DS15-269PERMIT # 5 -®
1
CONTRACTOR: ill 14 ryejl
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(Zl C C2
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SUBMITTAL DATE: 2_ / (o 1 5
ADDRESS: i41 (1\k,1/4.5 ( SI
NAME: Sr"r1 `—r kl
RESUBMITAL DATES:
PROJECT TYPE: etg,t\ir
-11(-C"i e() /[i//
ZONING
S,,'
PLUMBING
STRUCTURAL
MECHANICAL
ELECTRICAL
L —
Ifici --,
-'-
BUILDING
Miami Shores Village
Building Department FEB 0 0 2015
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 7952204 Fax: (305) 756.8972 BY:
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC 20 ILD, 004(
Permit No. D S •c -
Master Permit No.
Permit Type: BUILDIN ` 70� 4CEit ROOFING
JOB ADDRESS: 1 //VW 76 S 7-RLe E r
City:
Miami Shores County: Miami Dade Zip: 33/g0
Folio/Parcel#: /! - 3101- ao2S- 011 O/RESP& of szK3 8aiverm4 ".9,0 /73 ya- 6G 4°7-/ i &K 3
Is the Building Historically Designated: Yes NO X Flood Zone:
OWNER: Name (Fee Simple Titleholder): PETE lc G 0 LP Sftl / TI -1 Phone#: 305'. 717- 7/SS-
Address:
JSSAddress: /54/ /1/ lr) 9 STR T
City: /''f/4 f7 / . ,; ,-, i1.5 �' )! State: L Zip: / S
Tenant/Lessee Name: --T-68-4.4)-57am- Phone#:
Email: Ga )S/) /7R f E e cemc QS%. NOT
ii7/C,
CONTRACTOR: Company Name: ./V/.4047/ BRJ C/( C troil 7 4 c7 Phone#:
Address: baa % Sixi /S0 At/,E
City: /1?/,o9 "? / State: / L zip: 3.3 i
Qualifier Name: DEe1/11J/S / & Phone#: 3o3 S� 5 - 9I70
State Certification or Registration #: C & C 035 8'7J Certificate of Competency #:
Contact Phone#: q7 9170 Email Address: DE' b eS Ai It O& @ 6 1),4 /L , co/"i
DESIGNER: Architect/Engineer: Phone#:
r
Value of Work for this Permit: $ /4 3 0 0 Square/Linear Footage of Work: 73-0
Type of Work: DAddition OAlteration .MNew DRepair/Replace ODemolition
Description of Work: P( 'VEk Li i'" VE JAY/ wii ti(Als Y/ /)d,i f%q .- /'4#'7(/01✓6.
5'P/1 c/z.f
Color thru tile:
********** ********* ****************Fees*a+***************** ************************
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
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 F.I,FCTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AI'r'IDAVIT: 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of conunencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be aped /% j# ection ee will be charged.
�
�QSignature Jib' -"Jr'
S T'? ver or Agent
The foregoing instruumeYnnnttt was acknowledged before me this /7
day of alit Wi/,20,5by PETER Q6G,AS,J ,
who is personally known to me or who has produced .4, Rrc/Ffy+
G/CENSe As identification and who did take an oath.
NOTARY PUBLIC:
Si
Print:
My Commission Expires:
RA WALCOTT
Notary Public - State of Florida
•= My Comm. Expires Sep 7, 2016
•, Commission # EE 201682
Bonded Through National Notary Assn.
Signature
PArliVis Ro6Contractor
The foregoing instrument was acknowledged before me this I$
dayofJ69/'44WY ,20/.5, by Df' "Y, # s /po ,
who is sonaii kno to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
************************
APPROVED BY
Sign.
Print:
.4r'
My Commission Expire
""•,. AMARA WALCOTT
o? 1 0. o ary ublic - State of Florida
E. •' • f My Comm. Expires Sep7, 2016
iN• ,Ti
oc
'-9, � Commission # EE 201882
�
'4%;;;;,`." Bonded Through National Notary Assn.
*******************x<****•x*ro+x************x<e<*************
Plans Examiner
Structural Review
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
**
Zoning
Clerk
Jan 13 15 12:12p Miami Brick Contractors
3054283756
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD (8;°O) 487-1395
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
p.2
ROG, DENNIS M
MIAMI BRICK CONTRACTORS INC
9227 SW 150TH AVE
MIAMI FL 33196
Congratulations! With this license you become one of the nearly
one million Floridians licensed by the Department of Business and
Professional Regulation. Our professionals and businesses range
from architects to yacht brokers, from boxers to barbeque restaurants,
and they keep Florida's economy strong.
Every day we work to improve the way we do business in order to
serve you better. For information about our services, please log onto
www.myf!oridalicense.com. There you can find more information
about our divisions and the regulations that impact you, subscribe
to department newsletters and learn more about the Department's
initiatives.
Our mission at the Department is: License Efficiently, Regulate Fairly.
We constantly strive to serve you better so that you can serve your
customers. Thank you for doing business in Florida,
and congratulations on your new license!
DETACH HERE
RICK SCOTT, GOVERNOR
KEN WSON, SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
LICENSE NUMBER
The GENERAL CONTRACTOR
Named below 1S CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2016
ROG, DENNIS M
MIAMI BRICK CONTRACTORS INC
9227 SW 150TH AVE
MIAMI FL 33196
ISSUED: OS/11/20111 DISPLAY AS REQUIRED BY LAW
SEQ# L1 •8110001009