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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. $WiTr1181 Mum" Miami, FL BOt -BOOR / n For ° A i:06600 6041:0 18900900 8 2 2 The Sunshine State Lcemmasm 0450 -535 -33 793-0 L� cLU�a IM W 102 ST �• BIR7HOY►TE sm HOT. RM. _ ENDORM rim F 5M A TE i p"0 -99 B 06'2689 SWEDRIM M MIAMI SHORES VILLAGE Paint Color Approval and Agreement DATE: ! /``�d 2. OWNER'S NAME: L r //� �' L v ®''e PHONE: ADDRESS: ®°f.-46 Ally /d-;Z /h�•��2�`��'z acxac$ 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: