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BP-03-1710Page 4 PERMIT APPLICATION OFFICE USE ONLY ❑ OWNER - BUII.DER FORM ❑ PROOF OF OWNERSHIP ❑ CONDO ASSOCIATION APPROVAL (Attach) (Attach) (Attach) ❑ FIRE DEPARTMENT ❑ HRS / DERM APPROVAL ❑ BPR APPROVAL (Restaurants) APPROVAL (Commercial / (Septic / Sewer) 9 multi -family) ❑ CONCURRENCY ❑ IMPACT FEE ❑ CONTRACTOR REGISTRATION (New Construction) (New Construction) (On File) ❑ OTHER ❑ OTHER (Specify & Attach) (Specify & Attach) PERMIT FEES $3.00 per page (Scanning Fee) $ i, Miami Shores Village $ j Bond Metropolitan Dade County (C.C.F.) Inspector State Educational Fund State DCA (Radon) Code Enforcement Fine Zoning Review ISSUING OFFICIAL REVIEWED AND PREPARED BY: $ (sq.fL = x/1000 . E® SECTION BY DATE Zoning Electrical left Mechanical Plumbing Fire Public Works Structural Building Official 0 21 J (¢.01/sq.fL) TOTAL $ DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2NDAVE., MIAMI SHORES, FL • (305) 795-2207 • FAX (305) 756-8972 • http://www:miamishoresvillage.com PERMIT APPLICATION QCT 2 9 2003 Master Permit No. Subsidiary Permit No i�7®0 wt) INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. Complete the attached permit application which must be signed by the properly 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 MQ hp cation 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. Address Apt. City j� 1 State Zip Folio Number X--escription of Work T 0 � Irl 't f 00 to l Di ©� b0115� Lot Block Subdivision PB PG Zoning Linear Feet Current Use of Property Square Feet Units Floors Proposed Use of Property Tenant Information PERMIT -TYPE ( ✓ Building Electrical Mechanical Plumbing LPGX Roofing Fence Other ARCHITECT Name License No. Address Telephone Fax Value of Work As sessed/Appraised Value Flood Zone Base Floor Elev. PERMIT CHANGE (✓ ) Che. Contractor Revision Extension I, Rnnnlntnent PROPERTY OWNER Name ` Address ti(F )r ``1I hor e!�:> EL 3W9 Home Telephone-� f �11—t D Business Telephone I l�'l l Fax v6t& -1 r) 't -Q U cv.CeLit- M4 - TYPE OF MANAGEMENT ( ✓ ) - New Construction Enclosure Alteration Exterior Repair ,Mteira#60pterior Demolish = lora - � -4f Structure Shell Only 'on 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 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 fuWe that if the total cost of work to my home or business conform to the current code requirements of the Building A, �', o WARNING TO OWNER: Your failure to recor��� �1�i TICE 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, 181 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 FLORIDA, CPVNTY OF -DADE Signature of Owner AiAtNafne wom d subscribed before me this day of i e of Notary Public -State _ Cotarri ion#DD231984 SEAL: a7 : EXp� • Ju113, 2007 Co., Inn. 'v�,,,,,r Atlantic Personally known OR, Produced Identification Type of Identification Produced: 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 F1:0 Personally known Type of Identification Produced OR, Produced Identification Page 3 PERMIT APPLICATION 11 INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies)-in the space provided blow. 11 ELECTRICAL TYPE QTY. Minimum Fee Typi_- QTY. Dryer TyPu-� QTY. Outlet, Appliance TYPE QTY. Service Repair A/C Central 1-3 Ton Fan Outlet, Wall Service, Temporary 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 RangeMange 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 TYPI-1, Generator QTY. TYPE QTY. Refrigeration, Tons A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Wm. Tons Dryer Vents, Number of B Ventilation, Cost Air Handler, Tons Ductwork, Cost of ,_ le Liquid Periodic Inspections Barbecue Fire Sprinkler System �.') _ `P_Pressure Piping Supply, AC Well Bath Fan -Vented, # Fireplaces, Number of Pressure Vessel Temporary Toilet PLUMBING QTY. A/C Condensate Drains, Roof Miscellaneous Fixture Soakage Pit Bath Tab Dtinldng Fountain Mracellaneous 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 Pum 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 M[iiscellaneous Equi meat Sink Well, Supply RECEIVED AND REVIEWED BY: DATE: