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BP-02-0832Page 4 PERMIT APPLICATION OFFICE USE ONLY CHECKLIST ❑ OWNER -BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) PERMIT FEES $3.00 per page (Scanning Fee) $ Miami Shores Village $ ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) Bond $ Metropolitan Dade County (C.C.F.) $ / (sq.ft. = x/1000 x ¢.60) Inspector State Educational Fund $ (¢.005/sq.ft.) State DCA (Radon) $ (¢.ol/sq.ft.) Cock Enforcement Fine $ Zor Review $ TOTAL $ ISSUING OFFICIAL 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'1 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 PERMIT APPLICATION Master Permit No. Subsidiary Permit No. a coc2 ?),:A,� INSTRUCTIONS - The following steps must be taken to obtain from Step 1. Complete the attached permit application which must be signed by the propeM 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. APPLICATION F is Sr/Lz y c. ;13th Job Address: r �% �`` `� s Address Apt. City State Zip Folio Number '--Description of Work Lot Block -3 Sk s Subdivision Pi's. iE 'rS PB PG Zoning Linear Feet Current Use of Property Square Feet Units Floors Proposed Use of Property �v.V k i-•- 4-T-all'ue of Work '�'�' °'� 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 Supplement Reinspection PROPERTY OWNER Name J V A,,j Address jyo,3 IV F f v 4- " Home Telephone _� 5 -" S -( •y Business Telephone •ty 5 — 57 7� 3 Z 3 yr Fax �. . —451 —6-3,n TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'1 Attachment Other Add'1 Detachment Other ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. . ' d Address 737-3 l/ Telephone 3zl �— _ S-� ax � ST r9� (0 3 Qualifieril � — ok �� 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 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 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 (MDWASD) 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, I" 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. I STATE OF FLORIDA, C TY OF MIAMI -DADE STA FL RIDA`; UNTY F MIAM - E Signat of Owner �t_VA -eJ C4,c,L,;, A- Signature of Cogiraktor / Qualifier V FvJ �. A iL- l,i �C Vl wok "4_VL.L'J PritAame Print Name I (/ Sworn to and subscribed before me this 4' day of �W , Sworn to and subscribed before me this 15 day of Q r �i ` ature of Notary Public - State of Florida ro��1YA° RAUL MONTEAGUDO MY COMMISSION # CC 951161 EXPIRES: Jun 28, 2004 t 8003NOT MY FL Notary Service & Bonding, Inc. Personally known ro uce en cation r' bture of Notary Public - State of Florida : Y Pv1"n RAUL MONTEAGUDO r MY COMMISSION # CC 951161 9 OF fl�?Q EXPIRES: Jun 28, 2004 3-SOD -3- NOTARY FL Notary Service & Bonding, Inc. Personally known OR, Produced Identification Type of Identification Produced: Type of Identification Produced: Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. ' ELECTRICAL QTY. Minimum Fee TYPE Dryer QTY. TYPE Outlet, Appliance QTY. TYPE 1 Service Repair A/C Central 1 -3 Ton Air Handler, Tons Fan Outlet, Wall Fire Sprinkler System Process/Pressure Piping Service, Temporary Bath Fan - Vented, # 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/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 QTY. TYPE QTY. TYPE Minimum Fee Condensate Drain Generator Refrigeration, Tons A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost TYPE Miscellaneous Fixture A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Bath Tub Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Solar Water Heater Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel PLUMBING TYPE QTY. A/C Condensate TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. TYPE 1 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: DATE: ht 0 r n /00 • v n m ao En ct cam: M m " �m m CL O M �a ►i � a< m c� . aC O ►i V �H N.E. /4 rN A{/EE e i QO 09' 0.5 /00, c+ n O t:] Zk '< �,-n a+ F ct M tIJ = - "n Fy cG f4 O to c+ c+ 04 F- rA O RfoGAT Of T/fACI 4 Oi M 14M/ y J/V AN� aAY Pq 4t' �5T4TG°6 �.�0 86 w v n m ao En ct cam: M m " �m m CL O M �a ►i � a< m c� . aC O ►i V �H -110 0 OD m O c+ n O t:] Zk '< �,-n a+ F ct M tIJ = - "n Fy cG f4 O to c+ c+ 04 F- rA O x C f D t=7 F-j O c+ c+ 0 w mw C :lr m H H ' v 0 amm.• • EA cn m CD m ? C-) aO (n w c+ra M 0 C+ O y [:4s � x Cf7 m p' t' c+ (L O c a m CD M IV b Ct C �' ti r-, ►y � n Ao -r k c7 �f m C 0 g H p Fy c,W n CD n actri to y n ►iv'c+Ita to c+ aN►j ) $-4 ay+ ~n4 o ro 2 C. $� 0 b'N O bty n .-v m O O+ M F- cn • F `.� m a)— O I c 0 tr, C vt d � w m t' ! 1 APPLICANT: ':'J.'A:l'.h: OF FLORIDA DEPARTMENT OF HEALTH ONSImr' SEWAGE TREATMENT AND DISPOSAL SYSTEM EXISTING SYSTEM AND SYSTEM REPAIR EVALUATION CONTRACTOR / AGENT: s �,J LOT: BLOCK: SUBDIV: 1 [ PERMIT # ID #:Cl��_ TO. BE COMPLETED BY FLORIDA REGISTERED ENGINEER, DEPAl4iim EMPLOYEE, SEPTIC TANK CONTRACTOR OR OTHER CERTIFIED PERSON. SIGN AND SEAL ALL SUBMITTED DOCUMENTS. COMPLETE ALL APPLICABLE ITEMS COMPLETE TANK- CERTIFICATION BELOW OR ATTACH LETTER FROM A PERMITTED SEPTAGE DISPOSAL SERVICE. EXISTING TANK INFORMATION GALLONS SEPTIC TANK /GPD ATU LEGEND: MATERIAL: BAFFLED [Y. D' [ ] GALLONS SEPTIC TANK /GPD ATU LEGEND: MATERIAL: a BAFFLED: [Y / T [ ] GALLONS GREASE INTERCEPTOR LEGEND: MATERIAL: GALLONS DOSING TANK LEGEND: MATERIAL: # PUMPS:[ I CERTIFY THAT THE ABOVE NOTED TANKS WERE PUMPED ON j Y ST UCTURALLY SO /l HAVE THE VOLUMES SPECIFIED, Al �Nb, AND HAVE A [ SOLIDS DEFLECT 02� DEVICE j OUTLET FILTER DEVICE ] IN TALLED. ��tr it SIGNATURE OF LICENSED CONTRACTOR BUSINESS NAME DA E EXISTING DRAINFIELD INFORMATION ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM NO. OF TRENCHES [ J DIMENSIONS: le X `zo [ ] SQUARE FEET SYSTEM NO. OF TRENCHES [ ] DIMENSIONS: X TYPE OF SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND [ ] CONFIGURATION: [. } TRENCH [ ] BED [ DESIGN: [ ] HEADER [ ] D -BOX [-Al GRAVITY SYSTEM [ ] DOSED SYSTEM., ELEVATION OF BOTTOM OF DRAINFIELD IN RELATION TO EXISTING GRADE Lf INCHES [ ABOVE BELOh SYSTEM FAILURE AND REPAIR INFORMATION [%t ] SYSTEM INSTALLATION DATE TYPE OF WASTE [ P1160MESTIC [ ] COMMERCIAL [ ] GPD ESTIMATED SEWAGE FLOW BASED ON [ ] METERED WATER [ ] TABLE 1, 64E- 6,.FAC SITE CONDITIONS: [ [ ] DRAINAGE STRUCTURES l SLOPING PROPERTY [ J [ ] POOL [ ] PATIO / DECK [ } PARKING NATURE OF FAILURE: [ [ } HYDRAULIC OVERLOAD ] DRAINAGE / RUN OFF [ ] [ ) SOILS ROOTS [ [ ) ] MAINTENANCE WATER TABLE j [ ) SYSTEM DAMAGE ] FAILURE SymRTOM: [ [ J SEWAGE ON GROUND. ] PLUMBING BACKUP [ } [ ] TANK [ ] -D BOX /HEADER [ ] DRAINFIELD REMARKS/ADDITIONAL CRITERIA SUBMITTED BY : `c;,,�'a' TITLE /LICENS DATE:tpf DH 4015, 10/96 (Previous Editions may be used) Page 4 of I ttob T J 1j � STATE •A DEPARTMENT OF ONSITE SEWAGE DISPOSAL -,. . s _ PERMIT # I PROPERTY ID 9 1�-.'i ° i .. 1`r, mss") [see �n p nge Pares a or az ID znabqT�' ME BENCHMARK/REFERENCE PDX THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES,. SURFACE WATER: A114- FT DITCHES/SWALESS s - WELLS., PUBLIC: -4. LIMITED - -- — ___ — _ , _ O .t -. PRIVATE: FT BUILDING FOUNDAT16NS- FT PROPERkY LINESS Cj- FT POTABLE WATER LINES: FT SITE SUBJECT TO FREQUENT FLOODING. 10 YEAR FLOOD ELEVATION FOR SITE: $OIL PROFILE INFORMATION SITE I to to R USDA SOIL SERIES: 10 YEAR FLOODING? YES lac SITE ATIONS FT NSL/NGVD ?EXI 751 OBSERVED WATER TABLE: INCHES [ABOVE ELOW1 TYPES [PERCHED ESTIMATED WET SEASON WATER TABLE ELEVATION:Q- INCHES I ABOVE / BELOW ] EXISTING GRADE. HIGH WATER TABLE VEGETATION: [ ) YES j\?rNO NOTTLINGS I I YES ��o DEPTHS INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION's INCHES DRAINFIELD CONFIGURATION: ( I TRENCH BED OTHER (SPECIFY) R04ARKS/ADDITIONAL CRITERIA' SITE EVALUATED BY-A V - F-ft [DH 4045, 70196 (Replaces MRS -H Form 4095 [Page 31 which may be used) LN (Stock Plumber: 5744 -003 - 4075 -9) 1 4 vv PATES Page 3 of 3 „ r m - I lAposom r �z at Ao ov - - - -- - -- - - -- - -- -- -- - - r it 4a a d - -- - - - MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPA MEW APPLICATION FOR PLUMBING '7'� R IT Permit No .. ............... Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted 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 Taws of the State of Florida, OR ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village sball 6'compliad with, whether herein lea or noL A copy of approved plans and specifications must be kept at b during pr of wrork: �, Owner's Name and Registered Architect and /or Employing Plumber's Name No,- ___-- ____.._.._....._...,.. St rat.__......._,..._ :.. ........... .................... Strad Location and LOW Description 116t Subdivist Strad and Nwdw where work Is to be No.._. d. ... ; ::..�. . State work to be psfamafl,and 'purpose of _ (By Flom) New 8 Addition—.,_- .-- -.< -.. No. of Stories:. ...... BAT" $"t9VYRR® "VA- 81NK8 SLOP LAUNDRY URINAL: CATCH FLOOD onINK1146 TOTAL CLOSET' Size Septie Tank....-....-. ,; _Type of Tank .................. _. ....�..___w.Caty' Feet of Drain, Tile. -- ® Feet of Tack or Drain FieW ficom Wet!_., ----- -- . Nature of Water Supply: City- -w .Size Of Soakage 1°iit _ ._ .» .....,..... - .-,._ .. - ..._..... . tome wall kwwn, and who, being by me first duly sworn, upari oath dc�osoa wd.aays that he b the _....,.,... „. , .. ......_. of he b ht d are that he has carefully read the regoing application, and drat he did sfga ilia same, and that all facts " w MY cominissim Espires Noaley P" C' State Of Florida NOT : Are> fee Of $1.00 will be made when arch n4ovectim is mede-owepory by Impmper notice for hopection, or faulty materials � p OAT" TOR11ie SINK® TYeR BASIN DRAIN FOYNT'Ne FIXTURES CONTR. LIST - •- '�--- �,- C "acK *,-- - -�--r "- ^- ^---- +.r....�� .-- -- SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAOE PIT GREASE' TRAP SOLAR HgATER DERP WI sPRKLR. SYaTRM 6WIt110 POOL CONTR. LIST CHECK ...�.� Size Septie Tank....-....-. ,; _Type of Tank .................. _. ....�..___w.Caty' Feet of Drain, Tile. -- ® Feet of Tack or Drain FieW ficom Wet!_., ----- -- . Nature of Water Supply: City- -w .Size Of Soakage 1°iit _ ._ .» .....,..... - .-,._ .. - ..._..... . tome wall kwwn, and who, being by me first duly sworn, upari oath dc�osoa wd.aays that he b the _....,.,... „. , .. ......_. of he b ht d are that he has carefully read the regoing application, and drat he did sfga ilia same, and that all facts " w MY cominissim Espires Noaley P" C' State Of Florida NOT : Are> fee Of $1.00 will be made when arch n4ovectim is mede-owepory by Impmper notice for hopection, or faulty materials � p BUILDING ❑ ELECTRICAL ❑ PLUMBING ❑ ROOFING ❑ Owner of Building Architect Contractor or Builder MIAMI SHORES VILLAGE, FLORIDA DATE 195 PERMIT N® 3435 Contractor's License No. Work to be performed under this Permit ^_ _ Legal Lot ! I Subdi- Description e ! Bl. vision Address of Value of Amount of Building Project $___`�,__ —�� Permit $_ 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:— BY INSPECTOR 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 ac- cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY 6 _ 0W BUILDING ❑ ELECTRICAL ❑ PLUMBING ❑ ROOFING ❑.. - -- ❑ Owner of Building ?architect ,ontractor Dr Builder MIAMI SHORES VILLAGE, FLORIDA DATE 195 PERMIT ? 3172 Contractor's License No. Work to be performed under this Permit— ___ —.__ Legal Lot Subdi- Description Bl. vision — fiddress of Value of Amount of 3uilding Project $ ,+ Permit $ 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 'aerefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, irawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any ime 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 ganted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations )ertaining 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 lone by his agents, servants or employees. Signed: BY INSPECTOR 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 )ertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac- :epting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY ems-° �, WILDING ❑ ;LECTRICAL 'LUMEING ❑ 100FING ❑ PERMIT ? 3219 Work to be performed under this owner of Building _ architect DATE Contractor's License No. 195 ,ontractor r Builder Z .F . ,egal Lot Subdi- )escription s Bl. vision _ address of Value of + Amount of•; .m " uilding Project "� — Permit " 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 erefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, rawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any ne ff 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 7anted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations - rtaining 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 )ne by his agents, servants or employees. Signed: By ,. INSPECTOR 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 )rtaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac- �pting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY 6,n: MIAMI SHORES VILLAGE, FLORIDA BUILDING ❑ ELECTRICAL ❑ DATE 195 PLUMBING ❑ PERMIT N? 3192 Contractor's License No. ROOFING ❑ ❑ Work to be performed under this Permit__ —__s Owner of Building Architect Contractor or Builder Legal Lot Subdi- Description Bl. vision Value Value of Amount of Address of Building —� Project $— ._. Permit 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: — By INSPECTOR 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 ac- cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY a��- WILDING El MIAMI SHORES VILLAGE. FLORIDA � ,LECTRICAL ❑ DATE 195 )LUMBING ❑ PERMIT NO 3003 Contractors 300FING License No. ❑ ❑ Work to be per%rmed under this Permit—_—._ owner of Ulding Lrchitect ,ontractor r Builder AVC C ' � t = � k � f ,� 7 e' egal Lot Description address of ; f uilding -fl Bl. Subdi- vision Value of l Amount of Project $ II Permit $ 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 arefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, •awings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any ne 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 'anted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations )rtaining 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 zne by his agents, servants or employees. Signed: ., BY INSPECTOR 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 staining thereto and in strict conformity with the plans, drawings, statements or specifications' submitted to the proper authorities of Miami Shores Village. In ac- pting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY a� BUILDING MIAMI SHORES VILLAGE. FLORIDA - yF ❑ ELECTRICAL ❑ DATE 195 PLUMBING PERMIT N06 3 0 2 6 Contractor's ROOFING ❑ License No. ❑ Work to be performed under this Permit Owner of Building Architect Contractor or Builder Legal Lot Description ! Bl. /�— ' / , ,U F /,.a c Subdi- vision Address of - -- I Value of I Amount of Building '�- Project $_ Permit 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 lone by his agents, servants or employees. Signed: d BY INSPECTOR 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 ac- :epting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY G — y 0 BUILDING DATE ELECTRICAL El PLUMBING ❑ PERMIT j� o c U 4 4 9 Contractor's .� License No.' ROOFING ❑ ❑ Work to be performed under this Permit _ Owner of Building,. Architect _ Contractor or Builder Legal Lot I Subdi- , a '" 101- Description — II Bl. — vision -_ Address of ' Value of ° ° " Amount of # Building Project $ * `' Permit' 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 th ugh kno edge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in thtatements or sp ificcxtions and�at he: assumes responsibility for work done by his agents, servants or employees. t Signed: -'"' 97: INSPECTOR a In consideration of the issuance to me of this permit I agree to perform the work covered pertaining thereto and in strict conformity with the plans, drawings, statements or specificatiq;;s sub . ceptmg this permit I assume responsibility for, all work lone by either, *self, my =$gent; 6",;* - F nder in compliance with all ordinances and regulations to the proper authorities of Miami Shores Village. In ac- ploy CONTRACTOR OR BUILDER BY AUTHORITY 6 UMBING MIAMI SHORES VILLAGE, FLORIDA �r �' 195 ❑ DATE 40 PERMIT ' 0ontractq i , g ❑ - -' ❑ Work to be performed under this Permit of Builder Lot Dn i Bl. of Subdi- vision .a . :: ! I• 'a-' , Fe Value of Amount of Project $ J - — i I J Permit $ 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 or in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, fngs, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any 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 ed is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations ining 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 by his agents, servants or employees. Signed: INSPECTOR 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 fining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac- ag this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY 6-= tvillaye of Miami Shores 4042 I OB ADDRESS :, TIME READY RENARKS A I DATE ng i N? 3684 tillage of Miami Shores JOB i ADDRESS I TIME READY- OF INSPECTOR DATE �11a y� of Miami Shores 10R ADDRESS f A A2 /,Q 2 .� f ' INSPECTION I j TIME READY I INSPECTOR DATE illage of Miami Shores 11T® 3766 DRESS SPECTION READY MARKS 4 NSPECTOR DATE �'' a4 1a�e of Miami shores N° .3676 Ire A) IINSPECTOR DATE ? -/- a s �Dil � e o fiami Shares JOg ADDRESS ITIME READY. lv° 4019 INSPECTOR - -- DATE °'r MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305 - 795 -2204 Building Inspection Request Type gyp' Permit No. r Name _ Addresk--� Company _ Phone # _ For Inspector: Name & Date A ' �C' L PP rov Correction ❑ Re- Insp'n Fee ❑ .S �5N°. R �s ,�, 7�Zia�u .�(oned `U�Ba�e t�� Z7e�iani�ie�ti ' nx"� 10050 NE 2nd Ave * Miami Shores, FI 33138 CEIVEL" t" Phone 305. 795 -2204; Fax 305.756.8972 �3 2008 AFFIDAVIT OF COMPLIANCE WITH ROOF TO WALL CONNECTION HURRICANE MITIGATION RETROFIT FOR EXISTING SITE -BUILT SINGLE FAMILY RESIDENTIAL STRUCTURES PURSUANT TO SECTION 553.844 F.S. .To: Miami Shores Village Building Department Date: 1,0 13 L9t 10050 NF-,2n' Ave Miami Shores, Fl 33138 Re: Owner's Name: Z4 ),74 ltj , ® j Property Address: IJ o 4jt /d Z Oe'' Roofing Permit Number: J 'FiC ®�" b16 Dear Building Official: I�%it % /_ r�,Oh1� ertify that I have improved the roof to wall connections of the referenced property as required by the Manual of Hurricane Mitigation Retrofits for Existing Site - Built Single Family Residential Structures as adopted by the Florida Building Commission by Rule 913-3.047 F.A.C. Signature License Number State of Florida County of Dade s� - /eAcxr ?_ Print Name The undersigned, being the first duly sworn, deposes and says that he /she is the contractor for the above property mentioned. Sworn to and subscribed before me this day of u �� 20® Notary Public, Sate of Florida at Large (SEAL) RICHARD KOCH N OWY P011% StM of FWWA We 0 M %EX W701WRY 6+�1� FINAL COMPLIANCE