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BPP-15-2090 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-243375 Permit Number: BPP-8-15-2090 Scheduled Inspection Date: September 17, 2015 Permit Type: Pools/Whirlpools/Hot Tubs Inspector: Rodriguez,Jorge Inspection Type: Final Owner: LESCOT, GEORGES Work Classification: Repair Job Address:9125 NE 4 Avenue Miami Shores, FL 33138-3118 Phone Number (305)915-6037 Parcel Number 1132060140090 Project: <NONE> Contractor: POOLTECH OF MIAMI INC Phone: (305) 226-7510 Building Department Comments RENEWAL OF EXPIRED PERMIT BPP14-1329 Infractio Pas! CommentsINSPECTOR COMMENTS FaIsL Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-241613. No permit posted Secure pool with water Failed ❑ 9/16/15 OWNER WILL LIVE THE PERMIT PASTED OUT IN THE MAIL BOX Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. September 16, 2015 For Inspections please call: (305)762-4949 Page 26 of 31 F Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-241625 Permit Number: BPP-8-15-2090 Inspection Date: August 18, 2015 Admak y : Pools/Whirlpools/Hot Tubs Inspector: Dacquisto, David spection Type: Survey Final Owner: LESCOT, GEORGES ri (I Work Classification: Repair Job Address:9125 NE 4 Avenue Miami Shores, FL 33138-3118 one Number (305)915-6037 Col . rcel Number 1132060140090 Project: <NONE> Contractor: POOLTECH OF MIAMI INC Phone: (305) 226-7510 Building Department Comments RENEWAL OF EXPIRED PERMIT BPP14-1329 Infractio Passed Comments INSPECTOR COMMENTS False 1 Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. For Inspections please call: (305)762-4949 August 18,2015 Page 1 of 1 2492 WEST 72nd STREET TYPE OF PROJECT: SCALE: HIALEAH,FLORIDA 33016 BOUNDARY SURVEYDATEN A G PHONE:786416-1018 08-09-15 FAX:305-817-9709 PROJECT LOCATION: DRAWN BY: E-MAIL:josefanjul@ymail.com L.R. 9125 NE 4TH AVENUE FILEN : CITY,STATE&ZIP CODE JAF-14 PROJECT No: MIAMI SHORES, FLORIDA JAF-AF-912525 J A Ir 01013RIPM2=0 SHEET: 1 8MV10=1 , NOTE:ONLY VALID WITH PAGE 2 2 SHEETS FOLIO NO: 11-3206-014-0090 CERTIFIED TO: - 1. Georges Lescot's Miami S� hp s Viva aPPoVED By ;f DACE :PF C" wFZONING DEPTAUG 1 $ 2015 ELDG DEPT : SUBJECT i0CCMPLL4NCE"ALL �`� LEGAL DESCRIPTION: �8qN. STATE AN ;y Lots 13 and 14 in Block 49 of "MIAMI S c �1 a �rAt1Jlp1►>tppbas r orded in Plat Book 10 at Page 37 of the Public Records of Miami-Dade County, Florida. SURVEYOR'S NOTES: 1. LEGAL DESCRIPTION FURNISHED BY CLIENT. NO SEARCH OF PUBLIC RECORDS WAS MADE BY THIS OFFICE. 2. ANY ELEVATIONS SHOWN HEREON ARE PER NGVD (NATIONAL GEODETIC VERTICAL DATUM) OF 1929. 3. NO EXCAVATIONS WERE PERFORMED AS TO DETERMINE UNDERGROUND ENCROACHMENTS. 4. DISTANCES AND ANGLES ARE FIELD MEASURED AND CORRESPOND WITH RECORD DATA UNLESS NOTED. 5. THIS SURVEY WAS PREPARED FOR PERMITTING PURPOSE ONLY . PERMITTING FOR ADDITIONAL CONSTRUCTION ETC. MAY REQUIRE ADDITIONAL INFORMATION WHICH CAN BE OBTAINED FROM THIS OFFICE. 6. IN SOME INSTANCES, GRAPHIC REPRESENTATIONS HAVE BEEN EXAGGERATED TO MORE CLEARLY ILLUSTRATE RELATIONSHIPS BETWEEN PHYSICAL IMPROVEMENTS AND/OR LOT LINES, IN ALL CASES, DIMENSIONS SHOWN SHALL CONTROL THE LOCATION OF THE IMPROVEMENTS OVER SCALED POSITIONS. 7. ADDITIONS OR DELETIONS TO THIS SURVEY MAP BY OTHER THAN THE SIGNING PARTY OR PARTIES IS PROHIBITED WITHOUT THE WRITTEN CONSENT 96 THE SIGNING PARTY OR PARTIES. (CHAPTER 5J-17 OF THE FLORIDA ADMINISTRATIVE CODE PURSUANT TO SECTION 472.027A OF 4•_OQI1A STA.TUTE4 666640. • • 0000.• 0040.•. . . . . • • 4000... .•0000 0 00 60 •. 4000•. 0 00 4000.•. 0000• . 66640 0:009: 0 • • 6 0000 0400••. • 0 040.060 0.406•0 . 400 0400 4000 • • 66 . •. • • • 4000000 0000 40 • • • 40... NOTE: UPDATED POOL DECK 10-06-2014. ®= AIR CONDITIONER �=GOLF COURSE © = BELLSOUTH BOX =HANDICAP SPACE A ARC F.I.P. .I.R FOUND IRON PIPE OD RADIUS ® = CABLE BOX =INLET A/C AIR CONDITIONER R RECORD F.NAD. FOUND NAIL AND DISC R RIGHT-OF-WAY ® = CATCH BASIN ) =LIGHT POLE BEARING F.Pk.i ND PARKER KALON NAIL rNT RC CALCULATED S.I.R. S.I.P. SET 1 2 IRON R00 IPE IN =CONCRETE POLE * =METAL LIGHT POLE _MA& I.D. SURVEYORS IDENTIFICATION L LENGTH TAN TANGENT =CONTROL VALVE BOX Q =SANITARY MANHOLE H L.A.E. LIMITED ACCESS EASEMENT TYP. TYPICAL WORBEARING L.M.E. LAKE MAINTENANCE EA T ® =ELECTRIC BOX =SATELUTE DISH A M MEASURED W.E. WATERS EDGE 0 S T ox �o�= EXISTING ELEVATIONS =WATER METER ETEP PLATTED // WOOD FENCE • X CHAIN UNK FENCE ® =ELECTRIC METER pd =WATER VALVE AGE EASEMENTL+ FAVLMENI U A IRON ALUMINUM FENCE 8 =ELECTRIC SERVICE BOX�=WOOD POLE P. .8. N BEGINNING CURNLRP.O.C. DINT OF COMMENCEMENT - - — MONUMENT LINE 1,IFF tU.H. I WUNU WILL MULL P. .C. DIN CU VA - CENTERUNE =FIRE HYDRANT IVIF P M. PERMANENTMONUM NTS PROPERTY LINE ELE ®I POINT—TANGENCY =FLORIDA POWER &LIGHT BOX FLOOD ELEVATION INFORMATION: I HEREBY CERTIFY THAT THIS SURVEY HAS BEEN PREPARED BY THE OFFICE 9400 HEREON AND THAT I AM THE SURVEYOR OF RESPONSIBLE CHARGE FOR NONE OTHER THAN SAID OFFICE AOOITKINALLY,THIS SURVEY MEETS AND/OR EXCEEDS THE STANDARDS OF PRACTICE AS SET FORTH IN CHAPTER 5J-17 OF THE FLORIDA DATE OF FIRM: 09/11/2009 ADMINISTRATIVE CODE PURSUANT TO SECTION 472027 OF THE FLORIDA STATUTES COMMUNITYNo: 120652/VILLAGE OF MIAMI SHORES /j/ PANEL: 0302 SUFFIX:L SOURCE OF ELEVATION:M.D.C. ZONE: "X" BENCHMARK NO: & GNO FURLANO SURVEYOR AND APPER FLORIDA UCENSE NO.: 5044 BASE FLOOD ELEVATION: N/A ELEVATION: NOT VAUD WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF THE FLORIDA UCE14SED SURVEYOR/MAPPER NAMED ABOVE is 2492 WEST 72nd STREET TYPE OF PROJECT: SCALE: FLORIDA 33016 BOUNDARY SURVEY DATE: - 25' PHONE: PHONE:786-416-1018 FAX:305-817-9709 08-09-15 E-MAIL:josefanjul@ymail.COm PROJECT LOCATION: DRAVVN BY: L.R. 9125 NE 4TH AVENUE FILE NO: CITY,STATE&ZIP CODE JAF-14 PROJECT No: MIAMI SHORES, FLORIDA JAF-9112525 AF- J A a oat 9 r1am SHEET: 2 �TZCB>S• - NOTE:ONLY VALID WITH PAGE 1 2 SHEETS NORTH '--- SCALE: 1"= 25' FlP. 1/2"� — c 15 ALLEY PER PLAT 9'PAVED ALLEY FlP. 1/2' FIR 1/2' MOO tO 0.2' — 90'0'11` I U 0.4' 35.0' �1 a 89 9'49" 11.0 POOL 25.2' PUMP POOL 2 .1' 23.40' BRICK PAVER TILE 13.9' DRVEWAY I PAVERS 11.1' v iO in o M N 15.9' m N LIJ z� 1 4.00' o� 5.35 --� 0 a isI 12.70' Q � O o Iq 1-STOR� N RES#91 0 d R"^ GO > TILED W a a 3 w a a 4. 0' ( WALL w Q- w 12.70' 18.6' k 3 • • ' 7.0 ' 14.8' • • • in o Goo 4 z N •••••• • • • ••• � 25.0' 4.30' v •••••• • • • • o m • 0.1 •••••• • �� •• •• FlP. 1 2" 29.3' 17.70' 53.0' ••••• �•�•o� ��faiw * • No I.D. A/CLQ I • • ••••• • 5.00' UNIT •••w• = 1JV i••••i • • • f w • 51 � A •••••• •Goo•• �39.27f I 89'59'51' • 0000 t. 4' CHAIN LINK FENCE 0.4' ••• FIR 1/2' -f M 5' SIDEWALK FLP. 1/2" No I.D. 21' PARKWAY N.E. 91st. STREET — � � — 17TASPHALT PAVEMENT 70' TOTAL RIGHT-OF-WAY NOTE: UPDATED POOL DECK 10-06-2014. UPDATED POOL DECK 06-26-2015. ABBR LATMES AND LWRED O = BELLSOUTH BOX =HANDICAP SPACE A C F.LP. .I.R FOUND IRON PIPE OD R RADIUS = CABLE BOX =INLET A C AIR CONDITIONER R RECORD F.N&D. FOUND NAIL AND DISC R W RIGHT-OF-WAY ® = CATCH BASIN =UGHT POLE N F.Pk.N. FOUND PARKER KALON NAIL EASEMENT C CALCULATED A SI.R. SI.P SET 1 2 IRON ROD PE =CONCRETE POLE J�( =METAL LIGHT POLE I.D. SURVEYORS IDENTIFICATION L N TAN TANGENT =CONTROL VALVE BOX Q =SANITARY MANHOLE L.A.E.CH CHORD UMI ACCESS A M N TYp, TYPICAL -- 0 CHORD BEARING L.M.E. LAKE MAIN NANCEEASEMENT ® =ELECTRIC BOX �=SATEWTE DISH -R NOT ACCESSIBLE A M MEASURED W.E.---FWATER S EDGE +o°o=EXISTING ELEVATIONS =WATER METER 0 S OFFSET off — OVERHEAD WIRL LINE P PLATTED // WOOD FENCE X CHAIN UNK FENCE ® =ELECTRIC METER =WATER VALVE AGE EASEMENT -P.ZT—OF PAVEMENT POINT NO CURVATURE ❑ IRON ALUMINUM FENCE P.O.B. POINT OF BEGINNING =ELECTRIC SERVICE BOX'Q.=WOOD POLE CORNER - -— MONUMENT UNE P.O.C. POINT OF COMMENCEMENT CENTERLINE y� -FlRE HYDRANT UKILL MULLP.R.C. P0NT REVERSE CURVATURE - yo- M.1 ARU ENDS PERMANENT N M UM N � PROPERTY UNE ® =FLORIDA POWER &UGHT BOX W. IN Parmil J Oii R A ,gt{OREst Miami Shores Village ,•• �\ :, TYf � $1 •Q TutlS 10050 N.E.2nd Avenue NE Miami Shores,FL 33138-0000 ,e � Pet7'rt + 1t1 Ev ` Phone: (305)795-2204 i"CORrt3Dp' - o ... ot too Expiration: 0211412016 Project Address Parcel Number Applicant 9125 NE 4 Avenue 1132060140090 GEORGES LESCOT Miami Shores, FL 33138-3118 Block: Lot: Owner Information Address Phone Cell GEORGES LESCOT 9125 NE 4 Avenue (305)915-6037 MIAMI SHORES FL 33138- 9125 NE 4 Avenue MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 22,000.00 POOLTECH OF MIAMI INC (305)226-7510 Total Sq Feet: 447 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved: : In Review Final Date Denied: Survey Final Type of Work:Swimming Pool Occupancy:Private Review Planning Additional Info: RENEWAL OF EXPIRED PERMIT BPP14- Bond Return: Review Building Classification:Residential Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $13.20 Invoice# BPP-8-15-56753 DBPR Fee $9.90 DCA Fee $9.90 08/18/2015 Check#:7857 $721.00 $0.00 Education Surcharge $4.40 Permit Fee $660.00 Scanning Fee $6.00 Technology Fee $17.60 Total: $721.00 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 accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING,MECHANICAL,WINDOWS,DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVI ertify hat a 1 the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constructio z i or thorize the above-named contractor to do the work stated. August 18, 2015 Auth Signature:Ovffer / Applicant / Contractor / Agent Date Building Department Copy August 18, 2015 1 Miami Shores Village � uilding Department AUGais 2015 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 F`B�Cn2o/y_ BUILDING Master PermitNo, /'/` PERMIT APPLICATION Sub Permit No.9 BUILDING F-] ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION p RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: �I� � N-g VAI-e City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: /Flloo�d Zone: BFE: CFFFE: ? OWNER: Name(Fee Simple Titleholder):�tC'OE6�S l.� Fac,( Phone#: 3G'J I_1 5 (90J, jj Address: g112s xJ-E � 7X/ .�0 6 �/�/` )� 30/ - 807-W K7 City: ` 0-�� ,c�S State: f-c— Zip: _3 (� Tenant/Lessee Name: Phone#: Email: IQYVL .Tn r., Phone#:BU S226p'ITI0CONTRACTORCompany NamTWt ' - , O(/ Address: goo c5w 40-5-1L Q _ City: M,�QY31,(, L ^� State:� ZZiipp:,.�3511.46- Qualifier Name: Qk J.. V t 1 Phone#:�'�VJJ 1.11 ��1 0 State Certification or Registration#: Cf-JC74 rJ��3� Certificate of Competency#: T DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demoliyt�on Description of Work: /yl O e /M �\ 0,41(l o ✓ e v _ jL Specify color of color thru tile: r0 Submittal Fee$ Permit Fee$ 'W CCF$ CO/CC$ Scanning Fee$ ('0 .00 Radon Fee$ 9.C) 0 1 1DBPR$ (- [ o Notary$ Technology Fee$ 1 d . (C Q Training/Education Fee$ `� y Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ Z d� (Revised02/24/2014) , e f Bonding Company's Name(if applicable) Bonding Company's Address _ City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,AIR CONDITIONERS, ETC..... 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. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature OveNER or AGENT 4CONA The foregoing instrument was acknowledged before me this The fo egoing instrument was ackn ged before me this .zL da of J,A 2045 by day of V 20 is , by fjeion ho is personally known to rUr1k. Z[��YY(,Z who' personal) kno o me or o has produced as me or who has produced _ as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: 04—A 04 Print: L� Wary PUbliC State of Florida Commis #�FF 299407Seal: O4� Seal: 'Maxine Y Gomez �. My Comm.Expires Mar 12,2019MyCommissionEiT839239 ',�'�•r,O,��;pp1`1 BondeditooNsllansl*WyMsn.FIX Expires 09/30/2016 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) FLICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE Or FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CPC1458434 The COMMERCIAL POOL/SPA CONTRACTOR Named below IS CERTIFIED ` Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 DE IZAGUIRRE, FRANK JEFFREY POOLTECH OF MIAMI INC. 9002 SW 40TH STREET MIAMI FL 33165 ISSUED: 08/24/2014 DISPLAY AS REQUIRED BY LAW SECI# L1408240004118 U07269 Local Business Tax Receipt Miami-Dade County, State of Florida -THIS IS NOTA BILL - DO NOT PAY LBT 7159419 BUSINESS NAME&OCATION RECEIPT NO. EXPIRES . POOLTECH OF MIAMI INC RENEWAL SEPTEMBER 30 2015 9002 BIRD RD 7436712 Must be displayed at place o3 business MIAMI FL 33165 Pursuant to County Code Chapter 8A-Art.'9&10 OWNER SEC.TYPE OF BUSINESS POOLTECH OF MIAMI INC 196 SPECIALTY PLUMBING CONTRACTOR PAYMENT RECEIVED CPC1458434 BY TAX COLLECTOR` Worker(s) 5 $75.00 09/15/2014 FPPU14-14-007918 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, permit,or a certification of the holder's qualification;,to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirementrwhich apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles-Miami-Dade Code Sec ea-276. For more information,visifwww:ntiamidad ,gov xcQllectgr POOLT14 OP ID: DE CERTIFICATE OF LIABILITY INSURANCE =DATEDDYYYY) /2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME:CONTACT Kerry C.Tait Insurance By Ken Brown,Inc. PO Box 948117 A/CONNo. Ext):321-397-3870 A/c No): 321-397-3888 Maitland,FL 32794-8117 E-MAIL Kerry C.Tait ADDRESS:ktait@insbykenbrown.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Amerisure Mutual Ins. Co 23396 INSURED Pooltech of Miami Inc INSURER B:Bridgefield Employers Ins Co 10701 9002 SW 40 Street INSURER C: Miami, FL 33165 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IEXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD YYYY MM/LICY D1YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE T OCCUR GL20747450402 01/22/2015 01/22/2016 PRA EMISESEaoccurrence $ 100,00 _ MED EXP(Any one person) $ 5,00 _ PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGRE_GAT_E LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,00 POLICY LX jE 4 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: J $ AUTOMOBILE LIABILITY Ea aBINEDtSINGLE LIMIT $ 1,000,000 A X ANY AUTO CA20885530202 01/22/2015 01/22/2016 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS FX AUTOS Per accident UMBRELLA LIAB X I OCCUR EACH OCCURRENCE $ 3,000,00 A X EXCESS LIAB CLAIMS-MADE CU20843950302 01/22/2015 01/22/2016 AGGREGATE $ 3,000,00 DED i X RETENTION$ 0 $ WORKERS COMPENSATIONPER I---T-5TH- AND EMPLOYERS'LIABILITY Y/N X STATUTE I ER B ANY PROPRIETOR/PARTNER/EXECUTIVE83029917 02/18/2015 02/18/2016 E.L.EACH ACCIDENT $ 1,000,00 D? OFFICER/MEMBER EXCLUDE ❑N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ 1,000,00 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Frank Jeffrey De Izaguirre License#CPC1458434 CERTIFICATE HOLDER CANCELLATION MIAMISH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Miami Shores THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 N.E.2nd Avenue Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD SNoxes` PERMIT APPLICATION AUG 18, 2003 .... , I 003 - 15 -1 ------ ---_ _ Master Permit No. °,EEN �s Subsidiary Permit No. i F�ORIDp 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 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. APPLICATION Job Address: "1 ' 2 5 N C- Z)Q'D Address Apt. City State Zip �. o 1 0 u Folio Numbe Description of Worl�c J 1 M�11 10!21 Lot 1 Block — 1401n Subdivision Mof�� J sPB 10 PG?�- Zoningii Linear Feet Current Use of Property Square Feet'-1 14 + Units Floors Proposed Use of Property Value of Work ✓:- _ _ Bldg Value Tenant Information Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT TYPE (✓ ) PERMIT CHANGE (✓) TYPE OF MANAGEMENT (✓ ) Building Chg.Contractor New Construction Enclosure Electrical Renewal Alteration Exterior Repair Mechanical _ Revision Alteration Interior Demolish Plumbing Extension Relocation of Structure Shell Only LPGX Supplement Foundation Only Add'1 Attachment Roofing Reinspection Other Add'I Detachment Fence Other Other ARCHITECT ENGINEER Name Name V f f� m( C S License No. Licen o. wt Address Address t,/a 1 t� U-) 9 J F� —tA to T• L 331 SS Telephone Telephone ta�s L b`` '� (6q S Fax Fax cj r 6v/_ P OWNER C CTOR Name r. Q� me Addressq License No. � CdS� � r Address I Home Telephone o.T y "t � Q 1 �`.S Business Telephone 3� 901 q q S �, Telepho e,-_ i+7�c S i O Fa !!� Fax Qualifier ame�l youd App Fc e, 3o C)o �h eG Ll �� i Page 2 PERMIT APPLICATION i IMPORTANT I 1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant j 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, 1s'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 Co ctor. STATE;O A,COU OF MIAMI-DADE STACTE OF ORIDA,CO Y OF MIAMI-DADS Signature of ` gnature of Contract /On ier Print Name Print Name I i 'w(omt+oand subscribed fore me[his \dayof S2 o�mOto nd subscribed l�efo me this day of Signatureof N ry blic �ta e F . ;_.. Signature of N r t VAV. HER MARI BUTCHER ;�o^ P ', ar of Florida SEAL: µ''f to Pu State of Florida SEAL: - « X,` My CoSep 19,2006 My nExpresSep 19,2(106 ;,* «Ae. Co151864 C m fission#DD 151864 p` Bonded By Notional Notary Assn, FO'FO� Bonded By National Notary Assn. Personally known Personally known OR,Produced Identification Type of Identification Produced: Type of Identification Produced: { i -a Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below7711 IELECTRICAL TYPE QTY. TYPE QTY. TYPE QTY. TYPE Minimum Fee Dryer Outlet,Appliance 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) Temp Serv.,Construction Compactor Low-volt,Burglar Refrigerator,Domestic Temp for Test-30 days Deep Freezer Low-volt,Fire Renew-Temp Service Demolition Low-volt,Intercom/Teleph. Repair Circuits Dishwasher Low-volt,Television Service,Number of Amps MECHANICAL Minimum Fee Condensate Drain Generator Refrigeration,Tons A/C Central,Tons Cooling Tower Heating Strips,each Vent Hood,Cost A/C Wall/Win.Tons Dryer Vents,Number of Paint Booth Ventilation,Cost Air Handler,Tons Ductwork,Cost of Piping,Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping J001 1206ng Bath Fan-Vented,# Fireplaces,Number of Pressure Vessel PLUMBING TYPE Q-1,Y. 'I-YPE QTY. TYPE QTY. TYPE Q-1-Y. A/C Condensate Drains,Roof Miscellaneous Fixture 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 I i Drains,French Miscellaneous Equipment Sink Well,Supply RECEIVED AND REVIEWED BY: DATE: Page 4 PERMIT APPLICATION OFFICE USE ONLY CHECKLISTi ❑ 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) PERMIT FEES $3.00 per page(Scanning Fee) $ Miami Shores Village $ Bond $ Metropolitan Dade County (C.C.F.) $ (sq.ft.=x/1000 x 0.60) Inspector State Educational Fund $ (¢.005/sq.ft.) State DCA(Radon) $ (0.01/sq.ft.) Code Enforcement Fine $ Zoning Review $ TOTAL $ ISSUING OFFICIAL REVIEWED AND PREPARED BY: DATE: SECTION BY DATE CONDITION OF APPROVAL Zoning Electrical Mechanical &-4,> 2L v Plumbing Fire Public Works Structural Building Official Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795-2207 • FAX (305) 756-8972 • http://www.miamishoresvillage.com I ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAtN ITEM UNIT FEE ITEM UNIT FEE ITEIL. UNIT FEE BATH TUB SWITCH OUTLETS C�.:.�E � BIDET LIGHT OUTLETS CENTRAL HEATING 01SHWASHER RECEPTACLES I A/C (WIND) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/METER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY OVEN ABOVE GROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS d- 1 HP STEAM BOILERS SHOWER MOTORS OVER 1- 3 HP HOT WATER BOILERS SINK, POT/3 COMP. MOTORS OVER 3- 5 HP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES SINK, SLOP MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 HP VIOLATION INDIRECT WASTES A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS HEATER-NEW INST. GENERATORS TRANSFORMERS HEATER-REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER-WELL SPECIAL PURPOSE SWIMMING POOL OUTLETS COMMERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY-SEWER SIGN TIME CLOCK UTILITY-WATER FIXTLRES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS ORAINFIELD, 4- TILEAES. VIOLATION PUMP & ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) GAS PIPING i `SeoRes`�` R E CE PERMIT APPLICATION AUG ? £ Master Permit No. LPW 3_ aJ 1 PENTE8110 �.. .. _ Subsidiary Permit No. ��ORiDP' INSTRUCTIONS obtain a permit from Step 1. Complete the attached permit application which must be signed 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 competed 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. APPLICATION1 Job Address: 1 1" T�V� �Q � l`�� ` 3?)`3 Address Apt. City State "To a Zip d d Folio Number Description of Work Lot k Block Subdivision L PB10 PG Zoning Linear Feet Current Use of Property Square Feet—" Units Floors Proposed Use of Property Value of Work 3 Bldg Value Tenant Information Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT TYPE (✓ ) PERMIT CHANGE (✓) TYPE OF MANAGEMENT ( ✓ ) Building Chg.Contractor New Construction Enclosure Electrical Renewal Alteration Exterior Repair Mechanical Revision Alteration Interior Demolish Plumbing Extension Relocation of Structure Shell Only LPGX Y Supplement Foundation Only Add'I Attachment Roofing Reinspection Other Add'I Detachment Fence Other Other ARCHITECT ENGINEER Name Name V a 0 0 ec License No. License o. Address Address L—I 1 o 2 YN OC ,q0►rn+ IFL `S�1 ss Telephone Telephone Fax Fax S o •2. 10 P Y OWNER CONT CTOR N e Qi�' Q z N O t Address G 12 5 License NV � C� 'FL�� Jt J Address Home Telephone 05 —� 14 9 K, me -Fl- 2jr�' G S Business Telephone 1) C1 Telephone s—Z2CfSioFax O s, C2`OG 2fj5 Fax Qualifier Na ,,11K, ok rye Pwd Fee �3d. oo Check * ql 7 ' i Page 2 PERMIT APPLICATION IMPORTANT NOTICES 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 - Please read carefully. 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, V Floor,(305)679-1078. Once recorded,the Notice of Commencement must be POSTED AT THE JOB SITE in accordance wit ection 713-35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a C tr tor. STATE DA,CO OF MIAMI-DADE S TE OF ORIDA,COUNTY OF MIAMI-DADE Signature or ature of Contractor/Qu Z_C%r "D11 V6 "D11 Print Name Print Na e wom to and subscribed bef r me this y f ` om to and s bscri d ore me this day of f i Signator o %(may, bl - I HER Signature ota - ,PR �Y„, ARIA V, �NEIi ,20� � r Pu i St teo lorida P SEAL: _ SEAL: of PubllC-St of Florida :.y M on Expire�otl 19,2006 - :s+ %a ommission#D 864 » orlon Bx�IrogSep 19,2006 Bon d 9y Nationalry Assn. Commission#017 151864 Bonded By Nafiont�l Notary Assn. Personally known OR,Produced Identification Personally known OK,'Produced e i Type of Identification Produced: Type of Identification Produced: I 1 Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. ELECTRICAL Minimum Fee Dryer Outlet,Appliance 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) Temp Serv.,Construction Compactor Low-volt,Burglar Refrigerator,Domestic Temp for Test-30 days Deep Freezer Low-volt,Fire Renew-Temp Service Demolition Low-volt,Intercom/Teleph. Repair Circuits Dishwasher Low-volt,Television Service,Number of Amps MECHANICAL Minimum Fee Condensate Drain Generator Refrigeration,Tons A/C Central,Tons Cooling Tower Heating Strips,each Vent Hood,Cost A/C Wall/Win.Tons Dryer Vents,Number of Paint Booth Ventilation,Cost Air Handler,Tons Ductwork,Cost of Piping,Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Bath Fan-Vented,# Fireplaces,Number of Pressure Vessel PLUMBING TITE QTY. T VPE QTY. TYPE QTY. TITE, TY. A/C Condensate Drains,Roof Miscellaneous Fixture 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 j 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 t RECEIVED AND REVIEWED BY: DATE: I ' c � Page 4 PERMIT APPLICATION OFFICE USE ONLY CHECKLISTl ❑ 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) PERMIT FEES $3.00 per page(Scanning Fee) $ Miami Shores Village $ Mo ' Bond $ Metropolitan Dade County (C.C.F.) $ `y (sq.ft.=x/1000 x¢.60) Inspector State Educational Fund $ (¢.005/sq.ft.) i State DCA(Radon) $ (¢.01/sq.ft.) i Code Enforcement Fine $ Zoning Review $ TOTAL $ ISSUING OFFICL%L REVIEWED AND PREPARED BY: DATE: SECTION BY DATE . CONDITION OF APPROVAL Zoning Electrical Mechanical Plumbing -(J Fire VIV Public Works Structural Building Official Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795-2207 • FAX (305) 756-8972 • http://www.miamishoresvillage.com ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) ' PLUMBING ELECTRICAL MECHANICAL ITEM UNIT FEE ITEM UNIT FEE ITEM UNIT FEE BATH TUB SWITCH OUTLETS SPACE HEATERS BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES A/C (WIND) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/METER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY OVEN ABOVE GROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 HP STEAM BOILERS SHOWER MOTORS OVER 1- 3 HP HOT WATER BOILERS SINK, POT/3 COMP. MOTORS OVER 3- 5 HP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES SINK, SLOP MOTORS OVER 8- 10 FP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 FIP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 FP COOLING TOWERS WATER CLOSET MOTORS OVER 100 FP VIOLATION INOIRECT-WASTES A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS HEATER-NEW INST. GENERATORS TRANSFORMERS HEATER-REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER-WELL SPECIAL PURPOSE SWIMMING POOL OUTLETS COMMERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY-SEWER SIGN TIME CLOCK UTILITY-WATER FIXTLRES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS DRAINFIELO, 4- TILE/RES. VIOLATION PUMA 3 ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) GAS PIPING MIAMI SHORES VILLAGE BUILDING DEPARTMENT L� 305-795-2204 Buildi g I pection Request 4p Date Type Insp'n Permit No. Ue G — , Name Address Company Phone# Inspection Date Approved ❑ . i orrect�o �i� Re-Insp'n Feebv ❑ VLA. Ll t1i t MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305-795-2204 Building Inspection Request Date Type Insp'n Permit No. )" Name Address Company ` If A Phone# Inspection Date Approved ❑ Correction _ Re-Insp'n Fee ❑ 'ra � _ .� ear 1 �.,./. � �• �Y..� �,'�. MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305-795-2204 Building Inspection Request i Date Type Insp'n 9- VO Permit No. " Name Address Tl"�T Company Phone# i Inspection Date Approved ❑ Correction ` Re-Insp'n Fee ❑ wd ., r o MIAMI SHORES VILLAGE BUILDING DEPARTMENT ' V 305-795-2204 Building Inspection Request Date Type Insp'n ( (d tno) . Permit No. vt�p — t j �� [� Name Vn- (C '� Address G 1 .25 N� 4 Company � � Phone# Inspection Date �J Approved ❑ Correction Re-Insp'n Fee ❑ ,,MIAMI SHORES VILLAGE 'BUILDING DEPARTMENT 305-795-2204 Building Inspection Reque Date Type Insp'n C. a S Permit No. Name Address �. c. , I Company (-� Phone# i Inspection Date Approved ❑ Correction 1 l' i Re-Insp'n Fee ❑ I i l l ! i MIAMI SHORES VILLAGE ^� BUILDING DEPARTMENT 305-795-2204 Building Inspection Request D; [) D Type Insp'n Permit No. Na/e'*" VQJ�9�, -^ _ Address q I ;Ls Company 1' Ph,1 Inspection Date Approved ❑ Correction Re-Insp'n Fee ❑ kdVsa &ZC. A� ,021 Pool cL cA t--s tooev 3) V MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305-795-2204 Building Inspection Request Date', Type Insp,n Permit Nom Name 1_ Address T Company Phone# Inspection Date 1 Approved ❑ Correction Re-Insp'n Fee ❑ i k plc l - �1 S .c-co`�` Ae J. z �, s 't SWIMMING POOL OWNER'S CERTIFICATION Date Ob 13 03 Miami Shores Village Building and Zoning Department Attention: Building Official I certify that I am the legal owner of the property described as 13 14 oacyni : 0 3'+located at 4 We- f,1tn: re 13 In accordance with Section 33-12(f), Code of Metropolitan Dade County, I certify that I understand and agree that the swimming pool to be constructed at the above address cannot be used or filled with water until a separate permit has been obtained for an approved safety barrier, and such barrier erected, inspected and approved. I further understand that this certification,however, does not eliminate the need for obtaining a permit and erecting an approved barrier prior to final insp do and use of the pool. Legal Owner Note: This certification is to be submitted with a swimming pool permit applic ion . duplicate. 4 AllsbsS ORes R (� (E PERMIT APPLICATION i p J_ AUG 22003 Master Permit No. fj d, ___ __�� `__ Subsidiary Permit No. h ��ORiDp' ' to Step 1. Complete the attached permit application which must be si n@ ed 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. APPLICATION �, �1 Job Address: 912- 5 NAli Q_ ' ` own, �S ✓ �� Address Apt. City State Zip V V Folio Number Description of Work L Lot J Block LA q Subdivision- 01 IV— �1'�t)�S PB PG 3� Zonin Linear Feet 1 0J Current Use of Property y Square Feet Units Floors Proposed Use of Property Value of Work 9-1.0CO 0 Q Bldg Value Tenant Information Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT TYPE (✓ ) PERMIT CHANGE (✓) TYPE OF MANAGEMENT (✓ ) Building Chg.Contractor New Construction Enclosure Electrical Renewal Alteration Exterior Repair Mechanical Revision Alteration Interior Demolish Plumbing Extension Relocation of Structure Shell Only LPGX Supplement Foundation Only Add'I Attachment Roofing Reinspection Other Add'1 Detachment Fence Other Other ARCHITECT ENGIN ER Name Name JA ,q ��C J C License No. License No. ,•t Address Address 14'� 10SW2 Telephone Telephone., 5-- Fax Fax r P TY OWNER C CTOR IL A Name Q"e„ VaLdQ Z arae 1 Op o t Address License No. /r� G !� g1C15,MG )I }� N�%' myC S of lr? Aa Address -I 0O z 5'•`t-q C) ST- Home Telephone 2)0 5 1 q 6 1 -A b Q n%, I'r L 2)31 v j Business Telephone -�>Q 15 Q 3 2 Telephone ��_2 ZI O Fax Fax Qualifier N �O 10 VC EYom, C! l l hea dad App- Fe 3o.cx� 141-7 9 pR►� i i Page 2 PERMIT APPLICATION IMPORTANT NOTICES 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. r 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 1, 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, 151 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 Choosin ontractor. STA RIDA, UNTY OF MIAMI-DADE STAT OFELORIDA,CO Y OF MIAMI-DADE Signa Owner Signature of Contractor/ R Gkt Print Name A ' ,, e '� Print Name �'y I sworn t nd sub bed before me is day of Iv—? worn subscribed efo me[his y day,o "RY P • UTCHE Signature of p S ate of lorida RI V.BUT ER on Ex res 19,2006 PkY�U SEAL: '�, Pow o iss 151864 No ary b c- tat of Elori o ,;F 0,;tq` Bonded No' nal NotaryAssn. „ ;•_ My om on cpiresSep 19, Comi ission#DD 15 Bonded National Notary Assn. Personally known OR,Ro(Tc-e Identification 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 4TYPE QT 1'. TYPE QTY. TYPE QTY. TYPE Q-rY. Minimum Fee Dryer Outlet,Appliance 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) Temp Serv.,Construction Compactor Low-volt,Burglar Refrigerator,Domestic Temp for Test-30 days Deep Freezer Low-volt,Fire Renew-Temp Service Demolition Low-volt,Intercom/Teleph. Repair Circuits Dishwasher Low-volt,Television Service,Number of Amps TYPE QTY. -1-1-PE Q-rl-. TYI't] QTY. TYPE Q'I-Y. Minimum Fee Condensate Drain Generator Refrigeration,Tons A/C Central,Tons Cooling Tower Heating Strips,each Vent Hood,Cost A/C Wall/Win.Tons Dryer Vents,Number of Paint Booth Ventilation,Cost Air Handler,Tons Ductwork,Cost of Piping,Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Bath Fan-Vented,# Fireplaces,Number of Pressure Vessel PLUMBING TYPE QTY. TYPE QTY. TYPE QTY. TYPE QTY. A/C Condensate Drains,Roof Miscellaneous Fixture 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 j Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Draintield,4"Tile/Res. Lavatory Septic Tank Water Heater New Drains,Area Meter Set(Gas) Sewer Connection Water Re-p i e Drains,Floor Minimum Fee ShowerWater Service ` Drains,French Miscellaneous Equipment Sink Well,Supply If i RECEIVED AND REVIEWED BY: DATE: i Page 4 PERMIT APPLICATION OFFICE USE ONLY CHECKLIST ❑ OWNER-BUILDER FORM ❑ PROOF OF OWNERSHIP ❑ CONDO ASSOCIATION APPROVAL j (Attach) (Attach) (Attach) j ❑ 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) PERMIT FEESI $3.00 per page(Scanning Fee) $ J `� Miami Shores Village $ Bond $ Metropolitan Dade County (C.C.E) $ J q.ft.=x/1000 2 x¢.60) ! Inspector State Educational Fund $ �.�✓ (¢.005isq.ft.) State DCA(Radon) $ �. (¢.01/sq.ft.) Code Enforcement Fine $ Zoning Review $ G oc) TOTAL $ ISSUING OFFICIAL REVIEWED AND PREPARED BY: DATE: SECTION BYCONDITION OF A PPRONIAL D T Zoning Electrical Mechanical ,t a J--s Plumbing Fire ' Public Works Structural I OJ Building Official Revised July 2001 10050 N.E. 2D1D AVE., MIAMI SHORES, FL • (305) 795-2207 • FAX (305) 756-8972 • http://www.miamishoresvillage.com MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305-795-2204 Bui ding Inspection Request Date t Type Insp'n I �cl) Permit No. ,J I � Name V_0 Address /V A Company Lo CAI-- ' Phone# Inspection Date o Approved ❑ . . " y Correction Re-Insp'n Fee ❑ �V =rc � � � . 3 a3-7210 —7�1�% (�- � �b - 31v�'Z �ff ?� 4' � � Lw� jos u�- z1�5 �` - zz�' - zzos ��5�fW[d 4S �� T/ � MIAMI SHORES VILLAGE !' BUILDING DEPARTMENT 305-795-2204 r' Building Inspection Request Date Type Insp'n U/ Permit No. Q� Name Address , rf) aA Company v' _ Phone# Inspection Date , a s' ,. Approved coffe&ion�t i Re-Insp'n:Fee 1r r � � f N � lie ey 'o�t �. ... .:...... .. :..: a .'..,.. Miami Shores Village 1.0050 NE 2nd Avenue R Miami Shores, FL 33138 Inspection Record Page: 1 Inspection #: INSP2004-3322 Printed: 9/21/2004 Address: 9125 4 AVE NE Reference#: BP2003-1358 Applicant: PETER VALDEZ Directions To Parcel: Inspection Type: Final Building Date: 8/12/2004 Inspector: Curtis Craig Status: DENIED Passed? ❑ Required Steps: Comments: 1) Pool deck is still in setback- not installed as on approved plans 2) Still need to remove C/L fence in frontyard as noted on approved plans. Inspection Checklist: [Building ❑ ❑Site ❑ ❑Final Survey as Built El ❑Certificate of Occupancy ❑ ❑ ❑ ❑ ❑ ❑ ❑ Miami Shores Village Building Department OFFICE 10050 NE 2 Ave,Miami Shores,F133138 Tel: (305)795-2204 •Fax; (305)756-8972CUPY 3/7/2008 To: Pool Tech of Miami 9002 SW 40 St Miami, Fl 33165 Permit: BP2003-1358 Address: 9125 NE 4 Avenue Miami Shores Village FL33138- Date Expired: 5/3/2006 FINAL NOTICE Type: Swimming pool Date of Last Inspection: 4/15/2008 final denied Sir or Madam Dear S , Our records indicate that the above referenced permit has expired without obtaining the proper final inspection. In order to serve you better, we need to keep our files up to date. As per section 105.4.1 of the Florida Building Code, "Every permit issued shall become invalid (expired) unless the work authorized by such permit is commenced within six months after its issuance, or if the work authorized by such permit is suspended or abandoned for a period of six months after the work is commenced, or completed without obtaining the final inspection of the work performed.." Please be advised that open permits will hinder your ability to refinance or sell this property Please contact the Building Department, within 15 days of receipt of this letter in order to take care of this matter. Sincerely, y, CCaudio Grande(CBO) Building Director Miami Shores Village '� OFFIVE Building DepartmentPY : 10050 NE 2 Ave, Miami Shores, F133138 Tel: (305)795-2204 •Fax; (305)756-8972 cu� 3/7/2008 To: Current Owner 9125 NE 4 Avenue Miami Shores Village, FL 33138- Permit: BP2003-1358 Address: 9125 NE 4 Avenue Miami Shores Village FL33138- Date Expired: 5/3/2006 FINAL NOTICE Type: Swimming pool Date of Last Inspection: 4/15/2005 final denied Dear Sir or Madam, Our records indicate that the above referencedg proper ermit has expired without obtaining the p p p Per final inspection. In order to serve you better,we need to keep our files up to date. As per section 105.4.1 of the Florida Building Code, "Every permit issued shall become invalid (expired) unless the work authorized by such permit is commenced within six months after its issuance, or if the work authorized by such permit is suspended or abandoned for a period of six months after the work is commenced, or completed without obtaining the final inspection of the work performed.." Please be advised that open permits will hinder your ability to refinance or sell this property Please contact the Building Department,within 15 days of receipt of this letter in order to take care of this matter. Sincerely, Cfaudio Grande(CBO) Building Director SHORES G�! M. umM 60 `°R' Miami Shores Village g Building Department 10050 NE 2 Ave, Miami Shores, FI 33138 6/06/06 Tel: (305)795-2204 - Fax; (305)756-8972 To: Current Owner 9125 NE 4 Avenue Miami Shores Village, FL 33138- Permit: BP2003-1358 Address: 9125 NE 4 Avenue Miami Shores Village FL33138- Date Expired: 4/15/06 Dear Sir or Madam In order for us to serve you better, we need to keep our files up to date. Our records indicate that the above reference Permit has expired. The Building Department has determined that the work applied for has been completed with out the required inspections and it has been more than 180 days since your last approved inspection and thus your permit has expired as per Sec. 104.5.of the Florida Building Code. You are required to renew your permit and schedule all required inspections. In the event you do not comply with the requirements herein, the Building Department will file a complaint with Miami-Dade County Building Code Compliance Office for possible disciplinary action against your licensed contractor And/or if permit was obtained by the home owner the requirements of the Unsafe Structure Code of Miami Dade County Sec. 8-5. (3)will apply. "The building shall be presumed and deemed unsafe and a permit shall be obtained to demolish the structure or bring the building in to compliance with applicable codes as provided herein. " Please contact the Building Department, immediately upon receipt of this letter. Sincerely, �_K Mabel Vargas Administrative Assistant eN°RFS h� R E C E W E D PERMIT APPLICATION AUG 2003 ao®,�- 150 Master Permit No. Subsidiary Permit No. INSTRUCTIONS o obtain 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. APPLICATION Job Address: 2A �i Q Q n l s TL 11),'?i `Z) Address Apt. City State Zip Folio Number Description of Work �M') (C)9a L Lot Block 49, Subdivisi4rt� 1- J�10(eSPB10 PG 3 T Zoning Linear Feet Current Use of Property Square Feet Units Floors Proposed Use of Property Value of Work . Bldg Value Tenant Information Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT TYPE ( ✓ ) PERMIT CHANGE (✓) TYPE OF MANAGEMENT ( ✓ ) Building Chg.Contractor New Construction Enclosure Electrical Renewal Alteration Exterior Repair Mechanical Revision Alteration Interior Demolish Plumbing Extension Relocation of Structure Shell Only LPGX Supplement Foundation Only Add'I Attachment Roofing Reinspection Other Add'1 Detachment Fence Other Other ARCHITECT ENGINEER Name Name ,9 License No. Licen o. V Address Address 4 9 10 C::::�w 74 '7 Pk z►M,.L r L 3 3 r SS Telephone Telepho e Fax Fax P Y OWNER CONT CTOR Name �, Ck Id 9, Name Address(1 `'IS N C )4 A J e ;a nit� F License No. ' Address N ' Home 3 Telephone � 9(3�1 1 SW V?)A\C. � � -- � yq 6 Business Telephone 8 9 9 q S :3 �Z Telephone. (` �G1S21 Q OFax Fax v 1 Qualifier Namc�'b �y (JQ Z ' Pc6(3 Feet 30.00 Ckcj#` q 17g f _ Page 2 PERMIT APPLICATION IMPORTANT NOTICES 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 Stre t, 1s'Floor,(305)679-1078. Once recorded,the Notice of Commencement must be POSTED AT THE JOB SITE in accordance t Section 713-35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing o actor. _ STATE F CO Y OF MIAMI-DADE S FILA,COUNTY OF MIAMI-DADE r a e f Si f ctor/Qualifier v Print Name Print Name Sworn to and subscribed before me this day of Sworn to and subscribed before me this day of Signature f ta 1' - Sign r o b' - ta fIR�da� V.BUTCHER (vier,.V.BUTCHER SEAL =r" h p i tote of Florida SEAL :2 - nr.rtate of Floridaot p8ntx' 19:20056 864 r Ass . ",;. w c —N.- _ V nUC'!� ' x'C71 N01p Ssn. i Person a d ti kation P rso W tion Type of Identific ion Ce.\ Type of Ide tific 'on odt t - Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. ELECTRICAL TYPE Q-1-Y. TYPE QTY. TYPE QTY. TYPE QTY. Minimum Fee Dryer Outlet,Appliance 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) Temp Serv.,Construction Compactor Low-volt,Burglar Refrigerator,Domestic Temp for Test-30 days Deep Freezer Low-volt,Fire Renew-Temp Service Demolition Low-volt,Intercom/Teleph. Repair Circuits Dishwasher Low-volt,Television Service,Number of Amps MECHANICAL Minimum Fee Condensate Drain Generator Refrigeration,Tons A/C Central,Tons Cooling Tower Heating Strips,each Vent Hood,Cost A/C Wall/Win.Tons Dryer Vents,Number of Paint Booth Ventilation,Cost Air Handler,Tons Ductwork,Cost of Piping,Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Bath Fan-Vented,# Fireplaces,Number of Pressure Vessel PLUMBING TYPE QTY. TYPE QTY. TYPE QTY. TYPE Q,1-Y. A/C Condensate Drains,Roof Miscellaneous Fixture 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: or I Page 4 PERMIT APPLICATION OFFICE USE ONLY CHECKLIST ❑ OWNER-BUILDER FORM ❑ PROOF OF OWNERSHIP ❑ CONDO ASSOCIATION APPROVAL (Attach) (Attach) (Attach) i ❑ FIRE DEPARTMENT ❑ HRS/DERM APPROVAL ❑ BPR APPROVAL(Restaurants) APPROVAL(Commercial/ (Septic/Sewer) multi-family) I ❑ 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) $ Miami Shores Village $ /;z m O Bond $ n Metropolitan Dade County (C.C.R) $ `go (sq.ft.=x/1000 x¢.60) Inspector State Educational Fund $ (¢.005/sq.ft.) State DCA(Radon) $ (0.01/sq.ft.) Code Enforcement Fine $ Zoning Review $ TOTAL $ ISSUING OFFICIAL REVIEWED AND PREPARED BY: DATF7�1��rfi'�` SECTION BY DATE CONDITION OF APPROVAL Zoning Electrical 3 Mechanical Plumbing Fire Public Works Structural Building Official Revised July 2001 10050 N.E. 2-AVE., MIAMI SHORES, FL • (305) 795-2207 • FAX (305) 756-8972 • http://www.miamishoresvillage.com ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL ITEM UNIT FEE ITEM UNIT FEE ITEM UNIT FEE BATH TUB SWITCH OUTLETS SPACE HEATERS BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES A/C (WINO) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/METER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY OVEN ABOVE (MOUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 HP STEAM BOILERS SHOWER MOTORS OVER 1- 3 HP HOT WATER BOILERS SINK, POT/3 COMP. MOTORS OVER 3- 5 HP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES SINK, SLOP MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 HP VIOLATION INDIRECT WASTES- A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS HEATER-NEW INST. GENERATORS TRANSFORMERS HEATER-REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER-WELL SPECIAL PURPOSE SWIMMING POOL OUTLETS COMMERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY-SEWER SIGN TIME CLOCK UTILITY-WATER FIXTURES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS DRAINFIELO, 4' TILE/RES. VIOLATION PUMP & ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. _ kjo VC0 m n CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) GAS PIPING