Loading...
EL-03-270Page 4 PERMIT APPLICATION OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM ❑ PROOF OF OWNERSHIP ❑ CONDO ASSOCIATION APPROVAL (Attach) (Attach) (Attach) ❑ FIRE DEPARTMENT ❑ HRS / DERM APPROVAL ❑ BPR APPROVAL (Restaurants) APPROVAL (Commercial / (Septic / Sewer) multi -family) ❑ CONCURRENCY ❑ IMPACT FEE ❑ CONTRACTOR REGISTRATION (New Construction) (New Construction) (On File) ❑ OTHER ❑ OTHER (Specify & Attach) (Specify & Attach) $3.00 per page (Scanning Fee) $ Miami Shores Village $ "e" Bond Metropolitan Dade County (C.C.F.) Inspector State Educational Fund State DCA (Radon) Code Enforcement Fine Zoning Review $ REVIEWED AND PREPARED SECTION BY DATE Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official TOTAL $ Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795-2207 • FAX (305) 756-8972 • http://www.miamishoresvillage.com R EC E O VE D PERMIT APPLICATION SEP 1 d 2003 Master Permit No. 1 -y- 90 . -------- Subsidiary Permit No. INSTRUCTIONS - The follo�iing steps nitist be taken to obtain a permit from the Miami Shores N'illa-e: Step L Complete the attached permit application which must be sighed by the RrgpcM 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 competed an lice ation 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: f "T Address Folio Number lljy3� Lot �-Q �jBlo Subdivision Cid ITT Current Use of Property Proposed Use of Property Tenant Information PERMIT TYPE (✓ ) Bitilding Electrical 10-40, Mechanical Plumbing LPGX Roo Fence Other LA State Zip Description of Work G,G 7 -e - Zoning Linear Feet Square Feet ,�. U9anits Floors Value of Work �, f -6 Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT CHANGE ( O/ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. \ Address Telephone Fax PROPERTY OWNER Name Address A* t►a 5MW10-7 33>6/ Home Telephone 96 3 Business Telephone 31 ® r Fax TYPE OF MANAGEMENT ./ $ ` ® (sq.& = x/1000 Alteration Exterior x 0.60) $ (0.005/sq-ft) $ (o;01/sq.ft.) Foundation Only Add'1 Attachment Zoning Review $ REVIEWED AND PREPARED SECTION BY DATE Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official TOTAL $ Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795-2207 • FAX (305) 756-8972 • http://www.miamishoresvillage.com R EC E O VE D PERMIT APPLICATION SEP 1 d 2003 Master Permit No. 1 -y- 90 . -------- Subsidiary Permit No. INSTRUCTIONS - The follo�iing steps nitist be taken to obtain a permit from the Miami Shores N'illa-e: Step L Complete the attached permit application which must be sighed by the RrgpcM 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 competed an lice ation 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: f "T Address Folio Number lljy3� Lot �-Q �jBlo Subdivision Cid ITT Current Use of Property Proposed Use of Property Tenant Information PERMIT TYPE (✓ ) Bitilding Electrical 10-40, Mechanical Plumbing LPGX Roo Fence Other LA State Zip Description of Work G,G 7 -e - Zoning Linear Feet Square Feet ,�. U9anits Floors Value of Work �, f -6 Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT CHANGE ( O/ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. \ Address Telephone Fax PROPERTY OWNER Name Address A* t►a 5MW10-7 33>6/ Home Telephone 96 3 Business Telephone 31 ® r 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 f C�vAI License o. % t �' l�/'�� AddresssO y'2 Iv6V ✓ `S 333�� Telephone fS Fax Qualifier Nam 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 streegsidewalk. 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%6) 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 (50016) 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 CAnstruction Lien Law and Choosing a Contractor. A ' Print Name t 1 Print Name 1 S orn to and subscribed before me this—S�— day of Sworn to subscribed before me this Aq day of . G .2�.'— Signature of Notary Public - State of Florida Signature of Notary Public - State of Florida SEAL: az�Y'P�a4., CONSTANCEPOLEWSKI ?*: MY COMMISSION 9 CC 953795 •. EXPIRES: October 23, 2004 BondedThm Notary Public Undenvdters Personally known Type of Identification Produced: SEAL: otic • CONST EWSKI :�. •;�: ANCEP OL *: :*_ MY COMMISSIOPJ CC 953795 EXPIRES: October23, 2004 Personally known e d&6&WWeltu n 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 TYPE' QTY. Minimum Fee TYPE Q1 Dryer -y. 'ryl'l" Q'I-N'. Outlet, Appliance rypl" 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 Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) 'hemp 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 Condensate Drain Generator Refrigeration, Tons A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Wm. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Processawssum Piping Supply, AC Well Bath Fan -Vented, # Fireplaces, Number of Pressure Vessel Temporary Toilet PLUMBING A/C Condensate Drains, Roof Miscellaneous Fixture Soakage Pit Bath Tub Drinking Fountain Mscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Ca - Fixture Fountain Pump and Abandon Sprinkler System Ca - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Firer Stand Temporary Toilet Catch Basin Gas - Propane Pum 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 Miscellaneous E ui ment Sink Well, Supply RECEIVED AND REVIEWED BY: DATE: