DS-19-2273Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
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Permit NO.: aS49-19-2273
Permit Type: Driveways/Sidewalks/Slabs
Work Classification: Addition/Alteration
Permit Status: Approved
Issue Date:10/24/2019 1 Expiration: 04/21/2020
Location Address Parcel Number
1070 NE 95TH ST, Miami Shores, FL 33138 1132050120030
Contacts
JANENE CHURCH Owner
1070 NE 95 ST, MIAMI SHORES, FL 331382548
GENERATOR SUPERCENTER OF Contractor
BROWARD
MIGUEL TOSAR
3800 N 28 TER, HOLLYWOD, FL 33020
Business:3059005055 carlo@conkretaconstruction.com
Inspection Requests:
Description: PRE-FAB SLAB FOR GENERATOR Valuation: $ 250.00 Inspec`ion Re'
32 INCH X 55 INCH
49,
TotalSq Feet: 0.00
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
10/24/2019 $95.30
Credit Card
09/27/2019 $50.00
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 AF DAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating co st uction and zoning. Futhermore, I authorize the above named contractor to do the work stated.
0
Signature: Owner
/ Applicant / Contractor / Agent
Date
October 24, 2019 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
2UILDING ❑ ELECTRIC ❑ ROOFING
FBC 20
Master Permit WTI— C I
Sub Permit No. --61— 9—Z2 /3
❑ REVISION ❑ EXTENSION [:]RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOBADDRESS: ,�J �� I� �1 n ---5
City: Miami Shores County: J Miami Dade Zip:
Folio/Parcel#:,� ��� O1Z t✓t _/ �J�.J Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Nam� e (Fee Simple Titleholder): �� YPhone#:
m' C
Address: �V 0 � QS :SAfti �"e4
City: r 1.10 7. ` , \ 11300ce5 State: Zip:
Tenant/Lessee Name: Phone#:
Email:
,��,/
CONTRACTOR: Company Name:(- �Q'�LNIJ'�p
Address: "`�2l1 — - ,,� Y _
City: "G) lJ
Qualifier Name:
—f L_ Zip:
hone#:
State Certification or Registration #: 17W w�� Certificate of Competency #:
DESIGNER: Architect/Engineer:
hone#:
Address: City: State:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition
Description of Work:
❑ Alteration ❑ New 1 ❑ Repair/Replace
Specify color of color thru tile:
_ Zip:
❑ Demolition
Submittal Fee $ 2J 0 ?C'A Permit Fee $ 10O CCF $ /D► • /vU� D CO/CC $
Scanning Fee $ J • 00 Radon Fee $ Z 66 DBPPR,I$ Notary $
Technology Fee $J. 50 Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
I Qnn I nq . $ 3 5 TOTAL FEE NOW DUE $ - I S• 3 D
(Revised02/24/2014)
Y!
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.
S i g n a t u r��411-1
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of zicla 20 =� by
IN-'ty is rsonally known to
me or who has produced o -- as
Signature
CONT ACTOR`
The foregoing instrument was acknowledged before me this
day of 20 �, by
w�isper�sonallknown to
me or who has produced as
identification and who did take an oath.
identification and w
did take an oath.
NOTARY PUBLIC:
NOTARY PU I
Notary Public State of Florida
Carlo Cavallo
My Commission GG 323 005
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Sign:
Sign:
Expires 06/30/2023
Print:
Print:
Seal: +�
Notary Pu is State of rida
Carlo Ca atlo
Seal:
u*' c` Florida
ap
�y •
`oiwuwA
My Commission GG 323605
EaairesG6;3C;2073
•�.`i }23005
APPROVED BY
Plans Examiner
Zoning
(Revised02/24/2014)
Structural Review Clerk