BP-02-1010Village of Miami
shores Building Permit
10050 NE 2nd Avenue
Miami Shores, FL 33138
Permit Number: BP2002 -101
Phone: 305 - 795 -2204
Printed: 1 /16/2002
Page 1 of 1
Applicant: LUCILLE
CLUM
Owner: CLUM
LUCILLE
Contractor
Address:
Local Phone:
Cellular:
Parcel # 1132050240230
Legal Description: MIAMI SHORES BAY PK ESTS AMD PB 56-86 LOT 6
Job Address: 1430 NE 102 ST
Fees:
Description Amount
FEE2002 -298
Building Permit Application Fe $60.00 Total Fees: $66.20
FEE2002 -299
CCF $1.20 Total Receipts: $0.00
FEE2002 -300.
Notary Fee $5.00
Total Fees: $66.20
Permit Status:
Permit Expiration: 7/15/2002 Construction Value: $1,550.00
Work: EXTERIOR PAINTING AS PER AGREEMENT (OWNER BUILDER PERMIT)
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 3
This Permit is granted to the contractor or builder named above to construct
ordinances pertaining thereto and with the understanding that the work will be 1822
and approved by the proper municipal authorities. This Permit may be revoke LUCILLE M CLUM 04/78
authorization. A further condition upon which this permit is granted is the unde 1430 NE 102nd St / ea -=660
ordinances and regulations.pertaining to the work covered hereby whether she Miami Shores, FL 33138 -2622 — % / � d 'Z Date
by his agents, servants or employees.
Signed:
Pay to the
Order of
'4 (INSPECTOR)
In consideration of the issuance to me of this permit, I agree to perform the r
with the plans, drawings, statements or specifications submitted to the proper
myself, my agent, servants or employes.
Signed: (Contractc
D.. t.
BN.BS oa
Beek.
$WiTr1181 Mum"
Miami, FL BOt -BOOR / n
For ° A
i:06600 6041:0 18900900 8 2 2
The Sunshine State
Lcemmasm
0450 -535 -33 793-0
L� cLU�a
IM W 102 ST
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rim F 5M A
TE
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SWEDRIM
M
MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
DATE: ! /``�d 2.
OWNER'S NAME: L r //� �' L v ®''e PHONE:
ADDRESS: ®°f.-46 Ally /d-;Z /h�•��2�`��'z
acxac$ aac3c3, cxscacx3 ,es�c$csaae7;c�c3,csc>;csaa33ca cue$ cxxaaac>; eaeaycs', aacgeacsaac�kyc$ eacxac3s>; xaeae >;xaerafsaeaa3,cae�jca;�xs43cxx
ADDRESS OF SITE
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME: PHONE
�k�3����x3t3�k$ a��x�$ seaaakaea�de3, sxs�eaxsjeaa>; a$ a>; exs a; a3, a3, caase�kAs3�' k>; a�; cx$ t> axacasaaxsca aaex>;caas�a$a3,crcY,a�
All Elements on the site must be listed and indicate the color to be painted.
Walls
Fascia
o
Drip Cap/Drip Edge b
o
Soffit
Roof
Flower Bins
b
r
Shutters
C
Awnings
Chimney x
Doors and door jams
Garage Doors ftiry
Railings z
Fences Cn
Decorative Metal
All brick (simulated or regular)
Stucco Banding
Any other stucco features %tJ —
Accessory Buildings �
Other � ti�
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
s�es
Date Si Date
Signature of Contractor
Signature of Owner
APPROVED:
Building Official Date
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
4/23/01
Page 4
PERMIT APPLICATION
OFFICE USE ONLY
CHECKLIST
❑ OWNER -BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
❑ 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)
PERMIT FEES
$3.00 per page (Scanning Fee) $
Miami Shores Village $ 1
Bond $
Metropolitan Dade County (C.C.F.) $ i/� a (sq.ft. = x/1000
x ¢.60)
Inspector State Educational Fund $ (¢.005 /sq.ft.)
State DCA (Radon) $ (¢.011sq.ft.)
Code Enforcement Fine $
Zoning Review $
I " � f_ TOTAL $ t�
REVIEWED AND PREPARED BY:
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
DATE:
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com
X
PERMIT APPLICATION
Master Permit No.
Subsidiary Permit No
INSTRUCTIONS i be o obtain a permit from Shores
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: l�) L) !y ! j� /%,1 / % � �-1� 3 � 3c>
) ��Adddress ,�Agpt. City State Zip
Folio Number r� _� tV5 ' Wr ' o- -J description of Work
Lot
Subdivision PB PG
Current Use of Property
Proposed Use of Property
Tenant Information
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
Zoning Linear Feet
Square Feet
Value of Work �/ 6 d5 (1
Tax Assessed/Appraised Value
Units Floors
Bldg Value
Flood Zone Base Floor Elev.
PERMIT CHANGE (✓ )
Ch g. Contractor
Renewal
Revision
Extension
PROPERTY OWNER
Name k4l Ld //,� C_ li
Address / v ,
A /4- �` S' 4Zz z �
Home Telephone 30,-S— 75—!,?- 7
Business Telephone
Fax
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.
Address
Telephone Fax
Qualifier Name
Page 2
PERMIT APPLICATION
IMPORTANT
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.
AFFIDAVIT
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, 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.
STAT OF FLORIDA, COUNTY OF MIAMI -DADE
ignature of Owner
��� �� (��
Print Name
,Syrer,to and subscribed before me this 61-- day of ,
of Nbtarty Pubhc,�State offlor '
SEAL:
M�
Personally known OR, Produced IdentificatioL'
Type of Identification Produced: DG q 1O -
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:
Personally known
Type of Identification Produced:
OR, Produced Identification
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 QTY.
Service Repair
A/C Central 1 -3 Ton
Bath Tub
Fan
Outlet, Wall
Service, Temporary
Fire Sprinkler System Process/Pressure Piping
A/C Central 4 -7 Ton
Bath Fan - Vented, #
Fire Pump
Outlet, Switch
Filter Replace
Signs
Pool Piping
A/C Central 8 -15 Ton
Sprinkler Repair
Fixture - Fluorescent
Oven
Space Heater (kw)
A/C Central 16 -20 Ton
Fixture Light
Parking Lot Lights
Cap - Water
Spas/Hot Tubs
Gas - Appliance
A/C Central 20+ Ton
Pump, Domestic
Flood Lights
Plugmold/Strip
Subfeeds, No. of Amps
A/C Window
FPL - Load Central
Posts
Temporary Toilet
Swim Pool, Commercial
Catch Basin
Air Conditioners
Gas - Propane
Garbage Disposal
Range/Range Top
Swim Pool, Residential
Chiller
Generators, etc.
Receptacles
Pump, Replace - Pool
Switchboards
Urinal
Clear Violations
Dental Chair
Heat Recovery
Refrigerator, Comm. (p/PH)
Temp Serv, Construction
Compactor
Low -volt, Burglar
Refrigerator, Domestic
Ice Maker
Temp for Test - 30 days
Pump, Sump
Deep Freezer
Utility - Water
Low -volt, Fire
Renew - Temp Service
Indirect Wastes
Demolition
Low -volt, Intercom/Teleph.
Repair Circuits
Disposal
Interceptor
Dishwasher
Roof Inlet
Low -volt, Television
Service, Number of Amps
Domestic Well
MECHANICAL
TYPE QTY. TYPE QTY. TYPE QTY. TYPE Q-ry.
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 QTY.
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: