RC-17-53 (2)Vso/d• t—we
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Miam
i iam. Shores Village
Building Department
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BUILDING
PERMIT APPLICATION
❑ BUILDING
❑ PLUMBING
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 B\
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 201t-(
Master Permit No. 12C - S3
RE
ki,AR 2b .;.017
Sub Permit No.QEN - v3
❑ ELECTRIC ❑ ROOFING j'A REVISION ❑ EXTENSION ❑RENEWAL
❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR
JOB ADDRESS: aA NUJ Clq S �-
ay:
Folio/Parcel#:
Occupancy Type: Load:
Construction
YP
DRAWINGS
ga tl D i s a :: • es O
Flood Zopgr..�.•-+ -^BFE: FFE:
OWNER: Name (Fee Simple Titleholder): AV/\3A (A C.a.IzMu
Address: , .)c v c. of j.A 2L
Phone#: S2 -?-
City: State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: OvJ """ 4 Phone#:
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration #: Certificate of Competency #: q
DESIGNER: Architect/Engineer: l (�Vl$'�I-Gl,l/� O t-�,p}� ` I _. Phone#: �q - S'D4- d,
Address: t)jt� �`� S T City: 1•AC CAM( )e �Sta e: +C Zip: •
Value of Work for this Permit: $ kJO vcao Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑t �Alteration c ❑ New ❑ Repair/Replace ❑ Demolition
) Description of Work: V�(S1C�Q s 1� `� CQaItLkOfl, LJV14`t' `(-C.Y !i.4-100 tSI`on
r Cxc� �� wvv cvta e-eoM Tie
cre , Q 500 ) S)
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ (2 - 00 Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ a) - �1 Bond $
TOTAL FEE NOW DUE $ (h�' 00
(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: FYthUR FAILURE.:TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR'PAYINGKTWICE 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
OWNER or AGENT
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of VO',' 1,r\ , 20 G , by day of , 20 by
-NRAW. tQ C ( f' l,o is personally known to , who is personally known to
r
me or who has produced C) ( — `wZ as me or who has produced as
identification and who did take an oath. 1 �r1C e identification and who did take an oath.
1 I C,� NOTARY PUBLIC:
NOTARY PUBLIC:
Print:
Seal:
MAHARAI K. GONZALE
StIt":►` 1 EXPIRES O44602
'got Fro?Bonded .' November 2, 2020
Thru Notary Public Underwriters
Sign:
Print:
Seal:
*********************************/***********************************************************************
APPROVED BY
(Revised02/24/2014)
Plans Examiner
Zoning
Structural Review Clerk
Permit NO. RC-1 -17-53
Miami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
p • t Permit Type: Residential Construction
Work Classifi•-cation: Addition/Alteration
Permit Status: APPROVED
Issue Date: 3/21/2017
Expiration: 09/17/2017
Parcel Number
Applicant
94 NW 94 Street
Miami Shores, FL
1131010340230
Block: Lot:
SANTIAGO JIMENEZ ANTONELU
Owner Information
Address
Phone
Cell
SANTIAGO JIMENEZ ANTONELA
94 NE 94 Street
MIAMI SHORES FL 33150-
94 NE 94 Street
MIAMI SHORES FL 33150-
Contractor(s)
HOME OWNER
Phone
CeII Phone
(561)596-7146
Valuation:
Total Sq Feet:
$ 30,000.00
2000
Approved: In Review
Comments:
Date Approved:: In Review
Date Denied:
Type of Construction: REPLACEMENT OF NEW IMPACTE
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: REPLACEMENT OF NEW IMPACTE
Classification: Residential
Fees Due
CCF
CO/CC Fee
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Plan Review Fee (Engineer)
Scanning Fee
Technology Fee
Total:
Amount
$21.00
$50.00
$15.75
$15.75
$7.00
$1, 050.00
$120.00
$42.00
$28.00
$1,349.50
Pay Date Pay Type
Invoice # RC-1-17-62562
02/21/2017 Credit Card
01/11/2017 Credit Card
Amt Paid Amt Due
$ 1,299.50 $ 50.00
$ 50.00 $ 0.00
Available Inspections:
i
Inspection Type:
Final PE Certification
Drywall
Miscellaneous
Window Door Attachment
Tie Beam
Final
Framing
Insulation
Truss lnsp
Columns
Fill Cells Columns
Wire Lathe
Foundation
Window and Door Buck
F. Termite Letter
F. Elevation Certificate
Review Planning
Review Mechanical
Declaration of Use
Review Electrical
Review Electrical
Review Building
Review Building
Review Structural
Review Structural
Review Plumbing
Review Plumbing
Review Mechanical
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.
OWNERS AFFAVIT: I certify that : I the +•regoing information is accurate and that all work will be done in compliance with all applicable laws regulating
const ction a I zonin • Futhermor , 1 aut rize the above -named contractor to do the work stated.
21, 2017