DS-17-955Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Parcel Number
7-'
alkst$k�
on: Repair
APPROVED
Expiration: 11/1212017
Applicant
295 NE 95 Street
Miami Shores, FL 33138-
1132060133970
Block: Lot:
ALISON ANTROBUS ADAM SHE
Owner Information
Address
Phone
CeII
ALISON ANTROBUS ADAM SHEPARD 295 NE 95 Street
MIAMI SHORES FL 33138-
295 NE 95 Street
MIAMI SHORES FL 33138-
Contractor(s)
CHAMPION CONCRETE
Phone Cell Phone
(305)252-8055 (786)402-4802
Valuation:
Total Sq Feet:
Approved: In Review
Comments:
Date Approved: : In Review
Date Denied:
Type of Work: REPLACE BROKEN SIDEWALKS
Bond Return :
Scanning: 3
Additional Info:
Classification: Residential
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$1.80
$2.00
$2.00
$0.60
$100.00
$9.00
$2.40
$117.80
Pay Date Pay Type Amt Paid Amt Due
Invoice # DS -4-17-63599
04/06/2017 Credit Card $ 50.00 $ 67.80
05/16/2017 Check #: 2538 $ 67.80 $ 0.00
Available Inspections:
Inspection Type:
Final
Foundation
Review Planning
Review Building
In consideration of the issuance to me of this permit, I agree to perform 'e work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, stateme or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done '•y either 'yself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PLUMBING, MECHANICAL, WIND. S, DOO;'S, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing inform.: tion is a
construction and zoning. Futhermore, I authorize the abo
nd that all work will be done in compliance with all applicable laws regulating
do the work stated.
Authorized Signature: Owner / A. . ' =nt Contractor / Agent
Building Department Copy
May 16, 2017
Date
May 16, 2017
1
BUILDING
PERMIT APPLICATION
BUILDING 0 ELECTRIC
0PLUMBING 0 MECHANICAL
JOB ADDRESS:
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
RECEIVED
APR 06 2017
FBC 201`
Master Permit No. D c) 1'7— 95
Sub Permit No.
El ROOFING E REVISION 0 EXTENSION
0 PUBLIC WORKS 0 CHANGE OF
CONTRACTOR
2_4(5 /1/- qS y-
City: Miami Shores
0 CANCELLATION
El RENEWAL
SHOP
DRAWINGS
County: Miami Dade
Zip: (3 t
Folio/Parcel#: Is the Building Historically Designated: Yes
Occupancy Type: Load: Construction Type: Flood Zone:
NO
BFE: FFE:
OWNER: Name (Fee Simple Titleholder): �yv ' '4i 5)'l' pA/4..0. Phone#: 3°S 7 `P1( -,5 1 9
Address:
'/(A)_ ' 514P -tri
1
City: l 4�v'�! J �' !✓`'/ri State: Zip: ?✓ '/ 'i
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: 41Ai 1"g4 CAY OW t
Address:O2 Y'D /v)
1 City: .Di/L/IL
Qualifier Name: J/jir— '7,16.J/L, )
State Certification or Registration #:
DESIGNER: Architect/Engineer:
State:
Phone#: 30(2_52_ ees-f--
Zip: .?? f
Phone#:
Certificate of Competency #: CZ 6)5: 0®Y2.5
Phone#:
Address: City:
Value of Work for this Permit: $ 2125 0 Square/Linear Footage of Work: 1 1 i f%. ny ,no
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: A 924C wk 57`7/1 z 5~0.*
State: Zip:
Specify color of color thru tile:
Submittal Fee $ C.)�
Scanning Fee $
Technology Fee $
Structural Reviews $
(Revised02/24/2014)
PA -to
Permit Fee $ CCF $ CO/CC $
Radon Fee $ DBPR $ Notary $
Training/Education Fee $ Double Fee $
Bond $ s`y
TOTAL FEE NOW DUE$ ( I
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 installatiop 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 b f posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of s ch posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signat
The foregoing instrument was acknowledged before me this
Ce day of �— , 20 rl , by
L , who is personally known to
me or who has produced �v� as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of Atai
�1rn12 (/151L-4-1-5 , who is
, 20 11 , by
wn to
me or who has produced as
identification and who did take an oath11illliti,,
AgIcl Afibl rrr//i
® y�' <°44% .
•. * /moi
a �y • W�� a i
zto:4ti �•_ ;
NOTARY PUBLIC:
Sign: d ; y_
Print: `y••, s, oZ02�,5�a°�a4
Seal: o///r%011llll V 111\!� \\`\\�
***************************i MK s01.**f******************************************************************
dr, , �I
APPROVED BY
(Revised02/24/2014)
Plans Examiner
Structural Review
Zoning
Clerk
ordered By:
Rothman
&Tobin
ATTORNEYS AT LAW
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Miami Shores Village
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Property Address: 295 N.E. 95 STREET
MIAMI SHORES, FL 33138
yV1111kTV4*s.r=14 I R' Kr14114AN.1 Mt:. A',-- II -Y IMAI 1111040 13UUIVUAP(Y 0UKV0Y 1BA I htUt ANIJLUMI•(01L1
REPRESENTATION OF A SURV r" �� a�. i�. R MY DIRECTION. THIS COMPLIES WTH THE MINIMUM
-ECHNICAL STANDARDS, AS '' FORTH BY THE 4(, TE OF FLORIDA BOARD OF PROFESSIONAL LAND
SURVEYORS IN CHAPTER 017-5.FL99 ADMINI-," TIVE CODE PURSUANT TO 472.027. FLORIDA STATUTES.
4• e
SIGNED
MIGUEL
40T VAL1SWZIQ
-HIS MAP IS NOT VAUD WI
MND MAPPER.
FOR THE FIRM
<i�� ' P.S.M.No.5101
&ONICa�,s ATURE AND AUTHENTICATED ELECTRONIC SEAL AND/OR
D THE ORIGINAL RAISED SEAL OF A LICENSED SURVEYOR
NOTES: NO NOTES
MIGUEL ESPINOSA LA14D Salk
10665 SW 190TH Street • • • •
Suite 3110
MIAMI, FL 33157 • •••
PHONE:(305) 740-3319:
FAX #:(305) 669-319Q • • ; •
LB # 6463
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Survey:A-38892 Client File #: 13-095
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