DGT-18-1653Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit
Permit NO. DGT-6-18-1653
Permit Type: Decks/Gazebos/Trellises
Work, Classification: Pergola
Permit Status: APPROVED
Issue Date: 6/2112018 Expiration: 12/24/2018
Parcel Number
Applicant
1098 NE 96 Street
Miami Shores, FL 33138-
1132060143460
Block: Lot:
PAUL AND SUZY MOSHEIM
Owner Information
Address
Phone
CeII
PAUL AND SUZY MOSHEIM
1098 NE 96 ST
MIAMI SHORES FL 33138-2552
(305)757-8233
Contractor(s)
HOME OWNER
Phone
CeII Phone
Valuation:
Total Sq Feet:
$ 5,000.00
308
Approved: In Review
Comments:
Date Approved: : In Review
Date Denied:
Type Const: Pergolas
Classification: Residential
Scanning: 1_
Additional Info: NEW WOOD PERGOLA
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Notary Fee
P&Z Review Fee
Permit Fee - Gazebo/Trellise/Pergola
Scanning Fee
Technology Fee
Total:
Amount
$0.00
$0.00
$0.00
$0.00
$5 00
$0.00
$302.00
$9.00
$0.00
$316.00
Pay Date
Invoice #
06/15/2018
06/27/2018
Pay Type
DGT-6-18-67951
Cash
Credit Card
Amt Paid Amt Due
$ 50.00 $ 266.00
$ 266.00 $ 0.00
Available Inspections:
Inspection Type:
Slab
Final
Framing
Footing
Review Planning
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
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 ELECTRICIL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS 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/ F ermore, I authorize the above -named contractor to do the work stated.
June 27, 2018
Authorized Signature:Owner / Applicant / Contractor / Agent
Date
Building Department Copy
June 27, 2018 1
JOB ADDRESS: o q. v (\d q(t
City:
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 20 17 ("th
Master Permit NoT It,— 6 S3
Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION n RENEWAL
PLUMBING ❑ MECHANICAL (PUBLIC WORKS CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple
Titleholder): 5 zki filbs - Phone*, \ (5 ) v 1 " I "d ,
Address:tVQQ) f.. _xt2-
City: i vVI VV"/ v'' LtC!State: Zip: 3 3 ) (4
Tenant/Lessee Name: � Phone#:
Email: 3U 9 /Vir'61 1�_ 1 Oil aO) Y1/I 1 1 1 , W ' "
CONTRACTOR: Company Name: +0rY'r 0 (A) 4' 4Y 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: $ SI O 0O Square/Linear Footage of Work: 3og "
Type of Work: ElI�Addition I i Alteration Ti New Ti Repair/Replace ❑ Demolition
Description of Work: If1 p(.12l,Q 1 0 e �.( 1 I 11424 ee.s.Z. t 1 fi
1'16 - 4so
Specify color of color thru tile:
Submittal Fee $ So f % d Permit Fee $ 367 • CCF $ CO/CC $
Scanning Fee $ 477 . O Radon Fee $ DBPR $ Notary $ E • CO
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ 266 • CO
(Revised02/24/2014)
Bonding Company's Name (if applicable) .. l
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
1
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.
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrumen was acknowledged before me this The foregoing instrument was acknowledged before me this
1 S t Nday of U Vl`Q , 20 (8 , by _ day of , 20 , by
j�(y
' y I OS Ifl'e 1 YY) , who is personally known to , who is personally known to
T
meth who has produced 1T r+ V'* r 1 j C'1(S •( as me or who has produced as
identification
Sign:
Print:
Seal:
YANADY •RIE O
MY COMMISSION # FF 214031
EXPIRES: Ma h 25, 2019
e o' RLO B ndeed Thru Notary 'ublic Undenuriters
APPROVED BY r� (VI Plans Examiner Zoning
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Seal:
:***********************
Structural Review Clerk
(Revised02/24/2014)