RC-05-22-1260 CanceledMiami Shores Village ENTERED
Building Department JUN28P024
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY. —
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
CANCELLED FBC 2022
BUILDING 6/2je/2y Master Permit No. 1?,f-05-Z2-12(60
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [—]RENEWAL
❑PLUMBING ❑ MECHANICAL ❑ CHANGE OF %CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 155 N Vn-J - r'e-a4
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: t 1 '3101- Q) 3� Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type:
Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): MQ t i i�L/ / LP. Phone#: --?09 S 30_ a53 q
: S S Address/y eh
W l-7 S iYY� i' rr
City: �t o-vr\: 5ilore-5 State: T Zip: 331 Sb
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: d \-t.)\Aay- Phone#:
Address:
Email
Qualifier Name: Phone#:
State Certification or Registration #:
DESIGNER: Architect/Engineer: _
Email
Value of Work for this Permit:
Type of Work: ❑ Addition
Description of Work:
of Competency #:
Square/Linear Footage of Work:
❑K Alteration ❑ New ❑ Repair/Replace
, rl u CA A r m.P Q 5 P?x S, i 6-
Specify color of color thru
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Permit Fee $
DCA Fee $
Training/Education Fee $
CCF $_
DBPR $
❑ Demolition
CO/CC $
Notary $
Double Fee $
P&Z Review $ Bond $
TOTAL FEE NOW DUE $ _
(Revised04/26/2024)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
MortgdgesLender'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 instr nt was acknowledged before me this The foregoing instrument was acknowledged before me this
Z� day of -,J U rt.c 20 2H by day of 20 by
4! 1 c p-V rt-,r— who is personally known to who is personally known to
Mrae(or Who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: U/ -- `\Y`� Sign:
Print: t VI Ln Vt2 F Q O Print:
/// VivienneYao
YP
Seal: Pay oB'. Seal:
_O.- ` CommAld222410
Expires: Jan. 31, 2026
0F..` Notary Public - State of Florida
################ rj4iAt}#############i########i########}##iF4##i#}#####}#####}##}######k###}}#############}#####
APPROVED BY
Plans Examiner
Zoning
(Revised04/26/2024)
Structural Review
Clerk
6 12-e / 2&2 q
CA-)q-s
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Permit NO.: RC-05-22-1260
Permit Type: Building (Residential)
Work Classification: Alteration
Permit Status: Approved
Issue Date:09/12/2022 I Expiration: 03/13/2023
Location Address Parcel Number
155 NW 97TH ST, Miami Shores, FL 33150 1131010260130
Contacts
MATTIE PAYNE Owner HOMEOWNER Contractor
155 NW HOME OWNER
Ins ecbon Requests:
Description: HANDY CAPP-RAMP AS PER SUBMITTED i.. I Valuation: $ 2,000.00
LL
DRAWINGS ETC rt ai,�; �rWo= �'t
Total Sq Feet: 36.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$1.20
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.60
Permit Fee
$50.00
Planning and Zoning Review Fee
$70.00
Scanning Fee
$9.00
Structural Review ($60)
$60.00
Technology Fee
$10.00
Total:
$254.80
Payments
Date Paid Amt Paid
Total Fees
$254.80
Credit Card
09/12/2022 $204.80
Credit Card
05/18/2022 $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 AFFIDAVIT: I certify that all the
regulating construction and zoning. Futherv-0
is accurate and that all work will be done in compliance with all applicable laws
f named contractor to do the work stated.
Authorized Signature: Owner / Applicant /
Agent
Date
September 12, 2022 Page 2 of 2
RFCEIVEL7
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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
��F//B�� C20
BUILDING Master Permit Nokc—( S—g';� 1cAp
PERMIT APPLICATION Sub Permit No.
ILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION (5,8HOP
CONTRACTOR n DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip:
the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type:
OWNER: Name (Fee Simple
City: f V\ Q i,,a 1. State: .
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name:
Address:
City:
Qualifier Name:
Zone: BFE: FFE:
State Certification or Registration M Certificate of Competency #:
DESIGNER: Architect/Engineer. �I Phone#: � 4�% /
Address: �7 '�'yd7� �[ . ��(' ^ City: pp,State:Pzip:9
Value of Work folr this Permit: $ �\ f d 0 (� Square/Linear Footage of Work: a1
Type of Work: icy Addition ❑ Alteration ❑ New _ ❑ Repair/Replace ❑ Demolition
Specify color of color thru tile:
Submittal Fee $'750 - OD Permit Fee $ 50 _ C� ) CCF $ I • a
0 CO/CC $
Scanning Fee$ 'V V�'1l Radon Fee$ (;Z.i/V DBPR`�
R ($�(7�•V V Notary
Technology Fee $ V 1/ (l Training/Education Fee $ ^ (Y Double Fee $.
Structural Reviews $ -"- -_--- W. L/ (2 Bond $
(Revised02/24/2014)
11•
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable) _
Mortgage Lender's Address
City
State
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 low 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 sy_
OWNER orAGENT
The foregoing instrument was acknowledged before me this
day of $� .20 Z--PZ Zby
who is personally known to
me or who has produced L . as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:S
��3socg -o-
Seal:
ti
.:: ` uSlor a
�YARES: Fe'.
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.
NOTARY PUBLIC:
Print:
MY COMMISSION 8 HH 233322
EXPIRES: Fobnary 27, 2020
APPROVED BY 7 ^� Plans Examiner
�171V Structural Review
(Revised04/05/2022)
as
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Clerk
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