RF-09-18-2512 CanceledMiami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
/�IIJ�E��IMEf�01�E �E15R: (305) 762-4949
BUILDING rel�P/I/LI "I"1\✓h� LLC Master Permit
RF-os-z 1 - I Z4
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC 0 ROOFING
Sub Permit No
MAY V'3'
ZIUi9
LEM
FBC 20
RF-18-2512
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ® CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOBADDRESS: 1155 NE 100 ST
City Miami Shores County: Miami Dade Zip: 33138
Folio/Parcel#: 11-3205-019-0331 Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type:
Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): SIMON JAMES GOSLIN Phone#:
Address: 1155 NE 100 ST
City: MIAMI SHORES State: FL Zip; 33138
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: ESTRADA ROOFING Phone#: (786)385-3137
Address: 1738 SW 57 AVE
City: MIAMI State: FL Zip: 33155
Qualifier Name: DANIELGONZALEZ-LAUZAN Phone#: 305-668-8800
State Certification or Registration #: CCC1328913 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 ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of work: Close Roofing permit# RF-18-2512, no work performed.
40 ronr-c
Specify color of color thru
Submittal Fee
Scanning Fee $
Permit Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF
DBPR $
CO/CC $
Notary $
Double Fee $
Bond $
(Revised02/24/2014)
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 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
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of .20 , by
me or who has produced
who is personally known to
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of . 20 -4 by
as me or who has produced
identification and who did take an oath. identification and who did take an oath.
as
NOTARY PUBLIC: NOTARY PUBLIC:
Sign • Sign •
Print: t•(A Ild
Seal: Seal: qV Notary Public State of Florida
siD Anailyn Estrada
< My commission GG 173156
jof Expires ol/t0/2022
***********************************************************Ak Al,* * * **************************
APPROVED BY
Plans Examiner
Zoning
(Revised02/24/2014)
Structural Review
Clerk
ESTRADA
■ �� R O O FING
1738 SW 57 Ave, Miami, FL 33155
Phone: (305)668-8800 — Fax (786)279-0890
CCC1328913
May 22, 2019
Miami Shores Village
Building Department
10050 NE 2"d Ave
Miami Shores, FL 33138
RE: Simon James Goslin
1155 NE 100 St
Miami Shores, FL 33138
Permit# RF-18-2512
To Whom It May Concern:
I :_
This letter is to certify that no work has been performed on the above referenced. I would like to
request the cancellation of Roofing Permit# RF-18-2512.
Best regards,
11
Daniel Gonzalez-Lauzan (/
Qualifier of Estrada Roofing
STATE OF FLORIDA
BEFORE ME, the undersigned authority, on this—�—Iday of M a� 2019, personally appeared Daniel
Gonzalez-Lauzan to me well known to be the person described in and who signed the Foregoing and acknowledged
to me that he executed the same freely and voluntarily for the uses and purposes therein expressed.
WITNESS my hand and official seal the date aforesaid.
,�61ARY PUBLIC
My Commission Expires: n IWI 20 22
NotarY Pualo state of Plaids
¢'Yo AnaityEstrada MY Comrnn'"'V GG 173156
%47
Expires 01/1012022
1738 SW 57 Ave, Miami, F133155 • Ph (305)668-8800 • Fax (786)279-0890
BUILDING
PERMIT APPLICATION
Miami Shores Village
RECEIVED
Building Department SEEP 21 2018
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20 FT
Master Permit No. u ( ei ` 2A2�
Sub Permit
BUILDING ❑ ELECTRIC Q ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
IOBADDRESS: 1155 NE 100 ST
City: Miami Shores County: Miami Dade zip: 33138
Folio/Parcel#: 11-3205-019-0331 Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): SIMON JAMES GOSLIN Phone#:
A,idrnec. 1155 NE 100 ST
City: MIAMI SHORES
Tenant/Lessee Name: _
Email:
FL
CONTRACTOR: Company Name: ESTRADA ROOFING
Address: 1738 SW 57 AVE
City: MIAMI State: FL
Qualifier Name: DANIEL GONZALEZ-LAUZAN Phone
State Certification or Registration #: CCC1328913 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
33138
(786)385-3137
33155
Address: City: State: —Zip:
Value of Work for this Permit: $ �7 -5eO Square/Linear Footage of Work: 4 // 9
Type of Work: ❑ Additypn ❑ Alteration ❑ New N Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru
ya/V
w/ 7%4'0-
Submittal Fee $ Permit Fee $ CCF $ ,yy J CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary
Technology Fee
Structural Reviews $
(Revised02/24/2014)
Training/Education Fee $
Double Fee $
Bond $ -
TOTALFEENOWDUE$ �MQ • Zv
G ( 18 • 2P
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 a ence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
0j day of fCAO�)%1- , 20 I P by
S�'v>xr� I(IKY7� QL-61 fq , � p� p�.m�t to
me or who has produced as
CONTRACTOR
The foregoing instrument was acknowledged before me this
44— day a {tQYY6 '�' 20 1 '—�2 , by
J):nV) ce, (71 1 12 leg - %U vti h � _ allp_krtawr�
me or who has produced
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
as
(RevisedG2/24/2014)
Structural Review Clerk