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Miami Shore V'
S Village OCT
12016
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 5 1'
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 201(4 .,
BUILDING Master PermitNo.� C I(o- 7-%5 '
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: & 2 �� 7
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: ) l BFE: FFE:
OWNER:Name(Fee Simple Titleholder): " j-� s r� QTc Phone#:
Address:
City: r t U e 41 �r'i t1e,)State: Zip: 3
Tenant/Lessee Name: Phone#:
Email: r-A �l lot�� !Imes 11.(OV-1
CONTRACTOR:Company Name: Phone#:
Address: V1 �P�l
City: State: ` 1�— Zip: 331 3
Qualifier Name:1 '�Z+�— - ��� -A, Phone#: 3 0 5 '4-1 g " 3 1
State Certification or Registration#: Odd 3f�3 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 4000soo Square/Linear Footage of Work:4O Sg h
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace �1[:1 Demolition -1
Description of Work: -(��1F �/1 L�( 10�S [' ���c C-4. w►S del`�! PICX CS �X�� 1�Ai
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ • CO/CC$
Scanning Fee$ 2 Radon Fee$ DBPR$ Notary$
Technology Fee$ • 6C) Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ �®
TOTAL FEE NOW DUE$ s
(Revised02/24/2014)
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.
Signa a Signature C4�iw
OWNER or AGENT CONTRACTOR
The fo going instrument was ac nowledged before me this The foregoing instrument was acknowledged before me this
i
da of ilk 201 ,by day of 20 r ,by
who is personally known to 4�yL�E',who is personally known to
me or who has produced_ � /�� as me or who has produced 4/-- as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: Print:
, Y P i,,
Seal: `"o*a �/ JIM D.PAMPLIN
Notary Public-State of Florida Seal: ,o.P"""eJIM D.PAMPLIN
Rr a��.,
' • : My Comm.Expires,lan 13,2017 = ► ;°o Notary Public-State of Florida
FM.F.-o � Commission #EE 864892 ;o; My Comm.Expires Jan 13,2017
9r 1 sson t EE 864892
�xsswsrs*r*s *r*"�'>�-*a •s* *******rs*�+r<►sa�*a�*a*s�a����x***s• r�rarw*�xr*+x s*s*�sr•
Jim
APPROVED BYfr
Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
• y lty fcXfr i
ve►j° r, Miami Shores Village Nimit TweeResidenq,
10050 N.E.2nd Avenue NE1,2
IteTBttt 5
'•" Miami Shores,FL 3313&0000
_ Peal# $t,
Phone: (305)795-2204
��1v1124120'i � Expiration: 07/23/2017
Project Address Parcel Number Applicant
428 NE 91 Street 1132060190060
Miami Shores, FL 33138- Block: Lot: RAYMOND CARABOTTA
Owner information Address Phone Cell
RAYMOND CARABOTTA 3466 N MIAMI AVE
MIAMI FL 33127 1
Contractor(s) Phone Cell Phone Valuation: $ 500.00
CLEMDEL CONSTRUCTION CORP (305)856-4715
Total Sq Feet: 0
Approved:In Review Available Inspections:
Comments: Inspection Type:
Date Approved::In Review Fill Cells Columns
Date Denied: Final PE Certification
Type of Construction:CODE VIOLATIONS CORRECTION; Occupancy:Single Family Window Door Attachment
Stories: Exterior: Framing
Front Setback: Rear Setback: Insulation
Left Setback: Right Setback: Drywall Screw
Bedrooms: Bathrooms: Window and Door Buck
Plans Submitted:Yes Certificate Status: Review Planning
Certificate Date: Additional Info:CODE VIOLATIONS CORRECTIONS Review Structural
Review Mechanical
Bond Return: Classification:Residential Review Electrical
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Electrical
CCF $0.60Review Electrical
DBPR Fee $2.00 Invoice# RC-10-16-61850 Review Building
DCA Fee $2.00 01/24/2017 Credit Card $67.60 $50.00 Review Plumbing
Education Surcharge $0.20 10/31/2016 Credit Card $50.00 $0.00 Review Plumbing
Permit Fee $100.00 Review Building
Scanning Fee $12.00
Technology Fee $0.80
Total: $117.60
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 AFFIDAVIT: I certi t all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and-zoning. F e ore,I authorize the bov amed contractor to do the work stated.
January 24,2017
o e a e. w er / (cant / Contractor / Agent ate
B it ng Departme opy
January 24,2017 1