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CC-19-2428BUILDING 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 Ci 5 p�19 BY:_ C20i Master Permit No. F _ ff 10' 1 Iq 'AOS Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL F-1 PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP i CONTRACTOR DRAWINGS JOB ADDRESS: 412 / �r-47A 4 CD 'k -v C0 tr vy e -- City: 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): & irll4�OF'/SPi��� ` o�Phone#:IY6 LIZ l 30 Address: 4 `L f o i,�-se-. City: M ."(I M r' S�o��� S State: _ FL Zip: 3313,5" Tenant/Lessee Name: Email: r b �1 2 r7� I V e 1'r q / l Ll �/✓1.(f 1. Cp� CONTRACTOR: Company Name: lef/G1 �` a�v= —"--Phone#: Address: 4/!e Sit/ 54 -- City: ! qr-P, I' State: j L- Zip: 3 3 1 5 Qualifier Name: �C [ :-1 w P�, V-' l� Phone#: 2-2 6 Zff 6 G1,6-7 State Certification or Registration #: 8 C. !' j Q Certificate of Competency #: DESIGNER: Architect/Engineer: one#: Address:,+"`'f=' City: State: Zip: Value of Work forlhis Permit: $ 500,00 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair// eplace ❑ Demolition Description'of Work: k t /'! �G�Yf' W C�✓' i' Z o ,J��tli� Specify coldr of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 3-2-1 Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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. C/ D r Signature 4?z �i �JJ OWNER or AGENT The foregoing instrument was acknowledged before me this I�41/ -dayof ©C? 201G% by W i S ��-!(W , who is personally known to me or who has produced �2l �L1 as identification and who did take an oath. NOTARY PUBLIC: Print: rnn:cam %_D.•a � � � n. n: Geo Signature—o/` CONTRACTORL The foregoing instrument was acknowledged before me this I \ day of od— 20 11 by "J MVV- 1 -OW -01 , jwho is personally known to me or who has produced _ L as ���1111 Il//IIS/ identifi ation a(d who di take an oath.�y -`�nYIoR/IF //V/�i�� OTAR PUBLIC: Sign: o .�Q AGG 797268 Print: UN GZcn �a �••:°2e0�ded�r�c>'c.�r,�; Seal: A'' A� a'•..,o��\aF ' `\r.� Seal v V ///V/;�Bllll 111►10���\\`� APPROVED BY ZZ Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Issue Date: Location Address Parcel Number 421 GRAND CONC, Miami Shores, FL 33138 1132060520001 Contacts Permit NO.: CC -10-1 Permit Type: Building (Commercial) Work Clossftation Repair Expiration: 06/01/2020 GRAND CONCOURSE CONDO ASSN INC Owner AP BUILDERS OF SOUTH FLORIDA LLC tor 421 GRAND CONC GR UN6 JEFFREY W POWELL 6800 SW 40 ST 651, MIAMI, FL 33155 Business: 7862860107 LjLpbcfl0gmaiI.corn Description: REPLACE INTERIOR PLASTER DAMAGED BY WATER Valuation: $ 500.00 Inspection Requests: AND RE -PAINT. 305-762-4049 IN 2ND FLOOR HALLWAY Total Sq Feet: 15.00 Fees Amount CCF $0.60 Commercial Application Fee $50.00 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.20 Notary Fee $5.00 Permit Fee $50.00 Scanning Fee $9.00 Technology Fee $2.50 Work Without Permit 1st Offense $100.00 Work Without Permit 1st Offense $100.00 Total: $321.30 Building Department Copy Payments Date Paid Amt Paid Total Fees $321.30 Check # 2878 12/04/2019 $321.30 Amount Due: $0.00 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. m 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. Futhermore, I authorize the above name ontractor to the w r tate . Authorized Signature: Owner / Applicant / ontractor / Agent Date December 04, 2019 Page 2 of 2 AP BUILDERS JEFFREY POWELL 6800 SW 40th Ct Suite 651 Miami Fl 33155 Date: IZ)O4 I°I State of: �1 Dri 4 County of: Before me this day personally appeared Jeffrey Powell, who being duly sworn, deposes and says: That he or she will be the only person working on the project located at 421 Grand Concourse, Miami Shores F133138. !'IiAtor Signature A Sworn to (or affirmed) and sibscribed before me this rday of ( c. 2019 Byll , �)10 U01 Personally Known OR produced identification 3) L Type ¢1`1lentific4ion produced or AF4pName of Notary. '\\`y Y P FT NZ A H 25 O r' 0 • o #GG 287268 ded CC\$. �t into'. �b/ic Unde ;� STA S Detail by Entity Name Florida Department of Slate T-OAA, r:.,.�f :r7F .3�d5{'r<7�Fr +'S•�F{i :j�jrFrt r.t .i'S++�;)FRi' Department of State / Division of Corporations / Search Records / Detail By Document Number / Detail by Entity Name Florida Not For Profit Corporation `GRAND CONCOURSE CONDOMINIUM ASSOCIATION, INC. Filing Information Document Number N05000005775 FEI/EIN Number 20-2972125 Date Filed 06/03/2005 State FL Status ACTIVE Last Event AMENDMENT Event Date Filed 10/30/2006 Event Effective Date NONE Principal Address 421 GRAND CONCOURSE MIAMI SHORES, FL 33138 Mailing Address 421 GRAND CONCOURSE MIAMI SHORES, FL 33138 Registered Agent Name & Address Locatelli, Marcos 421 GRAND CONCOURSE Unit 16 MIAMI SHORES, FL 33138 Name Changed: 01/23/2019 Address Changed: 01/23/2019 Officer/Director Detail Name & Address Title President Locatelli, Marcos 421 GRAND CONCOURSE MIAMI SHORES, FL 33138 Title Secretary .DE OLIVEIRA, LOIS Page 1 of 2 DIVISION O> CORPORATIONS http://search. sunbiz. org/lnquiry/CorporationSearchISearchResultDetail?inquirytype=Entit... 10/28/2019 Detail by Entity Name 421 GRAND CONCOURSE MIAMI SHORES, FL 33138 Title Board Member ROMANIK, GEORGE 421 GRAND CONCOURSE MIAMI SHORES, FL 33138 Title Board Member Jester, Melinda A 421 GRAND CONCOURSE MIAMI SHORES, FL 33138 Title Treasurer Quinlan, James 421 Grand Concourse Miami Shores, FL 33138 Annual Reports Report Year Filed Date 2017 03/28/2017 2018 04/04/2018 2019 01/23/2019 Document Images 01/23/2019 --ANNUAL REPORT 04/04/2018 - ANNUAL REPORT 03/28/2017 -- ANNUAL REPORT' 05103/2016 -- ANNUAL REPORT 02/13/2015 -- ANNUAL REPORT 03/13!2014 - ANNUAL REPORT 02/22/2013 -- ANNUAL REPORT 02/04/2012 -- ANNUAL. REPORT 01:31 12011.__ ANNUraI_f 2EF?U(3wT 01!2512010 -- ANNUAL REPORT 03/20/2009 -- ANNUAL REPORT 01/18/2008 -- ANNUAL REPORT 03/19/2007 -- ANNUAL REPORT 10/30/2006 - _Amendment 05/25/2006 -- ANNUAL REPORT 06/03/2005 Domestic Non Profit View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF fomrat View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF forma View image in PDF format View image in PDF format View image in PDF' format View image in PDFformat View image in PDF format View image in PDF format ';�;.;•:Iz ^r.6a�;,nrrr: o 5fa!¢s, ::^ioi5:.i.Jn of r:nrcrr.1';:•c. Page 2 of 2 http://search. sunbiz.orglInquiry/CorporationSearchISearchResultDetail?inquirytype=Entit... 10/28/2019 Grand Concourse Condominium Association Inc. I r- 21 Grand Concourse Miami Shores, FL 33138, October 10, 2019 Miami Shores Village Building Department 10050 NE 2nd Ave Miami Shores, FL3 313 8 To the Building Department: Grand Concourse Association, Inc. gives AP Builders of South Florida LLC (F800" SW 40st #651, Miami FL 33155) permission to acquire permits for a 2nd floor hallway plaster repair on the premise located at 421 Grand Concourse, Miami Shores FL. Signature /-))>- Name Title Date Notary's Signal Name and Title Personally Kno IN Gl one) Type of ID Produced bAtf ,`\�Y • #GG 267268 Z • o �0 , �O Bonded ,NiiT #� Grand Concourse Condos -- ----M a ; Shr Ss VM' CI -F 421 Grand Concourse 2"d Floor• SY DATE Miami Shores, FL AppRpVEG•._ 33138 zON►NG Dr EI�TED EP t: �I_DP DEFT 0 T 1 5 2019 ��,�,1EGfi ,O Ct;tvi�'l_If BICE WI (N ALL FEDERAL � i�tv �`f �c��L�s Arlo u,EGULA(IO�:S BY: (ti STATE AN0 L - ---' 0000•• 0000 Unit 9 • dUAtIgR .. �"�:"Comm �•••• + ••••� 0000•• M I� • 1 ;yr • 0000 • • • • 0000•• • •• • 0000•• t 70 � • • i i � �A. 4 i �, • � 00.0.0 Unit 8 Unit, 14 V. Unit 1d •..' .. •+fit i .. .. 0000 " Second Floor Plan /,or ®4,5 �� 2 of Tao 7� le �o a`F C6n,�%fc'_� F. Ail ai /