DS-17-1216 Pe -A 216
Miami Shores Village 813T11>� Yi f"WayWS(L��1IV2#�Slb
10050 N.E.2nd Avenue NE Per!' 111.
Wear Aja tftcaftn:Addition/Aft"" tic�n;
Miami Shores,FL 33138-0000
Phone: (305)795-2204
PB7mrtSal ���`PRtE}
�roRw� Expiration: 11/26/ 017
Date F11/ 17
Project Address Parcel Number Applicant
17 NE 106 Street 1121360060260
JUAN&MARIA SANCHEZ
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
JUAN &MARIA SANCHEZ (305)345-0202
Contractor(s) Phone Cell Phone Valuation: $ 4,815.00
COASTAL GROUP CONSULTANTS LL (305)477-9030
Total Sq Feet: 774
Approved:In Review Available Inspections:
Comments:
Inspection Type:
Date Approved::In Review Final
Date Denied: Foundation
Type of Work:REMOVE EXISTING DRIVEWAY AND REP Additional Info: Review Building
Bond Return: Classification:Residential Review Building
Scanning:3 Review Planning
Review Planning
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
Bond Type-Owners Bond $500.00 Invoice# DS-5-17-63894
CCF $3.00 05/03/2017 Check#: 1784 $50.00 $596.00
DBPR Fee $2.00
DCA Fee $2.00 05/30/2017 Check#:1814 $96.00 $500.00
Education Surcharge $1.00 05/24/2017 Check#:3126 $500.00 $0.00
Permit Fee $125.00 Bond#:3408
Scanning Fee $9.00
Technology Fee $4.00
Total: $646.00
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 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. Futhermore,I authorize the above-n@Med4Wtractor to do the work stated.
May 30,2017
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
May 30,2017 1
c 07�
;c�,�,p;•� Miami Shores Village RECEIVED
� Building Department MAY ao�,
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 64-4
FBC 20Q`1
BUILDING Master Permit No.�� i 1 21
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
� JJ [[ p CONTRACTOR DRAWINGS
JOB ADDRESS: I Ill Cl II ��r Ef A
City: Miami Shores I�l County: Miami Dade Zip: 331,"')"1
1 1
Folio/Parcel#: a�f 8 LQWV I WO Is the Building Historically Designated:Yes NO_ V/
Occupancy Type: &FH Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):, �� Phone#:C � �q �'G`''q
Address: p 7 06 //� h 61.
City: M +oal B �r lU ro State:. Zip: 313 9
Tenant/Lessee Name: Phone#:
Email: �1
CONTRACTOR:Company Name: (/�o°C(' ,('( s R' 1w ) at �Y Phone#:
lA�
Address: 1()f-h Cf,
,, ii
City:__I' C jr I State: TI'" Zip: 3Y )
Qualifier Name:—Wi lyn Go-p A S0 Phone#: C4 G9 4So-S21
State Certification or Registration#: � 1 1 �1� ` Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ `1 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ®„New ❑ Repair/Replacep` ❑ Demolition
Description of Work: 1 I , :, r Bnck '
Specify color of color thru tile: 01C p
Submittal Fee$ ® Permit Fee$ `2-S ' CCF$ CO/CC$
Scanning Fee$ c7- Radon Fee$ 4DBPR$ . O�) Notary$
Technology Fee$ 4- a3 Training/Education Fee$ 1 Double Fee$
Structural Reviews$ Bond$ �500
TOTAL FEE NOW DUE$ c=7G
(Revised02/24/2014) 5p16 e (9
0
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 /_417
OWNER or AGWT ` CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me
a this
II day of ` 4'11 20 1-1 by day of + 20 1 .by
U Srn-In k i Z who is personally known to ���.�1�� ��� I who is personally known to
me or who has produced Ei, I) L as me or who has produced �L as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: N �� NOTARY PUBLIC: verrvq� tearyPubUcStataofFkWMa
Diana Ramirez
' my 4 nmiamwic"acts oaa221 08t=0200232W21F.xpIm"OW=o2o
Sign: Sign• }�
Print: I C Print: I�1t�9���.�L��(11'Y#'�
Seal: Seal:
APPROVED BY Plans Examiner C2Zoning
Structural Review Clerk
(Revised02/24/2014)
RECEIVED
r
MAY 0 3 2017
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