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RC-17-2202o'r l`P\C' 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 BUILDING PERMIT APPLICATION BUILDING ❑ ELECTRIC ❑ ROOFING ❑PLUMBING ❑ MECHANICAL JOB ADDRESS: 1 5-0 ❑PUBLIC WORKS 03 Master Permit No. Sub Permit No. RECEIVED AUG 3D1� Shy FBC 20 tu (LC - ZZOZ ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ CHANGE OF CONTRACTOR ❑ CANCELLATION ❑ SHOP DRAWINGS City: I Miami Shores Folio/Parcel#: 1 h- 32-i'.—o Occupancy Type: Load: County: b05 D Miami Dade zip: 3313$ Is the Building Historically Designated: Yes NO Conost c):gn_Type:: Flood Zone: .4240 OWNER: Name (Fee Simple Titleholder): I',A)k ow We Add ree�s((s: 11t 9yy0117 ((N �)_ City:N. Vv1) A►W) Y -o O") State: BFE: 7F -FE: Phone#: 305_Z067-2-0(07 Zip: 7? t 02— Tenant/Lessee Name: Phone#: Email: /�� ] /1 .,��`t']�,�,�( KIG�p 1 CONTRACTOR: Company Name: An & 'T Cvi ilUtl? t4 Phone#:( 5) `(1Q 5151 Address: 1411 5W sz . 1 � City: A 1£1 4 tL Zip: 33‘44— QQ Qualifier Name: 5i 1/ 9 Stater Phone#: (3o9at Et S� l 51 State Certification or Registration #: C_G-0$ $013 Certificate of Competency #: Q� DESIGNER: Architect/Engiineeer:/rj1 eV i l '�. -1V�� Phone#1305)2 3itE4 Address:/ 032— StV l I (Ciity: 1\44AVA‘ State zip: 33‘44--- Value of Work for this Permit: $ 3 DOL7,Go Square/Linear Footage of Work: 1�p4.-F Type of Work: ❑ Addition Alteration ❑ New ❑Repair/Replace v_velDem lition Description of Work: Specify color of color thru tile: Submittal Fee $ Permit Fee $ -390 • Cl CCF $ CO/CC $ Scanning Fee $ Radon Fee $ • 9 0 DBPR $ 5 ' 5 Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE $ �� J� 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. v J 2 OWNER or AGENT The foregoing instrument was acknowledged before'me this day of , 20 11 by I�, V,,who is personally known to me or who has produced DLit 453ilkWinas identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: APPROVED BY (Revised02/24/2014) ��1V ' n I t • • MY COMMISSION # FF151364 4,0Fcuoo EXPIRES: August 14, 2018 1 The foregoing instrument was acknowledged before me this WO' Y1 . day of. , 20 17 , by (a.(.\to \ , who is personally known to as me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: MY COMMISSION N FF151364 '�O�F F17Oe EXPIRES: August 14, 2018 ********** kit***** ******** k******************************************* Plans Examiner Structural Review Zoning Clerk Florida Dcr3rtm"ntof S•)te Den,: rtment of State / Division of CorooretiQs / Search Recordh / Pete/ By Document Number / D ns o 3- n@ar3-"n:r Detail by Entity Name Florida Not For Profit Corporation FULFORD UNITED METHODIST CHURCH, INC. Filing Information Document Number N93000000929 FEI/E!N Number 59-0860485 Date Filed 02/24/1993 State FL Status ACTIVE Last Event REINSTATEMENT Event Date Filed 11/04/2016 Principal Address 1900 NE 164 ST N MIAMI BEACH, FL 33162 Mailing Address 1960 NE 164 ST N MIAMI BEACH, FL 33162 Changed: 04/20/2007 Registered Agent Name & Address KING, JAMES 1900 NE 164TH STREET NORTH MIAMI, FL 33162 Name Changed: 01/21/2015 Address Changed: 08/11/2014 Officer/Director Detail Name & Address Title President King, James 13865 NW 5th Avenue NORTH MIAMI BEACH, FL 33168 Title Trustee Anderson, David 1960 NE 164TH STREET NORTH MIAMI BEACH, FL 33162 Title Officer KING, JAMES 1960 NE 164TH STREET NORTH MIAMI BEACH, FL 33162 Title Trustee MILLER, PATRICIA 1960 NE 164TH STREET NORTH MIAMI BEACH, FL 33162 Title VP Gould, B.B 901 NE 109th Street Biscayne Park, FL 33161 Title Director James, Beverly 1900 NE 164 ST N MIAMI BEACH, FL 33162 Title Officer Diaz, Alexandra 1900 NE 164 ST N MIAMI BEACH, FL 33162 Annual Reports Report Year 2015 2016 2017 Filed Date 01/21/2015 11/04/2016 04/07/2017 Document Images :4/07!2017 --ANNUAL REPORT 11/44 i _• iP' �T 01f21/2015 -- REINSJATEMENT 08111/2014 - Rea. Aaerit Chan" 04/10/2013 - A"ENDED ANNUAL REPORT 04/022413 -- AMENDED ANNUAL REPORT 4/01/2013 -- ANNUAL REPORT 04/1r2012 - ANNUAL REPORT 0;;22/2011 -ANNUAL REPORT M./Q2010 - ANNUAL REPORT 02/1 N2009 - ANNUAL REPORT View image in PDF format View image in PDF fam1at. View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format VI:w mage in PDF format 8/28/2017 Property Search Application - Miami -Dade County 'FFICE OF THE PRuPERTY APPL!i1SER Summary Report Property Information Folio: 11-3205-019-0050 Property Address: 1150 NE 103 ST Miami Shores, FL 33138-2652 Owner FULFORD UNITED METHODIST CHRUCH INC Mailing Address 1960 NE 164 ST NORTH MIAMI BEACH, FL 33162 USA PA Primary Zone 1100 SGL FAMILY- 2301-2500 SQ Primary Land Use 0101 RESIDENTIAL - SINGLE FAMILY: 1 UNIT Beds/Baths/Half 3/2/0 Floors 1 Living Units 1 Actual Area 2,711 Sq.Ft Living Area 2,126 Sq.Ft Adjusted Area 2,418 Sq.Ft Lot Size 9,375 Sq.Ft Year Built 1960 Assessment Information Year 2017 2016 2015 Land Value $337,500 $314,250 $285,750 Building Value $168,293 $168,293 $169,695 XF Value $3,739 $3,767 $3,140 Market Value $509,532 $486,310 $458,585 Assessed Value $509,532 $486,310 $458,585 Benefits Information Benefit Type 2017 2016 2015 Parsonage Exemption $509,532 $486,310 $458,585 Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Short Legal Description 5 53 42 MIAMI SHORES SEC 8 REV PB 43-67 W2OFT LOT 4 & E55FT LOT 5 BLK 175 LOT SIZE 75.000 X 125 Generated On : 8/28/2017 Taxable Value Information Previous Sale 2017 2016 2015 County Exemption Value $509,532 $486,310 $458,585 Taxable Value $0 $0 $0 School Board Exemption Value $509,532 $486,310 $458,585 Taxable Value $0 $0 $0 City Exemption Value $509,532 $486,310 $458,585 Taxable Value $0 $0 $0 Regional Exemption Value $509,532 $486,310 $458,585 Taxable Value $0 $0 $0 Sales Information Previous Sale Price OR Book- Page Qualification Description 06/02/2014 $100 29248-1576 Corrective, tax or QCD; min consideration The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appraiser and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asp Version: • Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Permit NO. RC -8-17-2202 Permit Type: Residential Construction Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 10/4/2017 Expiration: 04/02/2018 Parcel Number Applicant 1150 NE 103 Street Miami Shores, FL 1132050190050 Block: Lot: FULFORD UNITED METHODIST Owner Information Address Phone Cell FULFORD UNITED METHODIST 1150 NE 103 Street MIAMI SHORES FL 33138- (305)206-2067 1960 NE 164 Street N. MIANI BEACH FL 33162- Contractor(s) ANN CREST CONSTRUCTION INC Phone (305)986-8981 Cell Phone Valuation: $ 13,000.00 Total Sq Feet: 140 Approved: In Review Comments: Date Approved:: In Review Date Denied: Type of Construction: REMOVE AND REPLACE EXISTING Stories: Front Setback: Left Setback: Bedrooms: Plans Submitted: Yes Certificate Date: Bond Return : Occupancy: Single Family Exterior: Rear Setback: Right Setback: Bathrooms: Certificate Status: Additional Info: REMOVE AND REPLACE EXISTING Classification: Residential Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $7.80 $5.85 $3.90 $2.60 $390.00 $9.00 $10.40 $429.55 Pay Date Pay Type Invoice # RC -8-17-65043 10/04/2017 Check #: 1417 08/31/2017 Check #: 1367 Amt Paid Amt Due $ 379.55 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final PE Certification Drywall Miscellaneous Window Door Attachment Tie Beam Final Framing Insulation Truss Insp Columns Foundation Window and Door Buck Fill Cells Columns Wire Lathe Review Electrical Review Building Review Mechanical Review Plumbing F. Termite Letter F. Elevation Certificate Review Planning Review Structural Declaration of Use 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. OWNER . DAV T: constru A ! hor certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating Futhermore, I authorize the above-named contractor to do the work stated. ure: ner / Applicant / Building Department Copy Contractor / Agent October 04, 2017 Date October 04, 2017 1