RC15-1620Fr 5442.0
PERMIT dcZQ j - ( C92-0
CONTRACTOR: -IBA_
SUBMITTAL DATE: 6)30 2015
ADDRESS: QQG w 95 .---r
NAME: GN—c t ICG) NIZ-Rrl--.
RESUBMITAL DATES:
PROJECT TYPE:
PO c ( 3 °(‘'
ZONING
Ale
PLUMBING (1e "..Ce_c
STRUCTURAL
MECHANICAL
ELECTRICAL
.,
BUILDOXit
s
BUILDING
PERMIT APPLICATION
❑ BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION
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
OST
JUN x 2016
FBC 2014 s
Master Permit No. -1 S--\ 6
❑ PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
JOB ADDRESS: agS to l S
Sub Permit No.
❑ EXTENSION
CANCELLATION
❑ RENEWAL
SHOP
DRAWINGS
City: Miami Shores County: Miami Dade
Zip: ssaP
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type:
Load:
Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (FeeSim �Cl
le Title `.(0,►%C b \(iQz Phone#: 77,1-762 07,1-4
Address: k tI q5:
J
�L L
City: �� �� c I\e (ef State:
Tenant/Lessee Name:
Phone#:
Zip: -?Jddl
Email:
CONTRACTOR: Company Name: Phone#:
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: -To C-460-1( C _ �- ") 'T 4 TLC I S - 1
Specify color of color thru tile:
Submittal Fee $ 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)
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 bgt(d ig\►mit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of com Zeri nt and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a ' q' py of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7)'da$'s> fter the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspectioirj`ee will be charged.
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
2day of 3-1-3C , 20_, by day of , 20 , by
9si` i � '41,who is personally known to , who is personally known to
me or who has produced let_.... ' DOUrfk._ as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign:
Print:
Seal:
a‘\
-,5 ' NEXPL9 �4-
i
?:4 TO 20 FS.*.:46%
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o �0 :O
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Sign:
Print:
Seal:
****************************4SATA5IS ��*****************************************************************
°///1/11111111 "
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
-64.)Vi‘
765
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Peirmri- 5010/1„Aon CicieliAdn akr /VC
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RPC!Prk FD
JUN 2 9 2016
i7y O7?o,-
BUILDING
PERMIT APPLICATION
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
FBC 2010
Master Permit No.% ¶E 62-0
Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: ()CF./ / v F 7� Lit
City: Miami Shores
County:
Miami Dade
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titlehoretl,r): c5QIi ' j'{, O incidIn2 Z. Phone#: ?7Y 4
- 7 !2 - 07<L of
Address: d LC Mt 1S
City: i i tcArf % s be of
State: F 1 -
Zip: 334?1
Tenant/Lessee Name: lJ = nnn f Phone#:
Email: JG A 111.flc .ri 111E1(1 4)yf \c Carer
CONTRACTOR: Company Name: /Wrist c 6. r = Phone#:
Address:
City:
Qualifier Name: Phone#:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: Lc g /A7 A Phone#: pc- ?I'S- O .-C(
City: i/i twvii State: r4 Zip: .7.1/.r7
Square/Linear Footage of Work: 6.6V
Type of Work: i Addition ❑ Alteration ❑ New ❑r Repair/Replace ❑ Demolition
Description of Work: (l ci�! IPS 4dld r k,y -- f 4/50,-
State: Zip:
Address: /7 V7 ..174,,u £? Co -,r 71
Value of Work for this Permit: $ %0 6 6
Specify color
nofcolor thru tile: fc
Submittal Fee $ mow• ° Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ ((� Training/Education Fee $ Double Fee $
Structural Reviews $ @ (00 ' Bond $
TOTAL FEE NOW DUE $
(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 tfae,;pui(I(i4gprmit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspectioa e viitb cI argt d:`�'�cf
Signature ��GG�'��l�%7i Signature)
OWNER or AGENT
The foregoing instrument was acknowledged before me this
CONTRACTOR
The foregoing in"str'ument was acknowledged before me this
day of -U i , 20 (S , by day of , 20 , by
C�GC7 Maar-L(', who is personally known to
me or who has producedl L l N1J l S 1D as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
*********
APPROVED BY
(Revised02/24/2014)
Notary Public State of Florida
Sindia Alvarez
r My Commission FF 156750
Expires 09103/2018
, who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
******************************************************
Plans Examiner
Structural Review Clerk
Invoice
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000
Phone: (305)795-2204 Fax: (305)756-8972
For Inspections please call: (305)762-4949
Return to:
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000
Bill To
SANTIAGO MARTINEZ
450 W 95 Place
CHICAGO, IL 60657-
460 W 96 Stroot
CHICAGO, IL 60657 -
Permit Number: RC -6-15-1620
Invoice Date: June 30, 2015
Invoice Number: RC -6-15-56160
Bond Number:
Comments:
Fidential s ruction
ork C sssifcatic..,.
Date
06/30/2015
06/30/2015
06/30/2015
06/30/2015
06/30/2015
06/30/2015
06/30/2015
09/25/2015
06/30/2015 CCF
06/30/2015 Technology Fee
Fee Name
Miscellaneous Fee
Scanning Fee
Plan Review Fee (Engineer)
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Plan Review Fee (Engineer)
Fee Type
Calculated
Calculated
Calculated
Calculated
Calculated
Calculated
Percentage
Calculated
Calculated
Calculated
Fee Amount
$200.00
$0.00
$160.00
$0.00
$0.00
$0.00
$0.00
$120.00
$0.00
$0.00
Total Fees Due:
$480.00
Payments
Date Pay Type
06/30/2015 Check
Check Number Amount Paid
122 $360.00
Change
$0.00
Total Paid:
$360.00
Monday, August 1, 2016
Pteturn to:
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000
Bill To
SANTIAGO MARTINEZ
450 W 95 Place
CHICAGO, IL 60657-
160 W 96 Strcot
CHICAGO, IL 60657 -
Permit Number: RC -6-15-1620
Invoice Date: June 30, 2015
Invoice Number: RC -6-15-56160
Bond Number:
Comments:
ential onstr
ossification.
Date
Fee Name
Fee Type
Fee Amount
Total Due: $120.00 II
Monday, August 1, 2016