DS-19-2584Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
9290 N BAYSHORE DR, Miami Shores, FL 33138
Contacts
Permit No.. DS-10-19-2384
Permit Type: Driveways/Sidewalks/Slabs
�- Work Classification: New
Permit Status: Applied
Issue Date: 01/13/2020 Expiration: 07/13/2020
Parcel Number
1132050270240
RICKI LEE LONDON Owner
9290 N BAYSHORE DR, MIAMI SHORES, FL 331382949
GENERATOR SUPERCENTER OF Contractor
BROWARD
MIGUEL TOSAR
3800 N 28 TER, HOLLYWOD, FL 33020
Business:3059005055 carlo@conkretaconstruction.com
Description: NEW CONCRETE SLAB FOR GENERATOR Valuation: $ 600.00 Inspection Requests:
305-762-4949
Total Sq Feet: 28.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$0.60
Concrete/asphalt/pavers, slabs, dways,
$50.00
swalks
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.20
Planning and Zoning Review Fee
$35.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total
$145.30
Payments
Date Paid Amt Paid
Total Fees
$145.30
Credit Card
10/29/2019 $50.00
Credit Card
01/13/2020 $95.30
Amount Due:
$0.00
Building Department Copy
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 AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating constructio a d zoning. Futhermore, I authorize the above named contractor to do the work stated.
Authorize ignature: Owner / Applicant / Contractor / Agent
Date
January 13, 2020 Page 2 of 2
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
BUILDING
PERMIT APPLICATION
[Ztl"UILDING ❑ ELECTRIC ❑ ROOFING
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS
RECEIVED
0 T 2 9 2 019
BY:
'0T�'f'
FBC 20��
Master Permit No.-"
Sub Permit No. i -)'S (b- ( a) " 2.5 CJ y
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: Qc-�q-k-� 9 b"7410(1f1- a/ ,
Folio/Parcel#: uii — (3Is the Building Historically Designated: Yes
N 0 s/
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): oA� � Phone#—YW 2 [� I`"t 4
Address: ol(Fna`� go 1 ^jLr>l tl��
/�
City: 1 t 1 (M JJ State: Zip:
Tenant/Lessee Name: Phone#:
Email:_ QUOUO(�
CONTRACTOR: Co any Name: �pvv ((nn Phone#: , 3 ,
Address:1� �J
City: � 1`ljVUV-XX.
Qualifier Name: 1\ A\
State Certification or Registration #:
Certificate of Competency #:
Zip:
DESIGNER: Architect/Engineer: _ Phone#: —
Address: City: State:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: Addition ❑ Alteration ❑ New ❑ Repair/Replace
Description of Work:
Specify color of color thru tile:
Submittal Fee $ � • (-)X�) Permit Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Radon Fee $
Training/Education Fee $
CCF
DBPR $
Zip:
❑ Demolition
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ S - 30
(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
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 Q-XkG KK, S _D.1,y` Signature
_M1
OWNER or AGENT TRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 20 J by ,� /�Z da of �C- `�� , 20 1G3 . by
G i1 C ,uw D , who i sona ' V `� who is ers�nally known
me or who has produced as me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC: '
Sign:
Print:
Seal: .� �.? MY COMMISSION # GG 022907
;r EXFIRES: November 19 2020
'•.F Os r �• '?r tlEd rrwu Notary Pubic Ur&rw m
identification and who did take an
NOTARY PUBLIC:
s
Sign:
Print:
Seal: o c tat of Florida
Carlo Cavallo
rV
,My Commlaafon G 323605
6.pd� Expires OB130/2023
***********************************************************
APPROVED BY
Plans Examiner
Zoning
(Revised02/24/2014)
Structural Review
Clerk