RC-17-2422 (4)i"h,.:
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Certificate of Completion
Miami Shores Village
10050 N.E. 2nd Ave, Miami Shores, Florida 33138
Tel: 305-795-2204 Fax: 305-756-8972
Building Inspection Department
Description: GARAGE ENCLOSURE, KITCHEN REMODELING AT NEW LOCATION, NEW GUEST BATHROOM.
Permit Type Building (Residential) Bldg. Permit No. RC-10-17-2422
Owner CHRISTIAN LANSER Contractor HOME OWNER
Subdivision/Project Date Issued 02/07/2020
Construction Type V-B Occupancy Single Family
Square Footage
Location
175 NW 100 ST
Miami Shores, FL 33138
Type
609.00 Flood Zone X
If the building is located in a special flood hazard area documentation of the as -built lowest floor
elevation or lowest horizontal structural member has been provided and is retained in the records of
Miami Shores Village.
This certificate issued pursuant to the requirements of the Florida Building Code certifying that at the
time of issuance this structure was in compliance with the various ordinances of the jurisdiction
regulating building construction or use.
0
Building Officials Approval
Not Transferable
POST IN A CONSPICUOUS PLACE
Ismael Naranjo, CBO
��� h� p..t�� �'?��e�•� • • ^rj t' ~ ..r-r � ��i,^.'_'<i+1;� ����«�` 'S�„i:rifi �f�'(.��` !7 � "-'� �a ..,
� � ;,��f r �y -� �;��'` r•ti ��t �!'1� 5f�•�r} x�Y ti '.e�1, � ,•,^t,.�j�ir�� • �y �riy;�1' ^4 � .-i(� • r'r � i �S{�a+ '�✓i' Lam' A��,�'.�'
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.'� � .�_.:L:r..�� ._��� _ ..t �:�...:.--t./`•.Y It �:1�' Jdf�.. �`�3._ t rr./.�i A-. tiY �!����`�..�Gt.��
�ORio
Miami Shores Village
Building Department
10050 NE 2 Ave
Miami Shores FI.33138
Permit nio. RC-10-1.7-2422
Type: Building (Residential)
Ilmorkc/ass: Garage Encloture
Perlis Status: A r±dyed
Issue Date: 7/6/2018 Expires: 05/04/2020
INSPECTION REQUESTS: (305)762-4949 or log on at https://bidg.msvfl.gov/energov—prod/sel%ervice POST ON SITE
Requests must be received by 3:30pm
WORK IS ALLOWED: MONDAY THROUGH FRIDAY, 6:OOAM-7:OOPM 1131010230320
SATURDAY B:OOAM - 6:OOPM.
NO WORK IS ALLOWED ON SUNDAY OR HOLIDAYS
BUILDING AND ROOFING INSPECTIONS ARE DONE MONDAY THROUGH FRIDAY .
NO INSPECTION WILL BE MAD UNLESS THE PERMIT CARD IS DISPLAYED AND HAS BEEN APPROVED . PLANS ARE
READILY AVAILABLE. IT IS THE PERMITAPPLICANTS RESPONSIBILITY YO ENSURE THAT WORK IS ACCESSIBLE AND
EXPOSED FOR INSPECTION PURPOSES: NEITHER THE BUILDING OFFICIAL NOR THE CITY SHALL BE LIABLE FOR
EXPENSE ENTAILED IN THE REMOVAL OR REPLACEMENT OF ANY MATERIAL REQUIRED TO ALLOW INSPECTION .
Owner's Name: CHRISTIAN LANSER Owner's Phoney (305)772-4313
Job Address: 175 NW 100 ST Total Square Feet: 609
Miami Shores, FL 33138 .'I,
dotal Job Valuation: $ 35,000.00
Contractor(s) Phone Address
HOME OWNER
Description: GARAGE ENCLOSURE KITCHEN REMODELING AT NEW LOCATION, NEW GUEST BATHROOM .
06-27-2018
This property had a approved demolition permit issued on 05-09-2017. Also please see County records of review on file.
No work without permit was performed.
WY{lV��
�s>v . ti
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED
AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU
INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF
COMMENCEMENT.
Page 1 of 1
INSPECTION RECORD
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000
Phone: (305)795-2204 Fax: (305)756-8972
Permit NO. EEC-1 0-17-2422
Issue Date: 7/6/2018
Permit Type:
Worts Classification:, Garage Enclosure
INSPECTION REQUESTS: (305)762-4949 or Log on at https://bidg.miamishoresvillage.comlcap
REQUESTS ARE ACCEPTED DURING 8:30AM - 3:30PM FOR THE FOLLOWING BUSINESS DAY.
Requests must be received by 3 pm for following day inspections.
Expires: 01/02/2019
Residential Cbnsrruction Parcel0131010230320
Owner's Name: CHRISTIAN LANSEP, Owner's Phone:. (305)772-4313
Job Address:
Bond Number: 3819
AP WELDING AND STEEL MANUFA` (305)824
/VGw CJXa1/a/0J/ 7y `-f f
c¢�ry;elf
Total Square Feet:
Total Job Valuation:
609
$ 35,000.00
WORK IS ALLOWED:
MONDAY THROUGH FRiDAY, 8:OOAM - 7:OOPM.
SATURDAY 8:OOAM - 6:00PM.
NO WORK IS ALLOWED ON SUNDAY OR HOLIDAYS.
BUILDING AND ROOFING INSPECTIONS ARE DONE
MONDAY THROUGH FRIDAY.
j, 4--6 - -
NO INSPECTION WILL BE MADE UNLESS THE PERMIT CARD IS DISPLAYED AND HAS BEEN APPROVED. PLANS ARE READLY AVAILABLE. IT IS
THE PERMIT APPLICANT'S RESPONSIBILITY -f0 ENSURE THAT WORK IS ACCESSIBLE AND EXPOSED FOR INSPECTION PURPOSES. NEITHER
THE BUILDING OFFICIAL NOR THE CITY SHALL BE LIABLE FOR EXPENSE ENTAILED IN THE REMOVAL OR REPLACEMENT OF ANY MATERIAL
REQUIRED TO ALLOW INSPECTION.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED
AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU
INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
:ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF
COMMENCEMENT.
INSPECTION RECORD
STRUCTURAL
INSPECTION
DATE
INSP
Foundation
j
Stemwall
Slab
Columns (1st Lift)
Columns (2nd Lift)
4Of
Tie Beam
Truss/Rafters
Roof Sheathing
Bucks
Interior Framing
Insulation
Ceiling Grid
Drywall
Firewall
Wire Lath
Pool Steel
Pool Deck
Final Pool
Final Fence
Screen Enclosure
Driveway
Driveway Base
Tin Cap
Roof in Progress
Mop in Progress
Final Roof
Shutters Attachment
Einal Shutters
Rails and Guardrails
ADA compliance
DOCUMENT
Soi713e�arring Ceff
Soil Treatment Cert
Floor Elevation Survey
Reinf Unit Mas Cert
Insulation Certificate
+
Spot Survey
Final Survey
Truss Certification
STRUCTURAL COMMENTS
WINDOWS
& DOORS
INSPECTION
INSP
Attachment
PUBLIC
INSPECTION
WORKS
DATE INSP
Excavation
ELECTRICAL
INSPECTION
DATE INSP
Temporary PO
30 Day Temporar'V�
Pool Bonding
P"6ol'Deck Bonding
Pool Wet Niche
Underground
Footer Ground
Slab
Wall Rough
Ceiling
Roug440e6U
IX:
Telephone Rough
Telephone. Final
IU
U{
Ill
TV Rough
TV Final
Cable Roug
Cable Final
tp 6
Inte om Rough
Intercom Final~
Alarm Rough
Alarm Final
Fire Alarm Rough
Fire Alarm Final
Service Work With
ELECTRI
I1 1 aj
COM E TS
AW
t D 2`P
9
Final Sprinkler
Final Alarm
.190
INSPECTION
DATE
;INSP
Rough .c.,.,A
c
Water Service
2"d Rough
3c �
Top Out
Fire Sprinklers
1
Septic Tank
Sewer Hook-up
Roof Drains
Gas
LP Tank
Well
_..
Lawn Sprinklers
Main Drain
`
Pool Piping
Backflow Preventor
Interceptor
Catch Basins
,
Condensate Drains
HRS Final.
PLUMBING COMMENTS
INSPECTION DATE INSP
Underground Pipe
Rough
J
�
Ventilation Rough
Hood Rough
Pressure Test
Final Hood
Final Ventilation
Final Pool Heater
Final•Vacuum
421
MECHANICAL COMMENTS
V
40
3i
�jel,, l Na to L'" may
i1� 14o17� 12.0. yA n
D ID 20
LOT 4 ( LOT 9 LOT - 10 SCALE' I' ---20
I _BLOCK NN 1. 1 ( BLOCK 4 I BLocrc 4 I
I FOLw%�
IRON PIPE I I FO1110 y- I E '_ PTI
- - - - - WaNt PIPE - - i� 7 E 7 25 FEET OF LOTS 5, 6, i AND B. BLOCK 4, BONMAR PARK
/J ION ACC TO THE MAP THEREOF, AS RECORDED IN PLAT BOOK 24 PAGE 71 OF
75• ZrJ• 25 0 ` „� A... T*fuBLIC REC G F MIAMI-DADE CWNTY. FLORIDA.
DO* 89�6.* O \�Q • / /•%9. N A •\•yh� 0.5'WEST �� SIF•EYOR'S REPORT"AND GENERAL NOTES
�B. 6' q0 LVO VALID W.T.ONT THE ATTACIED SIPIEY Mu)
IN REMAIN of LDT - 5 N /
N LEGAL DESCRIPTION HAS BEEN FUPMISR BY THE CLIENT.
BLOCK - L EAST 25' of /
LOT 5 AMga1XDe I 2. REFERENCES Tn DEED RECOPO OR PLAT REFER TO MCUMENTs AND INSTRUMENTS OF RECORD As
BLOCK - 4 PART OF THE PERTINENT INFORMATION USED FOR THIS SURVEY WORK. MEASURED DISTANCES, DIRECTIONS
4rtR TANK AID ANGLES ALONG BOUNDARY LINES ARE IN CONSISTENCY WITH CORRESPONOIS VALIIEgFROM RECORDS,
I, I UNLESS OTHERWISE SHOWN • 00000
_ LOT - 16 3. THEM LANDS ARE SUBLECT TO ADDIT o AL RESgtCTIDNS O•RECORD THAT - �- - - - - - - - - r•.RE NOT FURNISHED TO rHE• 000
@ •
\OQ ``�/ ,/ 1. BLOCK - L OD I UMERSWNING REGISTERED SurtVEYOR. A TITLE 5@ARCI 1W NOOKEN PERFORMED. •
}\ L. NORTH ARROW DIRECTION IS BASED ON AN ASStM� �ERroIAr BEARINGS �F•B45ED �•+ 4ry ASSLMED •
"AST 25' OF •,11 / j�" \\ MEWDIAM ON A WELL -ESTABLISHED LINE, SAID LINE IS BEING NOTED AS CR Or THE6JRVEY�IAP. •
ID REMAIN OF LOT - 6 .� LOT - 6 /VI I M1 5. ONLY ABOVE GNtMO IMMOVEIENTS ARE SNOT* SE•.• `.1t+DATgeR, U*ERGR0*Qo ATURES AND• • • • • •
N BLOCK 4 \\ BLOCK - 4 �6. �D, L- UT ILMIES HAVE HOT BEEN LOCATED •
/N O / I b. FENCE OWNERSHIP HAS NOT BEEN DETERMINED `.�gfV'(RgM EXISTING FENCES W BUtMDARY LINES• •
/• CID ) 9. ARE APPROXIMATE FENCE/WALLS WIDTI AID CONDITIONS MIST BE CONSIDERED TO DETERMINE TRUE• • • • • •
/ 2B 16.5, 11 12' K I LOCATION LAMS LOCATED BEYWD PERIMETER 6Fk F% *,GMT OR MIGHTO NOT BE j-ING USED BYO •
_ ? ADANERS HAWING PARCELS NAVE NOT BEEN+ VESTIGFTED@ • • • • •
- 75'_ J % - 16.$' 10 7 THIS SURVEY MAP b INTENDED TO BE DISPLAYED LE SHOWN NEP 'N S S -ESSED IN
- U.SSURVEY FOOT ; • @ • @ •
1 9.78. /C _
8. THIS SIIRIEV MAP 15 BEING PREPARED FOP i F ARTYIPARTIES Jrjli 5 tERTIFIED TO
n 2O.B' � AND DOES Mi EXTEND TO ANY UNNenEO NglvrouAL, t1TY ASSIGNEE.
REMAIN OF LOT 7 \O 0 9. FLOODPLAIN INFORMATION. AS SCALED FROIiFE9ER� ySIRANCE RATE MAP (Fll t COnnIMITr
N EA T 25' OF N I ONE STORY - - N0. 120652 (PILLAGE OF MIAnI $HIES). PANEL lu302, SUFFIX L. RE V15E0 ON SEPT ITTI, 2009, iI15• • • • • •
(� BLOCK - 4 OT - 7 LOT - IS REAL PROPERTY FALLS IN ZONE -X' •
RESIDENCE N0. 175 • • •
B OCK - 4 BLOCK - 4 10. HORIZONTAL ACCURACY ACCURACY OBTAIN• TM'J•EAS• MENTS AND CALCULATIONS HEFTS ANO
F.F.ELEv =13.30'
I o pt•� O I EXCEEDS THE nINInUn HORIZONTAL FEATURE Ac uRAGY `R A URBAN ARE BEING EDUAL i0 FOOT IN •
9.76 w V4J I VERY CAL CONTROL AND ACCURACY THE EYATIONS AS SHOWN ARE 0101APTA ARE NATIONAL
• • • • •
1.1L' GEODETIC VERTICAL DATLM OF 1929 (NGVD 1 9) T �LOSIIRE IN FEE1�A5 COMPUTED. MfE's inF• E
1.3'EAsi 13.5' 15.6' 0.2'WESr �+ o
STANDARD OF PLtS OR MINIS 0.05 FEET TIME? THE SARE� ROOT OF THE LOOP DISTANCE IN MILES.:-! • •
\\. ELEVATAM ARE BASED ON A LEVEL LOOP FROM A 614THE F 1LUWING OFFkAAL BER&OIA: S. Z •Dy aD
\\b I S O. BENCH MARK B I: MIAnI-DADE COLMTY PUBLIC WORKS DEPARTMENT BENCH 'M RKA-56' _ NT # w
1 O • �l. ELE VATroN = 10.5E FEET 0900 } r� m
W BENCH MAIM R 2: MIAMI-DAM CWNTY PUBLIC WORKS DEPARTMENT BENCH MARK N-568, _I J
P REMAIN of LOT - 8 \�Q E4 T 25' OF -- - �O ELEVATION = 9 65 FEET W LL
Z N BLOCK - 4 OT 8 1 0. > Z
W I ✓) B ocK - 4 H B9 BD. a
t6.�S. }1,(.s L NO CD
"I DO
11 qp° K\O. 9.K aCC G� 1 HEREBY CERTIFY TO.
0 L 75 CIBRISTIAN LANSER. Z O h 3
Z - - V THAT THIS SURVEY CONFORMS TO THE STANDARDS OF PRACTICE AS SET FORTH BY THE FLORIDA J
N FWMi< 74.96' M. 7S.O9' M. BOARD OF PROFESSIONAL SUR'/EYORS AND MAPPERS- IN APPLICABLE PROVISIONS OF CHAPTER 5117. G
IRON PIPE 75. 00, P. 75. 00, P. IROU1 P FLORE)A ADMINISTRATIVE CODE PL.RJUANT TD SECTION 172027 FLOPTA STATUTES THK SURVEY IS O LL 0
3 FOUND " @ SE CORNER ACCLrATE AND CORRECT TC THE BEST OF MY KNOWLEDGE MID BELIEF J I
Dignalyugnedby J z IR ON PIPE OF THE WEST 25' Oday,C Mi.
Z b b CIS SOUTH 0.45 LOT IL Date Z0191Z 17 Lu o Jo
N \O' \p,
10.36:27-os'W
15ASPHALT PNEMENT ODALYS C BELLO�IZNAGA Q -
_ PROFES..,JNAL :.fVEYOR AND MAPPER LS6169. STATE OF FLORIOA
- € 50' TOTAL R/W 1 PER PS 2L - PG 71) - - FIELD WORK DATE .2"212C'9 LL
O 3 M z
N.W. TOOTH STREET J N
W n zo a
E
ADOITIpS AND DELETIONS TO THIS SURVEY MAP ARE PROHIBITED THIS $JIVE• MAP eND O] N d w
REPORT ARE HOT VALID WITHOUT THE SIGNATLRE AID OPGINAL RAISED SEAL OR WITHOUT
THE WTIENTICA TED ELECTROHIC SIGNATURE AND SEAL OF THE UNDERSIGNING FLORIDA
LICENSED SUNEYOR AID III -
LEGEND III ABBRE-TIONG
MAP OF BOUNDARY SURVEY
•
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PROPERTY ADDRESS:
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175 N.W. TOOTH STREET, MIAMI SHORES, FLORIDA 33150
�i-`� .�WW.. ... "` • T e•ffe s.R. • - +..+•�.•
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PROJECT N0. 20336 PAGE I OF I
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Miami Shores Village
10050 N.E. 2nd Avenue NW
( Miami Shores, FL 33138-0000
Phone: (305)795 2204
CORioQ
Permit No. RC-10-17-2422
Permit Type: Residential Construction
err it Work Classification: Garage Enclosure
Permit Status: APPROVED
Issue Date: 7/6/2018 1 Expiration: 01/02/2019
Project Address Parcel Number Applicant
175 NW 100 Street 1131010230320
Miami Shores, FL 33138- Block: Lot: CHRISTIAN LANSER
Owner Information Address Phone Cell
CHRISTIAN LANSER 175 NW 100 Street (305)772-4313
MIAMI SHORES FL 33150-
175 NW 100 Street
MIAMI SHORES FL 33150-
Contractor(s) Phone Cell Phone
AP WELDING AND STEEL MANUFACI (305)825-4511
Valuation: $ 35,000.00
Total Sq Feet: 609
Approved: In Review
Comments:
Date Approved:: In Review
Date Denied:
Type of Construction:
Occupancy: Single Family
Stories:
Exterior:
Front Setback:
Rear Setback:
Left Setback:
Right Setback:
Bedrooms:
Bathrooms:
Plans Submitted:
Certificate Status:
Certificate Date:
Additional Info: GARAGE ENCLOSURE, KITCHEN F
Bond Return :
Classification: Residential
Fees Due
Amount
Bond Type - Owners Bond
$500.00
C C F
$21.00
CO/CC Fee
$50.00
DBPR Fee
$15.75
DCA Fee
$10.50
Education Surcharge
$7.00
P&Z Review Fee
$35.00
Penalty Fee
$0.00
Permit Fee
$1,050.00
Plan Review Fee (Engineer)
$160.00
Plan Review Fee (Engineer)
$90.00
Plan Review Fee (Engineer)
$90.00
Preliminary Plan Review
$200.00
Scanning Fee
$39.00
Technology Fee
$28.00
Work without Permit Fee
$0.00
Total:
$2,296.25
Pay Date
Pay Type
Amt Paid
Amt Due
Invoice #
RC-10-17-66310
07/06/2018
Credit Card
$ 1,736.25
$ 560.00
10/11/2017
Credit Card
$ 200.00
$ 360.00
10/27/2017
Credit Card
$ 360.00
$ 0.00
Bond #: 3819
mvauaoie ins
Inspection Type:
Review Planning
Review Planning
Review Electrical
Review Electrical
Review Electrical
Review Building
Review Structural
Review Structural
Review Structural
Review Mechanical
Review Mechanical
Review Building
Review Building
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
construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated.
July 06, 2018 1
y�
Miami Shores Village
�sHO1s
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Map
Permit No. RC-10-17-2422
Permit Type: Residential Construction
Pen Work Classification: Garage Enclosure
Permit Status: APPROVED
Issue Date: 7/6/2018 1 Expiration: 01/0212019
Project Address Parcel Number Applicant
175 NW 100 Street 1131010230320
Miami Shores, FL 33138- Block: Lot: CHRISTIAN LANSER
Owner Information Address Phone Cell
CHRISTIAN LANSER 175 NW 100 Street (305)772-4313
MIAMI SHORES FL 33150-
175 NW 100 Street
MIAMI SHORES FL 33150-
Contractor(s) Phone Cell Phone
AP WELDING AND STEEL MANUFACI (305)825-4511
Valuation: $ 35,000.00
Total Sq Feet: 609
Approved: In Review
Comments:
Date Approved:: In Review
Date Denied:
Type of Construction:
Occupancy: Single Family
Stories:
Exterior:
Front Setback:
Rear Setback:
Left Setback:
Right Setback:
Bedrooms:
Bathrooms:
Plans Submitted:
Certificate Status:
Certificate Date:
Additional Info: GARAGE ENCLOSURE, KITCHEN F
Bond Return :
Classification: Residential
Fees Due
Amount
Bond Type - Owners Bond
$500.00
C C F
$21.00
CO/CC Fee
$50.00
DBPR Fee
$15.75
DCA Fee
$10.50
Education Surcharge
$7.00
P&Z Review Fee
$35.00
Penalty Fee
$0.00
Permit Fee
$1,050.00
Plan Review Fee (Engineer)
$160.00
Plan Review Fee (Engineer)
$90.00
Plan Review Fee (Engineer)
$90.00
Preliminary Plan Review
$200.00
Scanning Fee
$39.00
Technology Fee
$28.00
Work withoLt-Permit a
$0.00
Total �--�
$2,296.25
Pay Date
Pay Type
Amt Paid
Amt Due
Invoice #
RC-10-17-65310
07/06/2018
Credit Card
$ 1,736.25
$ 560.00
10/11/2017
Credit Card
$ 200.00
$ 360.00
10/27/2017
Credit Card
$ 360.00
$ 0.00
Bond #: 3819
Authorized Si naturer"Cw—ner / Applicant / Contractor / Agent
Building Department Copy
Avauaoie
Inspection Type:
Review Planning
Review Planning
Review Plumbing
Review Plumbing
Review Electrical
Review Electrical
Review Electrical
Review Electrical
Review Building
Review Structural
Review Structural
Review Structural
Review Mechanical
Review Mechanical
Review Building
Review Building
July 06, 2018
July 06, 2018
A �-fo
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et
BUILDING
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
7-PER APPLICATION
B MING ❑ ELECTRIC ❑ ROOFING
LV6tq1
12017
BY:
F BC 20 it
Master Permit No. C i1—iA ZZ
❑ REVISION
Sub Permit No.
❑PLUMBING ❑ MECHANICAL [-]PUBLIC WORKS [] CHANGE OF
CONTRACTOR
❑ EXTENSION ❑RENEWAL
❑ CANCELLATION ❑ SHOP
DRAWINGS
Folio/Parcel#: 11. 3 )// - 0 2 3-03LO Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (fee Simple Title
AddrPcc- I '�r' C_ �-j w
- Grp I nse►-
City: to I G I'- ) 1 .5 State: I I i
Tenant/Lessee Name: Phone#:_
Email:
CONTRACTOR: Company Name:` �` Ih °1 qh� 7 'f"ef? I (Phhoon M _
Address: W ` I J
City: t4 1 At LIB State: - 1
Qualifier Name: w " � �L(" Q o N-ro Phone
State Certification or Registration #: Lr l 1 .4� I 6 2 SS Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
13313�_''>
Address: City: State: Zip:
Value of Work for thi ermit: $ s �0 Square/linear Footage of Work: 09
Type of Work: Addition ❑ Alteration ❑ New 1' ` ❑ Repair/Replace ❑ Demolition
M�
Description of Work: ( 6C e f\C �L)vrC_ , f� i + CkOv\ VC fY10 & 1 1 f n Gk
w , ►Jew .6ucSA- (�G-levi c,
Specify color of color thru -tile: ((��
Submittal Fee $ 200 .01 Permit Fee $ 1 0 J l / CCF $ CO/CC $
Scanning Fee $
Technology Fee
Structural Reviews $
Radon Fee $
Training/Education Fee $
DBPR $ Notary $
Double Fee $ � oao + t a.),
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014) 6n . �2�_;
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 Y UR PROPERTY. JF YOU INT ND
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.
11
Signature
tk��—
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of J lJ ►) C .20 1 7 by
La ,)1 e Y, who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC: �---�
Sign:
Print: i0-
Seal: W "'R' r"o""
EI'STATE OF FLORIDA
Comm# FF098337
'4 E 18 Explres 5/3/2018
sssssssssss*ssss*sssss*sssssssssss�#ess
APPROVED BY
as
Signature
_-4W4:�:D
CONTRACTOR
The foregoing instrumen was acknowledged before me this
ac� day of Girl 20 /i - by
f- Alollso who is personally known to
me or who has produced C 4'(Sa -.'fd (
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
ssssYssssssssssss:sss
rlPlans Examiner
Structural Review
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Clerk
(Revised02/24/2014)