BP-02-0078Village of Miami Shores
10050 NE 2nd Avenue
Miami Shores, FL 33138
Phone: 305 - 795 -2204
Printed: 1/17/2002
Applicant: MIGDALIA
Owner: CARRILLO
Contractor
Local Phone:
Parcel # 1132050240200
Job Address: 1411 NE 102 ST
Fees:
FEE2002 -238
FEE2002 -239
FEE2002 -240
Building Permit
Permit Number: BP2002 -78
CARRILLO
MIGDALIA
Address:
Cellular:
Legal Description: 5 53 42
Description Amount
Building Permit Application Fe$60.00
CCF $0.60
Notary Fee $5.00
Total Fees:
$65.60
Page 1 of 1
PB 56-86 MIAMI SHORES BAY PK ESTS AMD LOT 24
Permit Status: Approved Permit Expiration: 7/10/2002 Construction Value: $100.00
Work: EXTERIOR PAINTING AS PER AGREEMENT (ONWER BUILDER PERMIT)
Total Fees: $65.60
Total Receipts: 0.00
J UJ
If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection
fee is $50.00, which must be paid in advance before calling for another inspection.
BLK 1
This Permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all
ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to
and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without
authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the
ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done
by his agents, servants or employees.
Signed:
(INSPECTOR)
BY:
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity
with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either
myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, Florida, and all prox isions of the Laws of the State of Flo 'da, all ordinances of Miami Shores Village and all rules and
regulations of the Building Division of Miami Shores Village shall be complied with, whether herein sp cified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
1� Date - - - - -- - - -- -- - ----- - - - - -- 19 - - -- �� T
Owner's Name and Address__ _` -�__._ _ No. ,/Q ------ I / --- __. Street_., V ___/-`- -- _
description of lot to be built on:
- -------- - - - - -- Block.- - - - - - - -- -
- -- -------- -_ -___ -- - - - -- -.and for no other purpose.
New Building_____ ..Remodeling____ w_� _ - -- A dition_ ^___- _ ------- Repairs----------- _.�M ___' No. of Stories.__
To be constructed of____ _ Roof Coe '
- -� - -- Kind of- foundatio - -- - - - -- - - -a -- ---- - - - - -- - - - - -- - -- - - - - -- - -- g - - - - -- -
Estimated Total cost of improvements $_---- 1��___!� CI____�� _ -- _Amount of Permit $ ---------- _ -- _ /- �: _ .- _. -. _ -_ -_
- -- - - -- - ---------------- - - - - -- - --
Zone cubage required----------- - - - - -- n , o -- ----- --Plan Cubage_- jz-- ' --
Distance to next nearest building -_ - - -_ - - - - -- - -.__ _ __ - -- .___Size of Building Lot ... _ - -- kT ------ - - - - ®- ---_._----------------------
Maximum live load to be borne by each floor ------ .___
i hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
besent to_ - _ - -- ------------------ •-------- - - - - -- ------ - - - - -- - - -- --- - - - - --
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of labor under the Flori da Workmen's Compensation Act, being Section 5966,,Compiled General Laws of Florida, Permanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from - all 06ntractors or sub- contractors employed by him
in the work to be performed under this permit; and will post or cause to bo posted fp in on on the site of the k such public notice
or notices as are required by the Act. The undersigned agrees to employ only suc;li,- su tractors, on work to b ""formed under this
permit. as are licensed by Miami Shores Village.
._. - - - - -- - -- - - - - -- - - - -- - - - - -- ( Signed)
STATE OF FLORIDA, -
COUNTY OF DADE. I ss'
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ep-
peared----- ---------- ----- — ----- - --- -- ----- - ---------------- -- - - - - -- -------- --- - - -- - -- - - __._ ----- -----------------------
- - -- - • -- - ------- ----- ----------- - -------- - --------- - ----- -------------- - - - - -- ------- -to me well known,
and who, being by me first duly sworn; upon oath deposes and says -that he is the - -__ - - - ---------------- ____ --------------- - --- - ------------- - - -- --
of the above described construction, that he has efully read tloregoing application, and that he did sign the same, and that all facts
therein by him stat are e. T
Permit No.______- _ __. ____ _Date_ ___--__- Read, Sworn to and Subscribed before me.
Disapproved- - -:_ _ Date - -- -_ - -- -- - - - - -•-- --- <-- ----- - - - - -- -------------------------------------
Notary Public, State of Florida
(Signed) -- - --- - - -- - --- -- -- - - - - -- - -- -
el My Commission Expires.- ---- --- ----------- -- - - -- -- --- -- - - - - -- ------- -•----- - - - - --
PLANNING BOARD---------.----. -- ___.____
Chairman- -- - - ---- ----- - -------------- -- ---- - - - - -- Member - - ----------------------- - - - - -- - - - - - -- -
Member--- - - - - -- -- - Member T:--------------------------- - - - - -- - - -- ------------------------------------------------
Member-- - - - -- - -- ------------------ --- --- - - - - -- _ -__ —__ -- - - Member ------------------ --- -------- --------- - - - --- -----
Council Approved --- - - - - -- . ---- - .------ ------------- _____ _ - - - -- --Date Disapproved . _ _ ------ . __ _ Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re-inspection fee of $1.00 will be charged when such re- inspection is male necessary by improper notice for inspection or faulty
materials and /or workmanship.
KA
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the appro` al of the detailed statement of the plans and specifications herewith submitted for the build-
ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, Florida, and all provisions of the Laws of the State of Florida all ordinances of Miami Shores Village and all rules and
regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
plans and specifications must be kept at building during rogress of the work.
_cam
° Date..._-.- --` s .•...---------- - -.... 1
Owner's Name and Address................... -- ---- - - - - -• .......... ...... _._. ._.-- •-- •-- ....- • - -..__ No../ V ..... _ Set. /424_
-
Registered Architect and /or Engineer._._._ .. - •---------••------------------- -- •----- - - --.. —------..._..:.---- . - - - - --
Name and address of licensed contractor- - _- Vie.__ , t.....__------._ ............................... ....----- ....- •.•_.------ -• - - --
Location and legal description of lot to be built on:
Lot -------- --------------------- _ - - - -- -_.. Block ------------- ...........
....
Street and Number where work is to be done ....... .
State work to be done and purpose of building (by
......... ..................... .. �. ....... __._ ....... - ........... --------------- _ - - - - -- _..._..•_.....and for no other purpose.
New Building .... _ ....... _ ............... Remodeling ------------- _............ Addition ............... -....... . -. Repairs .......................... No. of Stories ..........................
To be constructed of ...................... ...... Kind of fo ndatio -- ---------- ------------- I ---- - ----- ... Roof Covering ............................ ___ .............
Estimated Total cost of improvements $.- -. - - -. ....._ ...... ............Amount of Permit $ -------- _...------- ---------------------------------------------- •..............
Zone cubage required--_..-._•----------------_- ------------ ---- -------- -- -•-- -- ..Plan Cubage - - -- ------------------------------
Distance to next nearest building ................. _ ................... .._.._ .......... Size of Building Lot -------- --- ------ -----_ -------------- ........................... ..........
Maximum live load to be home by each floor---- .-- _--- . -_ - - -_ _ ___ . ._....---------_--- _--- _------ ._....._____ ... __.....
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its - construction may
besent to_ _ °_ _ ._._--- .___ ---- - --- - -- • --- -- -•-- ---- --- •- - - -- ------- ---- .................... • ---- --- -- ---- - - - - --
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen's Compensation Act, being Section 8988, Compiled General Laws of Florida, Permanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such su ntractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
( Signed )
STATE OF FLORIDA, p
COUNTY OF DADE. j ss
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared-------------- ---- ----------- - -- - -- —° - -- ----- --------- __ -------- - - - - - — _._._..___.__...__ --- . — -- _ - - - ---
__ _ ------ _- ___ - -. --------------- _--- _._.._-- .._.to me well known,
and who, being by me first duly sworn, upon oath deposes and says that he is the . .... ................ .............. .........................•-------- ..-- .-- ...------- - - -.._
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true. _
Permit No...._ _ ._ .. Date..; /4": y _,_ Read, Sworn to and Subscribed before me.
Disapproved�. Date i - - -- .---- -_ - - -_ -_- --------- . -------•---•------------------------------------------
Notary Public, State of Florida
( Signed) . — - ' -- -- . - -- - __- _ _ -- _
Bu dmg Inspector My Commission Expires ....... .......... .......
PLANNING BOARD._-.._- ,_-_ ....... _ ............ - -._.— _._DATE
Chairman - _._ .......... • - - - - -_ -____ _ „ ............._ _ _ ._w _ _ _ Member -- .... _ ............ - _._....
Member---------- -------- - ----- _________ ----------- - --- Member -- -------- _ --- — --- - -----
Member ----------- - -._ _.___ _ _.-------- - - -. Member _--- --__ --
Council Approved...___.._._..___ ____......_. ---------- ___ --- ...:..-.._ _.Date Disapproved -- --- -------------------------------------------------------------------------- Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
i'
IA I SHORES VI LLAG E
BUILpING INSPECTION DEPARTMENT
ll 3
APPL�CA'TtibN FOR UIL®INra PERMIT
Application is hereby made for the ap royar �f the detailed statement of the plans and specifications herewith submitted for the-build-
ing or other structure. herein described. Thi nplication is made in compliance and conformity with the Building Ordinance of Miami`
Shores Village, Florida, and all provisions of the Laws of the State of Florida all ordinances of Miami Shores Village and all rules and
regulations of the Building Division of Miami Shores Village shall be compliQ with, whether herein specified or rot. A copy of approved
plans and specifications must be kept at building during ptggress of the work.
�^
Date. .._.f ...._......._ ,19.E
Owner's Name and Address....A.4JA_....Z ... �a ..Y 82 ....... . ................ ..........._.. No...,
Registered Architect and/or Enginver. ..J-q. .'hl kk......va �ex....................... .^! H! LT9.!! T9LT!• SST4 ltT}MKS ^SfSTS!LTtTTSTiLSf2!1!.. ......•••.•.............
Name and address of licensed contr,Actor..Xj.'i.:ELaP._ ........... ®s`�«..L.c ; .� `L�._...5, .. ................ _. _....
Location and legal description of lot to be built on:
. Subdivision. « -.-(, p4 «...« .3�...
&L-Lot...- 2 r ........................... Block....... «.......... _.... «. l.... ®� .
Street and Number where work is to be ..._... ..... ....... . _.
State work to be done and purpose of building (by floors)...... - _....__.......... _ ...................... «..
a
........... .........« «.... « ............................ ....._........... « «..... .......�thll.i°�.� uA.�.NtS...» ®. ®1.. ... ! b�.. ._. «....................... «...
d ` «_
...................... ... .......... ......_ ................................ «_..... _ .. - «« .. «. _. «.._ .. _. .._ _ and for no other purpose.
New Building .............................. Remodeling ................. ...... _ Addition .................. ........ Repairs ........................... No. of Stories ...... ....... ... ......
«.
To be constructed of ............................ Kind of foundation .... __ ......................................... _:............ /Covering............ ........................_.
Estimated Total cost of improvements $... �3fl 5`�.. ....._ « «_.....- Amount of Permit 5�... �---.---«. fG--........« ...... -«. ..... _ « « .............. «-.-««
Zonecubage required ...... ............««......««.... ........__.«..._.. «_. «._.«. —__. -Plan Cubage ................... « _. «.___« ......... _« _. «_.. ....................... .
Distance to next nearest building ........................................... _-_..Size of Building Lot ........ ««- ...... _ .... .. ................ ...........................
:Maximum live load to be borne by each floor ......... .... .............. «« ..................................... « ............. __....._«_ .............. . ................ ..........................
I hereby submit all the plans and specifications for said building. All notices with reference tq the budding and its construction may
be sent to .. &►:Z. °...TOJIA?�J__- ... ph'.Q �._ tCC....._....� �P........(": ........ 1.1p �r�. �..9. ..U!� ?t'F^^. :. °' t..171 ..3, 96y
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of Iabor under the Florida 'Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Pe nanent Supplement.
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contra rs employed by him
in the work to be performed under this permit; and will post or cause to be posted for in ection on the site e k such public notice
or notices as are required by the Act. The undersigned agrees to employ only such sub actors, wor t formed under this
permit, as are licensed by Miami Shores Village.
Remarks ... _ ................. _ -------- - - ( Signed
STATE OF FLORIDA,
COUNTY OF DADE. ss
Before me, the undersigned authority, a notaxy public, duly authorized to administer oaths and take acknowledgments, personally ap.
peared :-
_.__ _ _ ____.« «__ __ «------ •-- - -. :.. �._ « ......... _ ..... __.._ _._ _ . «.. «_«— .._to me well known,
and who, being by me first duly sworn, upon oath deposes and says that he is the . ........... .................«.......................- «....__..__.........___._.._.._
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true. pp
Permit No. Date... �. -,.: L ... _ Read, Sworn to and Subscribed before me.
Disapproved. ......_._._ Date.-----_. _.__. ............................................................. _ ..-
Notary Public, State of Florida
( Signed ) _« .._.._.. «..._.._._... y 1?
Building Inspector M Commission Ex ires. .......... « ................ »-.. -
PLANNING BOARD .. .................. .................__.._. «. «DATE
Chairman ....... ... ........ _ ..........
..«
Member..... ............... ...... _.. «_............ ..._.._ _ _.
Member .. ... .. .............
- ._.._ «._ «.. _.. .. Y _..
Council Approved ...... -_ ............................. ..._._.. -- _-......._..«_Date
Member ..... _. ............... ......
Member«._.:... _ «. _ .. « «� « ....._ « « «_...« ............ ...._ ««
Member .........
Disapproved............ ___ .......................... .........................._Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Plannin;,T Board.
A re-inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and/or workmanship.
MIAMI SHORES VILLAGE#
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No..
Date.- 23 . ..... _ . .
.. _
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitt for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building. Division
of Miami Shores Village shall be Complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work. n�
Owners Name and Address___i �. 0 ��1 •w �-� No- �/ Street . • r :..
Registered Architect and/or Engineer -- a i/
Weying PIMMWI Nfim&- --
LOcation and Legal Dasatiptidn L&LDi6i ®� M►��1' �11� cam• � SubdivW,�_ _� 4r1k t�.r
Street and Number where work is to be performed —No " -
State work to be performe8 and purpose of building (By
New Building _.._ Remodeling Addition_._...... - Repairs-_.._.__ -_ ----- ---- _- No. of Stories - -- --------- - ------ - - --
Size Septic Tank Type of TSnk --__- ---_._ _ .- ...--- _.__Capacity
Feet of Drain TilR ._.._ Feet of Tank or Drain Field from Well__......._...,._.,.,. -
Nature of Water Supply: City Well. .Size of Soakage Pit.--.-.--.---_ --_..
Amount of Permit
V Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent Supplement, and lids com-
plied.. with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for ins# on on the site of the work such
public mot[ or notices as are
required by the Act. The undersigned agrees to employ only such sob- contractors, on to be performed er wit, as are
licensed by Miami Shores Village.
Plumber.
STATE OF FLORIDA, es. Master
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath fto� and -says that he is the_ .___.._.____._ ._...._ ..._._......�
of the above described construction, that he has carefully read the ffooregaing application, and that he did sign the same, sWi that all fads
therein by him stated are true.
My Commission Expires Notary Pu)lic, State of Florida —��
mauls otrrworl pee of $1.00 will be made when such 104n T 1 Lion is nw&*neoa�ry by improper notice for won. or faulty
GLOSRB
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKn
SLOP
SINKS
LAUNDRY URINALS CATCH FLOOR
Tuns BASIN DRAIN
DRINKING
FOUNT Ns
TOTAL
TOTAL
CONTR.
LIST
CHECK
-�
SEPTIC
TANK
SBWLR
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE-
TRAP
SOLAR
HEATER
DEEP SPRK SWIM'G
WELL SYSTt POOL
CONTR.
LIST
CHEcK
Size Septic Tank Type of TSnk --__- ---_._ _ .- ...--- _.__Capacity
Feet of Drain TilR ._.._ Feet of Tank or Drain Field from Well__......._...,._.,.,. -
Nature of Water Supply: City Well. .Size of Soakage Pit.--.-.--.---_ --_..
Amount of Permit
V Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent Supplement, and lids com-
plied.. with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for ins# on on the site of the work such
public mot[ or notices as are
required by the Act. The undersigned agrees to employ only such sob- contractors, on to be performed er wit, as are
licensed by Miami Shores Village.
Plumber.
STATE OF FLORIDA, es. Master
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath fto� and -says that he is the_ .___.._.____._ ._...._ ..._._......�
of the above described construction, that he has carefully read the ffooregaing application, and that he did sign the same, sWi that all fads
therein by him stated are true.
My Commission Expires Notary Pu)lic, State of Florida —��
mauls otrrworl pee of $1.00 will be made when such 104n T 1 Lion is nw&*neoa�ry by improper notice for won. or faulty
n
0
SWIMMING POOL OWNER'S CERTIFICATION
Date - / ':�;c � -
Metropolitan Dade County
Building and Zoning Department
Attention: Building Official
In accordance with Section 33- 12(f), Code of Metropolitan Dade County, I certify that I
understand and agree that the swimming pool to be constructed at the above address cannot be
used or filled with water until a separate permit has been obtained for an approved safety bar-
rier, and such barrier erected, inspected and approved.
I further understand that this certification, however, does not eliminate the need for ob-
taining a permit and erecting an approved barrier prior to final inspection and use of the pool.
(t ;L
Legal Owner
Note: This certification is to be submitted with a swimming pool permit application in duplicate.
123.03 -92
The Sunshine State -0
0640 -727- 11
14141 loom m ot3s
Wt.
per .
I x.3.68 0 ��
04 V6
E�
DZIAMI SHORES VILLAGE
Paint Color Approval and Agreement
V / 200 2..
OWI�rE NAME: PHONE. rah"— (-� f 2Z
ADDRESS: 1 NI Aim /p-Z -rC'
3,�sjcae3,cacac3,c�acacxae cxac> xxxac>; c> aae$ csic>; a>; ca cx>; xacac$ s3, e3e�caa>; c3, c>; cacY, cac$ c> cxxac3, c; c>; s>; a3cac3 ,ca;<>;cxk�csk>;<>:�x;��FSax
ADDRESS OF SITE:
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME: PHONE:
Ac3, c�c3e�$ cacyca; ��c�ea( a�; cax�caca;< acacica; �x>: aaa$ e>; cacae3, eaaacsexaya>; e�ycacaa$ ese$ e�ja>; a3, a�e�aeacac >e>erex�e>;cacxaaAa$aaa>;cae>;c
All Elements on the site must be listed and indicate the color to be painted.
Walls
Fascia
Drip Cap/Drip Edge
Soffit
Roof �P J
Flower Bins
Shutters
Awnings
Chimney
Doors and door jams
Garage Doors
Railings
Fences
Decorative Metal
All brick (simulated or regular)
Stucco Banding
Any other stucco features
Accessory Buildings
Other
0
r
0
x
cn
r
W
rn
H
H
x
z
c
a
M
x
En
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate
and that all work will be done in compliance with all applicable laws regulating
construction and zoning. I authorize the above -named contractor, if applicable, to
do the work stated. Furthermore , the paint colors will be as per the attached
samples.
Signature of Owner Date Signature of Contractor Date
APPROVED: WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
Building Official Date 4/23/01
Page 4
PERMIT APPLICATION
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM ❑ PROOF OF OWNERSHIP ❑ CONDO ASSOCIATION APPROVAL
(Attach) (Attach) (Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach) (Specify & Attach)
PERMIT FEES
$3.00 per page (Scanning Fee)
Miami Shores Village
Bond
J
$ a
/4� 1
Metropolitan Dade County (C.C.F.) $ =' C 5V
Inspector State Educational Fund
State DCA (Radon)
Code Enforcement Fine
Zoning Review
(sq.ft. = x/1000
x ¢.60)
(x.005 /sq.ft.)
(¢.01 /sq.ft.)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
,
REVIEWED AND PREPARED BY: DATE:
SECTION
BY
DATE
Zoning
Enclosure
Mechanical
Electrical
Plumbing
Repair
Mechanical
Alteration Interior
Roofing
Plumbing
Fence
Relocation of Structure
Fire
Shell Only
Public Works
Add'I Attachment
Structural
Other
Building Official
Other
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com
Ova
PERMIT APPLICATION
Master Permit No.
Subsidiary Permit No.
following INSTRUCTIONS - The obtain
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 submitted
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.
Job Address: /' M A1467 & —?..— / " 5�"
J Address (� Apt. City State
Folio Numbers! _3aO J & .2 054— Description of Work
Lot u Block ?,A a
Subdivision PB PG Zoning Linear Feet
Current Use of Property Square Feet Units Floors
d
Proposed Use of Property Value of Work �f " Bldg Value
Tenant Information Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
PERMIT TYPE (✓ )
Building
New Construction
Electrical
Enclosure
Mechanical
Alteration Exterior
Plumbing
Repair
LPGX
Alteration Interior
Roofing
Demolish
Fence
Relocation of Structure
Other
Shell Only
ARCHITECT
Name
License No.
Address
Telephone
Fax
PERMIT CHANGE (✓ )
Ch g. Contractor
Renewal
Revision
Extension
PROPERTY OWNER
Name ' A `LQ
Address
Home Telephone . --
Business Telephone
Fax
i
Zip
TYPE OF MANAGEMENT
(✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'I Attachment
Other
Add'1 Detachment
Other
ENGINEER
Name
License No.
Address
Telephone
Fax
CONTRACTOR
Name
License No.
Address
Telephone Fax
Qualifier Name
Page 2
PERMIT APPLICATION
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 6:00 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 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 streettsidewalk.
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 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 (DERM) and/or Miami -Dade Water and Sewer Department (MI)WASD) 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 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, P' 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.
STATE OF FJORIDA, COWYPF MIAMI -DADE
Si e of Owner /
ibed before me this day of L'1-
3itwdnuc of iAoiary r �r iair�� r'�'I1t'`� a 3,M 8Fi:#Eti
UU �
taxi';
SEAL: i, y¢ C U a f
.a
MY
FO NOV t a
STATE OF FLORIDA, COUNTY OF MIAMI -DADE
Signature of Contractor / Qualifier
Print Name
Sworn to and subscribed before me this day of
Signature of Notary Public - State of Florida
SEAL:
F F
Personally known OR, Produced Identification `°° Personally known
4P
Type of Identification Produced' !/ ( ` �C) " ~ Type of4dentificdtion Produced:°_
�-
OR, Produced Identificatipn
Page 3
PERMIT APPLICATION
INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below.
ELECTRICAL
TYPE QTY.
Minimum Fee
TYPE
Dryer
QTY.
TYPE
Outlet, Appliance
QTY.
TYPE 1
Service Repair
A/C Central 1 -3 Ton
Vent Hood, Cost
Fan
A/C Wall/Win. Tons
Outlet, Wall
Paint Booth
Service, Temporary
A/C Central 4 -7 Ton
Ductwork, Cost of
Fire Pump
Periodic Inspections
Outlet, Switch
Barbecue
Signs
Process/Pressure Piping
A/C Central 8 -15 Ton
Fixture - Fluorescent
Fireplaces, Number of
Oven
Space Heater (kw)
A/C Central 16 -20 Ton
Fixture Light
Parking Lot Lights
Spas/Hot Tubs
A/C Central 20+ Ton
Flood Lights
Plugmold/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
Low -volt, Fire
Renew - Temp Service
Water Closet
Demolition
Low -volt, Intercom/Teleph.
Repair Circuits
Water Heater
Dishwasher
Low -volt, Television
Service, Number of Amps
Water Heater New
MECHANICAL
TYPE
Minimum Fee
QTY. TYPE QTY.
Condensate Drain
TYPE QTY.
Generator
TYPE QTY.
Refrigeration, Tons
A/C Central, Tons
Cooling Tower
Heating Strips, each
Vent Hood, Cost
Drinking Fountain
A/C Wall/Win. Tons
Dryer Vents, Number of
Paint Booth
Ventilation, Cost
Air Handler, Tons
Ductwork, Cost of
Piping, Flammable Liquid
Periodic Inspections
Pool Piping
Barbecue
Fire Sprinkler System
Process/Pressure Piping
Cap - Fixture
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
Sprinkler System
PLUMBING
TYPE QTY.
A/C Condensate
TV'PE
Drains, Roof
QTY.
TYPE
Miscellaneous Fixture
QTY.
TYPE Q111Y.
Soakage Pit
Bath Tub
Drinking Fountain
Miscellaneous Repairs
Solar Water Heater
Bidet
Filter Replace
Pool Piping
Sprinkler Repair
Cap - Fixture
Fountain
Pump and Abandon
Sprinkler System
Cap - Water
Gas - Appliance
Pump, Domestic
Supply, AC Well
Cap - Sewer
Gas - Natural
Pump, Fire Stand
Temporary Toilet
Catch Basin
Gas - Propane
Pump, Re- circulate
Temporary Water Closet
Clothes Washer
Gas Piping
Pump, Replace - Pool
Urinal
Dental Chair
Grease Trap
Pump, Sprinkler
Utility - Sewer
Discharge Well
Ice Maker
Pump, Sump
Utility - Water
Dishwasher
Indirect Wastes
Relay Repair
Vacuum Pump
Disposal
Interceptor
Roof Inlet
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
Water Re -pipe
Drains, Floor
Minimum Fee
Shower
Water Service
Drains, French
Miscellaneous Equipment
Sink
Well, Supply
RECEIVED AND REVIEWED BY: