WS-16-2163Miami 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
c4BUILDIN
PERMIT APPLICM1ON
BUILDING ❑ ELECTRIC ❑ ROOFING
❑PLUMBING ❑ MECHANICAL
JOB ADDRESS: /cc . /V M. PO
••Lit
i am.
41-t,
RECEIVED
AUG 0 2 2016
BY:
FBC 2011
Master Permit No.`` v\IS 8 -16 -- 2163
Sub Permit No.
REVISION
UBLIC WORKS ❑ CHANGE OF
CONTRACTOR
City: Miami Shores
Folio/Parcel#: / %- 21.;i6- 003- 6 /00
Occupancy Type:
Count
Load: Construction Type:
Miami Dade
EXTENSION Q RENEWAL
❑ CANCELLATION ❑ SHOP
DRAWINGS
Zip: a3 /4,
Is the Building Historically Designated: Yes NO V
Flood Zone: BFE:
FFE:
OWNER: Name (Fee Simple Titleholder): SEA N / Al LEE Phone soS> g02. 232.6-
Address: /2 /l%(if) / /O ST
City: if / i%t'// sf4o&--S State r%
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: A71%2ICf / S7 4IVi ?A..OlJ/ Dv Phone#.( ) S13.O / V
Address: /OW)/ /U U) /4 s`r s7E /&
City: /� / 14-A4 / e
t / �• / zip: �3 / 7.2-_.
Qualifier Name: JE'r»df�4� 7"�D1zzT Phone#:
State Certification or Registration#: CGG /5/ 3a 7 ertificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: 1 Q City: State: Zip:
Value of Work for this Permit: $ 4)-1
, 1 6 .25 Square/Linear Footage of Work: 9 00
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:
zip: 33/6 8
-t-o R,epla c'e Ed Per rn;1- W 1 O - l F - 21 21
.3c0c)-e c fi Wo•cv-, (1 ) ''rnpac\- tAli ndihw3 i (3) irr c(-
Specify color of color thru tile:
�
Submittal Fee $ Permit Fee $ 300 CCF $ l a • 20 CO/CC $
Scanning Fee $ 1-'7. 0 Radon Fee $ 4 . '3 (3 DBPR $ 4 .5o Notary $
Technology Fee $ 1 f , 60 Training/Education Fee $ 4 • dT 0 Double Fee $
Structural Reviews $ 52rBond $ Q
TOTAL FEE NOW DUE $ QL I • 20
scz
0
(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 the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinsertion fee will be charged.
Signatur
OWNER or AGENT
e foregoing instrument was acknowledged before me this
't day of A , 20 14 , by
S,a A) T Al (bEE , who is personally known to
me or who has produced li-nv L10EA/St as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
NATHALIE DIAZ
'Seal: E'+° `�= Notary' Public - State of Florida
Commission # FF 230936
:>0Y. My Comm. Expires May 14, 2019
Bonded through Natio :I N
APPROVED BY
CONTRACTOR
The foregoing instrument was acknowledged before me this
-"'sT
day of
zroocrt-kcitJ
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign: /
Print: IV2-Y 1a G
Seal:
q vs-" , 20 / G , by
t1P2-; Who is personally known to
as
NATHALIE DIAZ
��► r11% _ "'tary 9. ttfilc - Stafa of Finrida
;N TTI •? Commission # FF 230936
My Comm. Expires May 14, 2019
''' ° Bonded through National Notary Assn.
*******************************************************************
Plans Examiner
Zoning
(Revised02/24/2014)
Structural Review
Clerk
Miami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Parcel Number
Issue
Permit NO. IM8-16-2163
Permit Type: Windows/Shutters
r Class cation: Window/Door Replacem
Permit Status: APPROVED
/2/2016
Expiration: 01/29/2017
Applicant
122 NW 110 Street
Miami Shores, FL 33168-4321
1121360030100
Block: Lot:
KATE J & SEAN T ALBEE
Owner Information
Address
Phone
Cell
KATE J & SEAN T ALBEE
122 NW 110 Street
MIAMI SHORES FL 33168-
(561)827-9779
122 NW 110 Street
MIAMI SHORES FL 33168-
Contractor(s)
AMERICAN STORM PROTECTION
Phone Cell Phone
(305)264-0446 (305)513-0514
Valuation:
$ 21,468.25
Total Sq Feet: 400
Type of Work: REPLACING 17 IMPACT WINDOWS & 3 IM
No of Openings: 20
Additional Info:
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Educatioi''Surcharge
is l
Permit Fee
Scanning Fee
Technology Fee
Total_.€
Amount
$13.20
$4.50
$4.50
$4.40
$300.00
$3.00
$17.60
$347.20
Pay Date Pay Type
Invoice # WS-8-16-60830
08/02/2016 Credit Card
Amt Paid Amt Due
$ 347.20 $ 0.00
Available Inspections:
Inspection Type:
Window Door Attachment
Final
Review Building
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
acceptingthis 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.
OWNERSAFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
constructio _ nd zoning. Fptl'rmore, I authorize the above -named contractor to do the work stated.
4-0 /\.4freAAD
Author d Signature: Owner / Applicant / Contractor / Agent
August 02, 2016
Date
Building Department Copy
August 02, 2016 1