BP-2002-1649 ° PERNIIT APPLICATION
Master Permit No. 31
Subsidiary Permit No. y o • 1►a 5`
INSTRUCTIONS -The following steps intist be taken to obtaill a perillit,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 submit-
ted along with this permit application.
Step 2. Submit the completed Mplication with all necessary documents to the Building,Planning and Zoning Department for processing. During the
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processing of your application,you may be asked to submit additional information.
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`, ob Address:
Address Apt. tty State Zip
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Folio Number Ll escrip' n of Work
Lot Block Afz
Subdivision PB PG Zoning Linear Feet
Current Use of Property Square Feet I
yU��nits Floors
Proposed Use of Property `value of Wo L Bldg Value
jTenant Information Tax Assessed/ ppraised 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 Rejoption of Structure Shell Only
LPGX I Supplement 14pjj0#on Only Add'l Attachment
Roofing Reinspection Ot Add'l Detachment
Fence Other
Other
ARCHITECT ENGINEER
! Name Name
License No. License No.
Address Address
Telephone Telephone
Fax Fax
*11" PROPERTY OWNER CONTRACTOR
Name Name Q/
Address ll,A, License No.
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'5310 Address
Home Telephone /SC
Business Telephone VJ Telephone Fax
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Fax Qualifler Name
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PERNIIT APPLICATION j
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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.
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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.
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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, P,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.
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STATE OF FLORIDA,COUNTY OF MIAMI-DADE STATE OF FLORIDA,COUNTY OF MIANH-DARE
q\�J'iglntatare of er� � � Signature of Contractor/Qualifier
print Name Print Name
to subscribed before me this d® Sworn to and subscribed before me this day of ,
ignature of tary Pub'c- tate of Florida Signature of Notary Public-State of Florida
SEAL: SEAL:
Personally known OR,Produced Identification ''/ Personally known OR,Produced Identification
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Type of Identification Produced —.--)
Ji ll fl�b 10-- %R-a31a U of ldendfl ation Produced:
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PERNIIT APPLICATION
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INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies)in the space provided below.
ELECTRICAL
TYPL QTY. TYPE Q'I'Y. TYPE QTY. TYPE, Q'IY.
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.gVPH) 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
rvIECHANICAL
TYPE QTY. TYPE QTY. TYPE QTY. T YPE,
Minimum Fee Condensate Drain Generator Refrigeration,Tons
A/C Central,Tons Cooling Tower Heating Strips,each Vent Hood,Cost
A/C WhEffin.Tons Dryer Vents,Number ofPaint Booth Ventilation,Cost
'E Air Handler,Tons Ductwork,Cost of Piping,Flammable Liquid Periodic Inspections
Barbecue Fire Sprinkler System Processfflressure Piping
Bath Fan-Vented,# Fireplaces,Number of NPressure Vessel
PLUMBING
TYPE QTY. TYPE QTY. TYPE Q'ry. 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
i 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
fDishwasher 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
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RECEIVED AND REVIEWED BY: DATE:
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PERMIT APPLICATION
OFFICE USE ONLY i
❑ 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 Ll OTHER
(Specify&Attach) (Specify&Attach)
PER'1VI IT FEES
$3.00 per page(Scanning Fee) $
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Miami Shores Village $ C '
Bond $
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Metropolitan Dade County (C.C.F.) $ C) (sq.fL=x/1000
x 0.60)
Inspector State Educational Fund $ (¢.005/sq.fc) 1
State DCA(Radon) $ (¢.01/sq.ft)
Code Enforcement Fine $
Zoning Review $
Notary $
TOTAL
ISSUING OFFICIAL
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REVIEWED AND PREPARED BY: DATE:
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SECTION BY DATE
CONDITION OFAPPROVAL
Zoning
Electrical
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Mechanical
Plumbing
Fire j
Public Works
Structural
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Building Oficial i
Revised July 2001
10050 N.E. 2-AVE.,MIAMI SHORES,FL• (305) 795-2207 •FAX(305)756-8972 • http://www.miamishoresvillage.com