126 NE 97 St (6)Disapproved
(Signed)
0
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
�
Date..._.._ :
`Y
Owner's Name and Address. .� �___ �° R No.. P-L
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot Block
Street and Number where work is to be done
State work to be done and purpose of building (by
New Building Remodeling
To be constructed of Kind ofJoundatior
Estimated Total cost of improvements $_. __ Amount of Permit $,
Zone cubage required U -Plan Cubage
Distance to next nearest building Size of Building Lot
Maximum live load to be borne by each floor.-:: „_:_
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice
or notices as arc required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed) {•"
therein by him stated are true.
Permit No. .... ` t ____ -_. Date
MAA O S N O REM VO LLA E
BUILDING INSPECTION DEPARTMENT
APPUCAT0®ON [FOR 20..DOL®MS PERWIT
Subdivision
floors) �_.e/�.s�_�- - - -• --
and for no other purpose.
Addition Repairs No. of Stories
oof Covering
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
to me well known,
and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
Chairman
Member
Member
Council Approved Date
Date -
Notary Public, State of Florida
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval
the Planning Board.
A re- inspection fee of 51.00 will be charged when such re- inspection is made necessary by improper notice
materials and /or workmanship.
I • - 1
Street._ . .
Read, Sworn to and Subscribed before me.
Building Inspector My Commission Expires
PLANNING BOARD DATE
Member
Member
Member
Disapproved Date
has been obtained from
for inspection or faulty
Approintd
.Correct Ion
Re -Insr n Fee
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305 - 795 -2204
Building Inspection Request
.D.ye
Type
Permit No. /40 / ( A
Name SA)
Addrm
Company
Phone Of
inspection Date
BUILDING
PERMIT APPLICATION
FBC 2001
Contractor's Company Name De r
Contractor's Address L i „1
Total Fee Now Due
(Continued on opposite side)
Miami Shores Village
Building Department
10050 l.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Permit Type (circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) `` I. • /1, . #Phone #
Owner's Address - A (-= a . '
City State Zip
Tenant/Lessee Name
Job Address (where the work is being done) i - (' Ai e '
City Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES NO
S �) . 6 r ti� , I J 6
City State Zip
Qualifier ✓ . ,r i
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
S Value of Work For this Permit 6, , � - ` Square Footage Of Work:
Type of Work: ❑Addition ❑Alteration ❑New Repair/Replace ❑ Demolition
/-
f_ " J f!
Describe Work: � %: e e_ f j'� L �` �ti G� � 1 /.>:.� j r ,v-
** *** * * * * *** * * * *** * * * * * ** * ** F ees * * * * *** * ** * * * * * * * * * * * * * * * * * * **
Submittal Fee $''; ., � e.y.� � Permit Fee $ . "= , � CCF $ � D CO /CC
Notary $ Training/Education Fee $ f 0 Technology Fee $ S 0
Scanning $ Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
fc0F1 gP /5
Permit No.
Master Permit No.
s
Phone #
A
Phone # � �' f C% -
2 r j
Bonding Company's Name (if applicable)
Bonding Company's Address
City
Mortgage Lender's Name (if applicable) rr / f{
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 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 Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of , 20 _, by , day of , 20 , by
who is personally known to me or who has produced who is personally known to me or who has produced
Ac identification and who did take an oath. as identification and who did take an oath.
NOTARY PUI
Sign:
Print:
My Commissic
* * * * * * * * * * **
* * * * * * * * * * **
APPLICATIO
Chc 05/13/03
Plans Examiner
J Engineer
�. En eer
:��',�� ! ' � tag
Zoning
/
State ` Zip
[NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
********************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
********************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
• 10050 N.E. 2nd ►;venue • Miami Shores, Florida 33138 • 305-795-2204
Date Job Address / -' ✓ ' Tax Folio if -
s
Legal Description Historically Designated: Yes No
Owner /Lessee/Tenet Master Permit #
Owner's Address
Contracting Co. Address
t
Qualifier / - SS# Phone
State # Municipal # Competency #
Square Ft. Estimated Cost (value)
Signature of owner and/or Condo President
Notary as to Owner and/or Cond
My Commission Expires
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
"...'.1 ;Si J, Uo18,3411
• J a nr • ACv,�,� r;bat,
Phone
Date Signature of Contracto or Owner Build
er/
Notary as to Contractor or Owner Builder
Ins. Co.
IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY,
THERE WILL BE NO INSPECTION. RE- INSPECTION FEE IS $50.00 AND MUST BE PAID IN ADVANCE
BEFORE CALLING FOR ANOTHER INSPECTION.
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING
WORK DESCRIPTION:
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN
YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR ANY ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that
all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required
for all disciplines.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be ne in compliance with all applicable laws
regulating construction and zoning. Furthermore, I authorize the above named contractor to do the work st ed.
/
My Commission Expires ° - R•� - °° y"
Date
Date
FEES: PERMIT RADON C.C.F NOTARY
APPROVED: TOTAL DUE
Zoning Building Electrical
Mechanical Plumbing Structural Engineer
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
• �
PERMIT NO. TAX FC�IO NO. 1/° .12-06°0/3.25549
STATE OF FLORIDA:
COUNTY OF MIAMI -DADE:
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real
property, and In accordance with Chapter 713, Florida Statutes, the following information
is provided in this Notice of Commencement.
1. Legal description of property and street/address: M9 , 1/ J// S SC / Q/ P,7 72 1OT/l,)/ a-' 7
tai 9/ / Z7r // L L/ €/9 / .Z& ,w6. 97 .. /:.€4 4- --7---
/,M// . X'It5 FZ . 33/38
2. Description of improvement f (///f/vie /2 //T
3. Owner(s) name and address: ZAlil . rerkC.9i,/iit/ /26 c . 97 s7
Interest in property: agi Nc2
Name and address of fee simple titleholder.
4. Contractor's name and address: Seats 466 g' e°2.
5. Surety: (Payment bond required
Name and address:
Amount of bond $
6. Lender's - name - and - address:
Notary Public
Print Notary's Name
My commission expires:
123.01 -52 PAGE 4 8/02
by owner from contractor, if ItIME OF LO" 111 CC ''.
I HEREBY C. ' FS'
Al
provided by Section 713.13(1)(a)7., Florida Statutes,
different • ate is specified)
Si • a e of Owner
Print Owner's Name v t ZA 02 67l .1 , /7
Sworn to and subscribed before me this
Q(
day of
A , G'5
2 -
2.0 -1
ices: 3 ?/S?3
Gi O/ &L SaAJ/ , sg &v/).
/2,4w wnvN Fe- 333/3
c :FN 2004R071 730
OR Bk 22584 Ps 2806;flps)
.RECORDED 08/18/2004 11 :19:46
HARVEY RUVII'h CLERK. OF COURT
MIAMI -DADE COUNTY} FLORIDA
LAST PAGE
7. Persons within the state of Florida designated by Owner upon whom notices or other documents may be served as
Name and address:
8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided
in Section 713.13(1)(b), Florida Statutes.
Name and address: y�
fx
9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a
6 N6 A) Prepared by / P5
PAUL ARIAS
i •' egQN_#DD186411
EXPIRES: FEB 20, 2007
Bonded through Advantag
111111111111111111111111111111111111111111111
s: 935,A1.u/, 3/ fd�o�uE
"4,5u Ire D.
PoiuP/WW Sii�I� fL
?069
!Tam: Cho= VGC"
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 7/2/2004
Parcel # 1132060132540
Applicant: DOUGLAS
Owner: MCLAUGHEN
JOB ADDRESS: 126 NE
Contractor SEARS ROEBUCK & CO
Local Phone: 954 - 590 -2203
Signed: (INSPECTOR)
W �' � � `►r►1��11 Ill W�I W �i �il � � � �� � � Ill
Permit Number: MC2004 -114
MCLAUGHEN
DOUGLAS
97 ST
Fees:
FEE2004 -6583
FEE2004 -6584
FEE2004 -6585
FEE2004 -6586
Description
Building Fee
CCF
Training and Education Fee
Technology Fee
Total Fees:
Amount
$100.00
$4.20
$1.40
$2.50
$108.10
Total Fees: $108.10
Total Receipts: $0.00
Contractor's Address: 6801 w. sunrise blvd.
Permit Status: APPROVED Permit Expiration: 12/27/2004 Construction Value: $6,504.00
Work: A/C REPLACEMENT 4 TONS
Signed: (Contractor or Builder)
Legal Description: 1 53 41 6 53 42 MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 10 & W5FT LOT 9 & E1/2
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 responisibility for all work
done by either myself, my agent, servants or employes.
BY:
Page 1 of 1
•
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20m11j
Address
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT A
305-795-2204
B ilding Inspection Requeste&Zea_
AaA'
DatC j 60 r • /
142
Type Insp'n
Permit No.
Name
Company _
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Phone #
Inspection Date
Approved IJ
Correction ga, //2"e-- ;760'‘,/
Re-Insp'n Fee EJ
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MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305-795-2204
Building Inspection Request(,-;th,/,',''
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Type Insp'n !.-
Permit No
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Name
Address
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Inspection Date
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BUILpING
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SHORES VILLAGE
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