WS-19-2916Miami 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
BUILDING
PERMIT APPLICATION
BUILDING ❑ ELECTRIC ❑ ROOFING
1RECE1VED
MA 2 9 020
'5y:
TH
FBC 20 ,
Master Permit No. WS-12-19-2916
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF Q CANCELLATION ❑ SHOP
I,1 CONTRACTOR DRAWINGS
JOB ADDRESS: 127 N St
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:1132060132460 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Liz Rodriguez
Address: 127 NE 9th St
City: Miami Shores State: FL
Tenant/Lessee Name:
Email:
one#:
Phone#:
33138
CONTRACTOR: Company Name: The Home Depot Phone#: 407-768-3357
Address: 2455 Paces Ferry Rd C-11
City: Atlanta State: GA Z
Qualifier Name: Roberto Sanchez Phone#: -
State Certification or Registration #: CGC1522717 Certificate of Competency #: _
DESIGNER: Architect/Engineer: Phone#: -
Address: City: State
Value of Work for this Permit: $ 12608 Square/Linear Footage of Work:
Type of Work:eoork:
ddii i fitWS:1i:21:9:916!�
w ❑■ Repair/Replace
Cahcel erm
Descriptionof p
Specify color of color thru the:
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Permit Fee $
Radon Fee $
Training/Education Fee $
CCF $_
DBPR $
p: 30339
Zip:
❑ Demolition
Co/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
' ccdri�eZ- %0` gL1301- A sr,, ---v
P.onding Company's Name (if applicable)
Bonding Company's Address
City
State
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 Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of , 20 by day of e td , 20-e by
who is personally known to Roberto Sanchez who is personally known to
me or who has produced as me or who has produced as
�— identification and who did take an oath. identification and who did take an qalK,; c?sr Aaron Hallich
---' w��. NOTARY PUBLIC
NOTARY PUBLIC: NOTARY PUBLIC: _:r
�-..;5: -. STATE OF FLORIDA K(; }:
:��:.�,�. ✓'' Comn lkGG951577
Expires-1/27/2024
Sign: Sign:
Print: Print: ✓err �, .Z=—/>-, `% '`
Seal: Seal:
############################ #### ### ###################################################################
APPROVED BY ,P, I ws E finer Zoning
Structural Review Clerk
(Revlsed02/24/2014)
,r' , 1 6,
��
Permit # WS-12-19-2916
Contractor — Roberto Sanchez CGC 1522717
Customer Name — German Rodriquez
Address — 127 NE 97t' Street, Miami, FL 33138
The Home Depot Job # 10913997
Miami Shores Village Building Department:
Please cancel the above permit. The customer cancelled the job prior to the start of any
work.
Please forward any refund to:
The Home Depot
Attn: Branch Coordinator
6500 NW 12th Ave
Ft Lauderdale, FL 33309
954-244-2012
If you should have any questions, please contact Richie Roberts at 407-378-6681
richie.roberts@expeditepermit-com
Contractors Signature-
Sworn to and subscribed before me this Ll day of M O�rGh , 20 W by Roberto
Sanchez who is X personally known to me or
produce as identification.
�a°rasp Ashley Raines
NOTARY PUBLIC
Notary Signature�STATE OF FLORIDA
Commit GG235646
y"'tip; .1 Expires 7/5/2022
1
BUILDING
PERMIT APPLICATION
104 (4 LI 301 (5)
Miami Shores Village r;i NTERED
Building Department DEC 10 019
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 B.Y�
INSPECTION LINE PHONE NUMBER: (305) 762-4949 6+(,�
FBC 20 l'j
Master Permit No.WS —1 2 ^ I -1 ^ 271
Sub Permit No
OBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
JOB ADDRESS: 127 NE 97TH STREET, MIAMI SHORES, FL 33138 1
Folio/Parcel#: 11 -3206-013-2460
Occupancy Type: R-3 Load: Construction Type:
OWNER: Name (Fee Simple Titleholder): GERMAN RODR
ArHr,w 127 NE 97TH STREET
City: MIAMI SHORES State:
Tenant/Lessee Name:
Email:
CANCELLATION ❑ SHOP
DRAWINGS
Miami Dad Zip: 33� 9r
Is the Build is ally Designated: Yes NO X
III d Zone: BFE: FFE:
EZ Phone#: 786-503-2507
Zip: 33138
Phone#:
CONTRACTOR: Company Name: E POT Phone#: 407-378-6681
Address: 2455 PACES FE Y RJVIP C-11
City: ATLANTA State: GA Zip: 33039
Qualifier Name: ROBERTO HEZ Phone#: 407-378-6681
State Certification or Registration #: CGC1522717 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 12608 Square/Linear Footage of Work: 1432
Type of Work: ❑ Addition ❑ Alteration ❑ New N Repair/Replace ❑ Demolition
Description of work: REPLACE 3 IMPACT GLASS WINDOWS & 2 IMPACT GLASS DOORS SIZE
FOR SIZE
Specify color o color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $ _
CCF $_
DBPR $
CO/CC $
Notary
Double Fee $
Bond $
TOTAL FEE NOW DUE $ _
b
0
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
Zip
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 �v� `�� Signature
OWNER or AGENT
CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of ^.%CX EMb�12 20 /' by (y day of Nuyefn6CnL 20 19 by
6.3en,1-6 5Aijd4 , is personally c wn to e2Tb w is personal) wn to
me or who has produced as me or who has produced as
identification and who did take an oath.
NOTA
Sign:_
Print:
Seal
STATE OF FLORIDA
Cam* FF958M
Expires 6/4=0
identification and who did take an oath.
NOTARY
Sign:_
Print:
Seal:
NOTARY PUBLIC
Carom# FF958M
Expires 6/4/2020
APPROVED BY ` �'� Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)