DS-18-1971BUILDING
PERMIT APPLICATION
BUILDING ❑ ELECTRIC
❑ PLUMBING ❑ MECHANICAL
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
Miami Shores Village ��c
Building Department
artment ��L'
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Master Permit No. �-`j--' O I qI —10
Sub Permit No.D5
❑ ROOFING ❑ REVISION ❑ EXTENSION El RENEWAL
❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
JOB ADDRESS: /030 � s c/-
City: /Miami Shores County:
Folio/Parcel#: // c• 3c OS / " 00 76
Occupancy Type: sr Load:
Construction Type:
c
OWNER: Name (Fee Simple Titleholder): r�� 2/V [ e-ii./ Qin
Address: /03 O iC , 9r '
City: ` 6,l,a / ff,a-- State: /:1-•
Tenant/Lessee Name: A
Email:
CONTRACTOR: Company Name: 1, 411
Address: /y7 6 Jill
City: _AA /A,%
Qualifier Name:
1,14,1t. /V 7 c:,
/4t. r.
Stat : cZ-•
vie h,2
State Certification or Registratio 4#:( 6 / 30 / J 3 42.
DESIGNER: Architect/Engineer:
Address:
CONTRACTOR DRAWINGS
Miami Dade Zip: 33) 3 r
Is the Building Historically Designated: Yes NO V
C iS Flood Zone: BFE: FFE:
:oG
s" 790 57 Pi-70
Phone#:
Phone#:
Zip: T/✓Q
v,�s3cf 790 S797
Phone#: 3v
Zip: ?sr 7aJ
g 7p?
Phone#:Roc'QeP'
Certificate of Competency #:
Sri dO6V-7
Phone#:
Value of Work for this Permit: $ 6s o
State: (' Zip:
Square/Linear Footage of Work:
City:
Type of Work: Lid Addition ri Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: rp» S/j►i 9(Z4,0.0.-6 , dt ffl ¢1A
2-7 kid 9ear'. / QQQ
Specify color of color i*hri 'thl� . ?,
3 `+ 4,,z
Submittal Fee $ Permit Fee SAbo •
` GO CCF $ 4CO/CC $J
Scanning Fee $ Radon Fee $ Z • CD DBPR $ • Cl� Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ • GO
(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
r , t
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 standardsof 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. ti y ,.
"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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the,absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
t
Signature
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
a
dayof ,/�/ /� /� , , 20 by
P/74.vho is personally known to
me or who has produced as .or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
c day of rp �3 / , 20 / rb , by
, who is personally known to
identification and who did take an oath.
NOTARY PUBLIC
Sign:
Print:
Seal:
lAUt: ,n6rm nTr+eSuA
Sign:
Print:
Seal:
•
di
47e w pibided ins
**********************************************************************************************************
as
+P` •:;44. ALEJANDRA GRIGORESCU
MY COMMISSION t FF 143529
EXPIRES: July 21, 2018
rF O: coe fended Ttru ladget Natery StiViCe$
at'` •!4. ALEJANDRA GRIGO1E$CU
R MY COMMISSION t FF 143529
EXPIRES: July 21, 2018
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Pe
MIt
Permit NO. DS-7-18-1971
■ Permit Type: Driveways/SidewalkslSlabs
Work Classification: New
Permit Status. APPROVED
Issue Date: 817/2018
Expiration: 02/03/2019
Parcel Number
Applicant
1030 NE 95 Street
Miami Shores, FL
1132050120070
Block: Lot:
ROLAND NIEMAN
Owner Information
Address
Phone
Cell
ROLAND NIEMAN
1030 NE 95 ST
MIAMI SHORES FL 33138-2548
Contractor(s) Phone
ALL QUALITY ELECTRICAL SERVICE (305)968-7832
Cell Phone
Valuation:
Total Sq Feet:
$ 650.00
36
Approved: In Review
Comments:
Date Approved: : In Review
Date Denied:
Type of Work: NEW GENERATOR PAD
Bond Return :
Scanning: 1
Additional Info:
Classification: Residential
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
P&Z Review Fee
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$0.60
$2.00
$2.00
$0.20
$35.00
$100.00
$3.00
$0.80
$143.60
Pay Date Pay Type
Invoice # DS-7-18-68310
07/23/2018 Credit Card
08/07/2018 Check #: 1758
Amt Paid Amt Due
$ 50.00 $ 93.60
$ 93.60 $ 0.00
Available Inspections:
Inspection Type:
Final
Foundation
Review Building
Review Planning
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, MEFHANICA INDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AF AVIT: I c rtify that all the for' .('r*• information is a cu :te and that all wo
construction d on . F hermore, auto a above -named c• tr• for o do the ork
Authorized Signature: Owner / Applicant / Contractor / Agent
w t be dope in compliance with all applicable laws regulating
CC1'August 07, 2018
Date
Building Department Copy
August 07, 2018 1