`FIC)N SITES. Other construction may have a trailer
which requites a separate permit.
t>. PORTABLE TOILETS for a construction site require a separate permit.
7. DO NOT DISCI LARGE WAFER INTO 'DIE RIGHT OF WAY OR STORM DRAINS without approval from the Building. Planning and Zoning Department.
8. EQUIPMENT AND MATERIALS SHALL BE S FORF.D at least 10 feet from the edge of pavement.
9. Department of Health and Rehabilitative Service; (IiRS) 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 requited for applications involving sewers.
of
1t
�y r
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 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 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, I m Floor, (305) 679- 1078. Once recorded, the Notice of Commencement must be POSTED AF 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
Sitatatu9= of Owner
Print Name
Sworn to and subscribed before me this _Act__ day of _..
m
Signature of N tart' Public - State of Flo
SEAL:
,ettnt«., Luvyanka Sequeira
i : Commission #DD219113
4.:V Expires: Jun 02, 2007
Bonded
'rnnnt+` Bond • Co., Inc.
Personally known R, Produ Identification
Type of Identification Produced:
OF FLORIDA, . • 'NTH,' AMI -DADE
Print Name
Sworn to and subscribed b fore me this 19_412. day of _
. .444! � . —i � t
Signatu ofN``t+bic tirquella
'751: Commission #DD219113
z`'' *:•.• Expires: Jun 02, 2007
Bonded Thin
Atlantic Bonding Co., Inc.
Personally known OR. Produced Identification Fit:Ala PL
Type of Identification Produced: O-
SEAL:
•
Page 3
PERMIT APPLICATION
INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below.
( ICAL
Minimum Fee
-
Dryer
Fau
Fire Pump
;
nutlet, Appliance
Outlet, Wall
Outlet, Switch
Service Repair
— —
A/C Central 1-3 Ton
Service, Temporary
A/C Central 4 -7 Ton
A/C Central 5 -1S Ton
Signs---
Fixture - Fluorescent
Oven
Space heater (kw)
A/C Central 16.20 Tan
Fixture Light
Parking Lot Lights
Spas /Hot Tubs
t :iii.: Central 20+ Ton
Ali. Window
Air Conditioners
Flood Lights
FPI, - Load Central
Garbage Disposal
Piugnwld /Strip
Posts
Range/Range Top
gubfeeds, No. of Amps
S wi
shim fool, f.onalaacFCi.ai
Swim Pool, Residential
I Chiller
Generators, etc.
Receptacles
Switchboards
Clear Violations
heat Recovery
Refrigerator, Comm. (p /PIl)
-
Tem Serv., Construction
P`
Compactor —
Low-volt, Burglar
Refrigerator, Domestic
Temp for Test - 31) days
Deep Freezer
—t—
Low -volt, Fire '
Renew - Temp Service
!
Demolition
Low -volt, InterconVTcieph. ;
Repair Circuits
Dishwasher
-
Low -volt, Television
Service, Number of Amps
Minimum Fee
AIC Central, Tons
I A/C Wall/Win. Tons
IAir Handler, Tons
Barbecue
Condensate Drain
Cooling Tower
Generator
Heating Strips, each
Dryer Vents, Number of
Paint Booth
Ductwork, Cost of
Bath Fan - Vented, #
Fire Sprinkler System
Fireplaces, Number of
Piping, Flammable Liquid
Process/Pressure s/Pressure Piping
Pressure Vessel
Refrigeration, Tons
Vent Hood, Cost
V it C
enh atian, Cost
j
Periodic Inspections 11
A/C Condensate
Bath stub
Bidet
Cap - Fixture
Cap - Water
Cap - Sewer
Drinking Fountain
Filter Replace
Miscellaneous Fixture
Miscellaneous Repairs
Pool Piping
Solar Water Heater
Fountain
Pump and Abandon
Catch Basin
Clothes Washer
Dental Chair
Discharge Well
Dishwasher
Disposal
Gas - Appliance
Gas - Natural
Gas - Propane
Gas Piping
Grease Trap
Ice Maker
Indirect Wastes
Domestic Well
Laundry 'fray
Interceptor
Drainfield, 4" Tile/Res.
Lavatory
Drains, Area
Meter Set (Gas)
Drains, Floor
Minimum Fee
Drains, French
Miscellaneous Equipment
Pump, Domestic
Pump, Fire Stand
Pump, Re- circulate
Pump, Replace - Pool
Pump, Sprinkler
Pump, Sump
Sprinkler Repair
Sprinkler System
Supply, AC Well
Temporary Toilet
Temporary Water Closet
Urinal
Relay Repair
Roof Inlet
Septic Connection
Septic Tank
Sewer Connection
Shower
Sink
Utility - Sewer
Utility - Water
Vacuum Pump
Water Closet
Water Heater
Water Heater New
Water Re -pipe
Water Service
Well, Supply
RECEIVED AND REVIEWED BY: DATE:
Page 4
PERMIT APPLICATION
OFFICE USE ONLY
d.,
;SA 444.'F
G OWNER - BUILDER FORM
(Attach)
O FIRE DEPARTMENT
APPROVAL (Commercial /
multi - family)
Li CONCURRENCY
(New Construction)
L1 OTHER
(Specify & Attach)
L] PROOF OF OWNERSHIP
(Attach)
• IIRS / DERM APPROVAL
(Septic I Sewer)
LI IMPACT FEE
(New Construct ion)
LI OTHER
(Specify &. Attach)
0 CONDO ASSOCIATION APPROVAL
(Attach)
3 BPR APPROVAL, (Restaurants)
LI 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
(sq.ft. = x/1C00
x 4.601
(0.005/ sq.ft.)
(4A1/sq.ft.)
TOTAL $
ISSUING OI FICIAL
REVIEWED AND PREPARED BY: DATE:
CONDITION OF APPROVAL
Revised July 2(01
10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /wwwaniamishoresvillage.com