DS-17-22 Per�r'Vp
Miami Shores Village JL Permit Ve:DrlV0Wl (St
10050 N.E.2nd Avenue NE
Worstrcatlrrt:Aitit?nJarat'
it1;
Miami Shores,FL 3313&0000 ��
.. permit
`tion Phone: (305)795-2204
�u latent � 17 Expiration: 07/04/2017
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Project Address Parcel Number Applicant
87 NE 92 Street 1132060130290
PATRICK COWAN
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
PATRICK COWAN 87 NE 92 Street (786)547-3255
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 6,500.00
CHAMPION CONCRETE (305)252-8055 (786)402-4802
Total Sq Feet: 850
Approved:In Review Available Inspections:
Comments: Inspection Type:
Date Approved::In Review Final
Date Denied: Foundation
Type of Work:DRIVEWAY PAVERS.BROKEN SIDEWAL Additional Info:DRIVEWAY PAVERS.BROKEN SID Review Planning
Bond Return: Classification:Residential Review Building
Scanning:2
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $4.20 Invoice# DS-1-17-62526
DBPR Fee $2.00 01/05/2017 Credit Card $ 101.20 $50.00
DCA Fee $2.00
Education Surcharge $1.40 01/04/2017 Credit Card $50.00 $0.00
Notary Fee $5.00
Permit Fee $125.00
Scanning Fee $6.00
Technology Fee $5.60
Total: $151.20
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 ELECTRICaPLUMBINECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIThe foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoninuthorize the above-named contractor to do the work stated.
January 05, 2017
Authorize / Applicant / Contractor / Agent Date
Building Department Copy
January 05, 2017 1
Miami Shores Village
Building Department R—FCFIV
10050 N.E.2nd Avenue,Miami Shores, Florida 33138 A2017
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 BY:
F��BC�C 20t �`
BUILDING Master Permit No. I)s [_n —ZZ
PER T APPLICATION Sub Permit No.
7UILDING ❑ ELECTRIC ROOFING REVISION EXTENSION RENEWAL
PLUMBING ❑ MECHANICAL PUBLIC WORKS CHANGE OF [:] CANCELLATION ❑ SHOP
(g�°� CONTRACTOR DRAWINGS
JOB ADDRESS: fN-rMr,6 G o 60W AA y Aj� I
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11-3 ?.01'—0 Q , QZ q 1) Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: ` Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):-N-71-MCC �-+® Phone#:
Address: 'Y7 tj 1z q Z- s
�D
City: �� .S ��� State: � `— Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: c y/ l&/ 6iVe >C Phone#:-21) Z'57L YW�9'
Address:
City: 4 0/V" State: Zip:_�317
Qualifier Name: AAA— s/�d Phone#:g� �7�`' �
.
State Certification or Registration#: Certificate of Competency#:6w�, 006?5
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ k6soo. Square/Linear Footage of Work: IT5 _S2 -�'1'_/�
or
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: r(
Specify color of color thru tile:
Submittal Fee$ b0 t Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ �
(Revised02/24/2014) ` 7�
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 Aelivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must a posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence o uch posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged befo a me this The foregoing instrument was acknowledged before me this
S� day of J6a,)00"7 ,20 ,by day of 20 , by
PC,�-t<`GtA- 40 WCX" ,who is personally known to ' 14 5156who is personally known to
me or who has produced ®���6 w�® 'e f as me or who has produced r,v ` %C.as
identification and who did take an oath. 3 6®"0 identification and who did take an oath.
NOTARY PUBLIC: NOTARY PU
Sign: n YYYYYY/// Sign:
Print: > CL -Sy40 Print: U a06C�
Seal: Seal: ,�;tvfig, YANADYPRIETO
Stefan Basilio .: MY COMMISSION H FF 214031
*E CommISSIOt1 Fi140832 � '�= EXPIRES:March 25,2018
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f of F;9P' Bonded Thru Notary Public lJndenL+rftnrs
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www.AARON OTARY.COM
APPROVED BY t Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Z " ' N4 REVIEW REQUIRED , v
Florida Health Miami-Dade County '��
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