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RF-13-2540✓aid �'�t . Qv�/�+/o�C. ,elrJf•��+'io°�c_ L1✓�w G'"e. �b 1 Miami Shores Village RECEIVED BuildingDepaltment JAN072021 10050 N.E.2nd Avenue, l`✓Jami Shores, Fioricia 33138 BY: ptz� Tel: (305) 7,95-2204 Fax: (305) 756-8972 INSPECTION' L."NE PHONE NUMBER: (305) 762-4949 FBC 20 BUILDING Master Permit No. V-' �3- �_5"�70 PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROCFING ❑ REVISION ❑ EXTENSION ❑RENEWAL []PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP 1 I CONTRACTOR DRAWINGS JOB ADDRESS: `� �i 10 4 S I City: Miami ShoresCounty_ _Miami Cade zip: 33)39 Folio/Parcel#: I I - 2 I% - 0 12- 0110 _ Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: lood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): l ,,f MILLE kAi2 S Phone#: -b b � w 0 1 b 2,6 Address: I � N1 IN &_ T City: �Alpn� C�ItW3 State: —_ Zip: Tenant/Lessee Name: Phone#:_ Email: CONTRACTOR: Company Name: Phone#: Address: City: 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 ❑ Alteraticn ❑ New LJ Repair/Replace ❑]Demolition Description of Work: I G h0Fi Nw ? Qo ftiQ� l.-�.0UtL I rl� 0�►-�1STI 4 4��'iI (1 Specify color of color fhru tile. - Submittal Fee $ Permit Fee $ Scanning Fee $ Technology Fee $ Structural Reviews Radon Fee $ Training Education Fee $ CCF $ DBPP $ -- CO/CC $ - �_— Notary $, _ Double Fee $ _ Bond $ TOTAL FEE NOW DUE $ _ (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 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. am�Signatur OWNER or AGENT The foregoing instrument was acknowledged before me this J.� day o/f��a hvOL� 20 ��, by GAM 2 T( i / f who is p rsonally known to me or who has produced ki vC2 1'.E I ct,4^ J11F as identification and who did take an oath. [ELM Sign Print: I I Iv Signature__ CONTRACTOR The foregoing instrument was acknowledged before me this day of me or who has produced 20 , by who is personally known to identification and who did take an oath. i<Cell f-AXA Illt311149 SigH. Print: Seal: Seal: Notary Pubic Stets of Ronda Julio C Benavente AAy Comm,sa= HH 032515 as APPROVED BY Pians Examiner Zoning Struciurai Review Clerk (Revised02/24/2014) Co,V�c�e II�F�oN :[Oswc+iow To� Hoy-dw, I 1kl121 vl F/om' Ot/V/tt&7 /41feec1 - QPv/vpc Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: BUILDING ,-7`-.^ L��,� U "= il `YuN ti 7 [Ui3 B �_ FBC 20to Permit No. Master Permit No. 1`` Z�r, I? _ �?S740 C<� ROOFING JOB ADDRESS: _ t 5 K� C 10 q �9 IT r` City: Miami Shores County: Miami Dade Zip: Folio/Parcelk Is the Building Historically Designated: Yes OWNER: Name (Fee Simple Titleh Address:�� lS A/ / 6 C City: M 1� ( �Y& pu TenantUssee Name: Email: x) 1 .5 P 1) " CONTRACTOR: Compan Name: Address: J i� City: Qualifier Name: State Certification or RReg'istration #: Contact Phone#: Y j `f'9_( State: L NO Flood Zone: I� 1 s zip: '-�fy 7 �J 7 [ J (f Certificate of Competency #: Address: �� %Jf /,J4dYq 6fgC(0_7C Lv�% DESIGNER: Architect/Engineer: Phonek Value of Work for this Permit: $ Square/Linear Footage of Work: 0 Type of Work: ❑Addition ❑Alteration , ❑New ❑Repair/Replace Color thru tile: ❑Demolition ***************************************Fees******************************************** Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ CCF $ CO/CC $ DBPR $ Bond $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature Owner or Agent The foregoing instrument was acknowledged before me this day of 02kb 20/, by TJnW tl l A- /UUY,{�14 who is personally known to me or who has produced i` .0 n- As identification and who did take an oath. NOTARY Sign: Print: My Commi4sion Expires APPROVED BY Notary Public State of FlorMe Contractor Tpe foregoing instrument was acknowledged before me thisq day of 20,5 by O� wh er ally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Print: ply Commission EE 191923 Expires 04/23/2016 My Plans Examiner Structural Review * MY COMMISSION A EE 008090 EXPIRES: August 23, 2014 Bonded Thru Budget Notary SerWc" Zoning Clerk (Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) 6 STATE OF FLORIDA _____-� DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET LT32399-0783 �� TALLAHASSEE SIMPSON, PAUL ANDREW SIMPSON'S HOME INC 7137 PINECREEK LANE COCONUT CREEK FL 33073 (850) 487-1395 STATE OF FLORIDA AC# 6 2 4$ L 0 6 i Congratulations! With this license you become one of the nearly one million DEPARTMENT OF BUSINESS AND Floridians licensed by the Department of Business and Professional Regulation. PROFESSIONAL REGULATION Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. CCC1327154 08/05/12 128029705 i ! Every day we work to improve the way we do business in order to serve you betters For information about our services, please log onto www.myfloridalicense.com. CERTIFIED ROOFING CONTRACTOR There you can find more information about our divisions and the regulations that SIMPSON, PAUL ANDREW impact you, subscribe to department newsletters and learn more about the ? SIMPSON' S HOME INC i Department's initiatives. i Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. IS CERTIFIED under the provisions of Ch.489 Fs ; Thank you for doing business in Florida, and congratulations on your new license! expiration date: AUG 31, 2014 L12080500122 DETACH HERE Report Viewer Page 1 of 1 i N ! 1�/1 ► N i100% PLEASE CUT OUT CARD BELOW AND RETAIN FOR FUTURE REFERENCE ----------- ------------------------ --------------- ------------------ IMPORTANT ----------------------- STATE OF FLORIDA Pursuant to Chapter 440.OS114), F.S , an officer of a corporation i DEPARTMENT OF FINANCIAL SERVICES who elects exemption from thhis chapter by Mng a cereffaq of election under this section not ecover beneffts or this DIVISION OF WORKERS' COMPENSATION co"wrawitlen unMr onr`"p er. F CONSTRUCTION INDUSTRY EXEMPTION 0 Pursuant to Chapa y ter 440.05(12 F.S., Certificates of election to be exempt... only within the scope of the business or trade : L listed on the of election to be exempt CERTIFICATE OF ta.WTM TO BE Elresrr MOM PLORIOA 'D VOORKERt' COMRRSATWH LAW election to be Pursuant ampta d Chapter"of15(13 F.S.,Nofim e memo exempt and certlMxtes of slara� ro be exenyft ehall be lFFEnTrvE DATE MOM EXPIRATION! DAM BZ7/1015 N sur to revocation If, at any time after Me Wg of the notice ' PERem: NNIPSON PAUL A E or tfa issuuroe of the certificate, the person named on the notice or certificate no longer maate the requirements of this yam; �dp� R Section for issuance of a certificate. The department shall woke a ceNfkale at any time for YMxs of the person named on the to E certifcatee meat the moadraments of this section. BUSINESS NAME AND ADDRESS: SIMPSON'S HOME INC 7137 PINECREEK LANE COCONUT CREEK FL 33073 SCOPES OF BUSINESS OR TRA LICENSED GENERAL PLUMBING NOC AND ROOFING - ALL KINDS ;CONTRACTOR DRIVERS I------------------------------------------------------------------------------------------------------------- AND DRIVER ' OFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS? (850)413.1609 https:Happs8.fldfs.comlcrreportviewerlreportViewer.aspx?data=kdvpginc9D7Q3gH6TER6... 8/25/2013 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2013 THROUGH SEPTEMBER 30, 2014 DBA: Business Name: SIMPSONS HOME INC Owner Name: PAUL A SIMPSON Business Location: 16 NE 4 ST STE 110 COCONUT CREEK Business Phone: 954-804-0829 Receipt #:ROOF NG/SHEET Business Tvr,5-1430 Business Opened:o5/22/2006 State/County/Cert/Reg:CCC13 2 7154 Exemption Code: Rooms Seats Employees Machines Professionals 1 For Vending Business Only Nam6wr of Machines• Tax Amount Transfer Fee j NSF Fee Penalty a . ir r— Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non -regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: PAUL A SIMPSON 16 NE 4 ST STE 110 FORT LAUDERDALE, FL 33301 2013 - 2014 Receipt #04B-12-00002032 Paid 09/30/2013 27.00 - - - - - BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT - - - 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2013 THROUGH SEPTEMBER 30, 2014 DBA: S IMPSONS HOME INC Receipt #: 18 5 -14 3 0 Business Name: Business Type: ROOFING/SHEET METAL CONTRACTOR (ROOFING CONTRACTOR) Owner Name: PAUL A SIMPSON Business Opened:05/22/2006 Business Location: 16 NE 4 ST STE 110 State/County/Cert/Reg: CCC1327154 COCONUT CREEK Exemption Code: Business Phone: 954-804-0829 Rooms Seats Employees Machines Professionals 1 Signature For Vending Business Only Numher of Yen6t....e. Tax Amount I Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 10.001 0.001 0.00 0.0-0-1 27.00 Receipt #04B-12-00002032 Paid 09/30/2013 27.00