RC-17-2632BUILDING
PERMIT APPLICATION
BUILDING ❑ ELECTRIC
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
Master Permit No.
❑ ROOFING 0 REVISION
Sub Permit No.
❑PLUMBING 0 MECHANICAL El PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
JOB ADDRESS:
A/6 to/SF Si'
RECEIVED
MAR 01 2018
FBC 2014
2c/1- 2 2
❑ EXTENSION
EANCELLATION
RENEWAL
❑ SHOP
DRAWINGS
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes
Occupancy Type: Load: Construction Type: Flood Zone: BFE:
3 3 ( 3 V
NO
FFE:
OWNER: Name (Fee Simple Titleholder): Ma-r/et/ / Phone#: S — 3(Z - it/ 2-
Address: /.. SO NE /O/ S� .
City: /tzt16t ! -,? c�- p yCs State: P_ zip: 3 3 / 3 e
Tenant/Lessee Name: I I Phone#:
Email: k )cn'7 r2 ->7 ` el/S-0Z4 I )'7&It
CONTRACTOR: Company Name: 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: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration
❑ New ❑ Repair/Replace
Description of Work: eA71/C.
❑ Demolition
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $ CO/CC $
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
1✓p
of 1':1 rY t
Bonding Company's Name (if applicable)
Bonding Company'sAddress
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.
Signature G= �i Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
1 day of n/7e , 20 1 6 , by day of , 20 , by
h1C.-(d'c rNJ,QA personally known to , who is personally known to
me or who has produced i t. '�f ��/s F'1 /� as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: /( . �,As SILVE, 11111111��"i,,, NOTARY PUBLIC:
.• �gSI ON F ''rs
..k�,r6,202e3'Oi9• s
Sign: _/�� L�l / : ��� `�'"•* 'sign:
Print: 3*/. CFQdmel6o ,i1rint:
l� •�
god�:k :m
i724,9' .CE.P�.... •• Seal:
I I
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
(\Q2
\\\0(6\9'
BUILDING
PERMIT APPLICATION
VUILDING ❑ ELECTRIC
❑PLUMBING ❑ MECHANICAL
JOB ADDRESS: 1250 NE 101 st.
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
•.fig
LW? S0 AON
Q2AIa3altf
FBC 20 ("-ice
Master Permit No. Z.G - 263 Z
Sub Permit No.
❑ ROOFING ❑ REVISION
❑PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
❑ EXTENSION ❑ RENEWAL
❑ CANCELLATION ❑ SHOP
DRAWINGS
City: Miami Shores
Folio/Parcel#:11-3205-008-0020
County:
C/
Occupancy Type: Load: Construction Type: Flood Zone: BFE:
Clijr—
OWNER: Name (Fee Simple Titleholder): Maria & Neil McGuinness rill
1
1250 NE 101 st. if
Address: r-
City: Miami Shores state: FL Zip: 33138 rir9
Miami Dade Zip:
Is the Building Historically Designated: Yes
Phone#:
Tenant/Lessee Name: Phone#(3) 31f2 -
Email:
CONTRACTOR: Company Name: e I -rpr 1' S Phone#:
Address: lam') O S . Pou)er 1t (\e 2d
City: t ). 9 CCppt-t State: FL Zip:
Qualifier Name: Hr k �p CY\co�r+ n Phone#: `IS4 - SS 4,
State Certification or Registration #: C- 6Co 4(0432- Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State:
Square/Linear Footage of Work:
Value of Work for this Permit: $ % AI vpQ
Zip:
Type of Work: ❑ Addition n Alteration n New ❑ Repair/Replace ❑Demolition
Description of Work: (Remove 4 replace ki-L1Atn Co.totnt4s CSarne 10ui \)
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ (C •
Scanning Fee $ Radon Fee $ 6 •
Technology Fee $ • Q Training/Education Fee $ 4 • 00
Structural Reviews $ Q
CCF $ ` CO/CC $ SO • ob
DBPR $ of - OJ Notary $ N
Double Fee $ A
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $ �SE:=4`;'
A
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.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
3/ day of IOG7L , 20 / , by
Macl4 J ' 4v) lS, who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal: reG*y,,, NancyC[USte
,e% COMNIISSIONlfF181155
r ?►' EXPIRES: Dec 4, 2018
%,144tie
WWW MRONNOTARY.COM
APPROVED BY
as
The foregoing instrument was acknowledged before me this
36/41 day of :7c,-i' .
, 20 1 % , by
Ar i (le w mar , who is personally known to
me or who has produced
as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
Sit
too. woo
low
*******************************************************************
I7
Plans Examiner
Zoning
(Revised02/24/2014)
Structural Review
Clerk