842 NE 96 St (12)MIAMI SHORES VILLAGE
• BUILDING DEPARTMENT
305- 795 -2204
Buildi nspection Request
Approved
Re- Insp'n Fee
Date
Type Insp'n
Permit No.
Name
Address ( PO" 6
Company AA
Phone # U 6772- q-
Inspection Date
0
BUILDING
PERMIT APPLICATION
FBC 2001
Miami Shores Village
Building Department
Permit Type (circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) Cs-41-41 Phone # ? >
Owner's Address ' t Z
City \•\ - ssm. -S State
Tenant/Lessee Name
Job Address (where the work is being done) A..g91) --
City Miami Shores Village County Miami -Dade
Is Building Historically Designated YES NO -
Master Permit No.
Zip 3 ?�7��i
Permit No. 1 I
Phone # --
Zip -g
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Contractor's Company Name �-t-1 Phone #
Contractor's Address
City State Zip
Qualifier
Architect/Engineer's Name (if applicable) ► . Phone #
Architect/Engineer's Address
City State Zip
$ Value of Work For this Permit Square Footage Of Work: (GO
Number of: Bays Stories Families Bedrooms
Type of Work: DAddition ❑Alteration New ❑ Repair/Replace
Describe Work:
Baths
❑ Demolition
I 0 , - . * * * * * ** * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
County Escrow Fee $ I j Permit Fee $ AO Zotary $
Education/Training Fee $ if _ , • Tech $ 4t Scanning $ Radon $
Code Enforcement $ % and $ Struct. $
Minus Plans Check Fee $ Total Fee Now Due $ (Continued on opposite side)
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
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 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 inspect '• ich occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will . = approved and a reinspection fee will be charged.
Signatur
Owner . r Agent Contractor
The foregoing instrument as 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
as identification and who did take an oath.
As identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: Print:
My Commission Expires: My Commission Expires:
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
State Certificate or Registration No. Certificate of Competency No.
***************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ********************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY: S FEB 0 9 Plans Examiner
Engineer
Zoning
chc7/7 /03
(Certificate of Competency Holder)
Signature
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SURVEY CERTIFY TO : — A'(
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THE ATTACHED SKETCH OF BOU
REPRESENTATION OF A FIELD
STANDARDS AS SET FORTH BY 1
61G17 -6 FLORIDA ADMINISTRATI\
FOR: I IJqQ L1 Q(
JOB NUMBER 0 .05
F.B. NO. �►
DRAWN BY: L
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 2/22/2005
Applicant: CLINTON
Owner: STAPLES
JOB ADDRESS: 842 NE 96
Contractor
Local Phone:
Parcel # 1132060142900
Signed: (INSPECTOR)
Building Permit
Permit Number: BP2005 -194
STAPLES
CLINTON
ST
Contractor's Address:
Page 1 of 1
Legal Description: MIAMI SHORES SEC 3 PB 10 -37 LOTS 5 & 6 BLK 75 LOT SIZE SITE VALUE
Fees: Description Amount
FEE2005 -2294 Building Fee $160.00
FEE2005 -2295 CCF $0.60
FEE2005 -2296 Notary Fee $5.00
FEE2005 -2297 Technology Fee $4.00
FEE2005 -2298 Training and Education Fee $0.20
FEE2005 -2299 Scanning Fee $6.00
FEE2005 -2300 Submittal Fee ($50.00)
Total Fees: $125.80
Total Fees: $125.80
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration: 8/8/2005 Construction Value: $500.00
Work: WOOD FENCE
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.
Signed: (Contractor or Builder) BY:
•
•
}
Owner's Name and Address_
New Building
Afr
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
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.
Registered Architect and /or Engineer _�
Name and address of licensed contractor — __4"0! ?1 __ — 37 4 -ar a
Location and legal description of lot to be built on:
Lot Block Subdivisi
Street and Number where work is to be done
State work to be done and purpose of building (by floors )_ if
2'
7
an for no other purpose.
Repairs No. of Stories__—_—__—
Remodeling Addition
To be constructed of KindAlaut da Roof Cover
p ��
Estimated Total cost of improvements $__ -- -�� — __ —_ -- Amount of Permit $
Zone cubage required _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 are 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 (Si
(Signed) _Jr- 9 j
g )--
Date • l [/ 119S
No.84/ 2 Street_a _E
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oa 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
therein by him stated are true. p
Permit No / 7 6 4 Date /l p � G ' ' Read, Sworn to and Subscribed before me.
Disapproved Date r +
' ' Notary Public, State of Florida
( Signed) ',� % v� ,
Building Inkpector 1) l d �
J / My Commission Expires
PLANNING BOARD DATE
Chairman Member -
Member Member
Member Member — _ — — ^—
Council Approved Date Disapproved Date
NOTE: A. charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re-inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
•
MIAMI SHORES VILLAGE
BUILDIN ". INSPECTION DEPARTMEN
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the det.iled statement of the plans and specifications herewith submitted for the build-
ing or o he structure her. i.. described. This applicatio■ is made in compliance and con w.th the Building Ordinance of Mia. ii
Shores Villae Flor'da, and all pro% isions of the Laws d the State.: of Ftrid.. all o d nances Mi . Shores Village and all rules and
regulations of the Building Div.: f•ti of :N.ciarri Shor; . illage F '1 ',e noi ipl.ed with, whether herein specified or not. A copy of approved
plans .1 n d specificati •n must be kepl at building durin progress of tl.e wcrk.
Owner': Name and Address
\Pfk./V't
Registered Architect and/or Engineer.
Permit No
Disapproved ______ _ .........
(Signed) ......
Neig
0. 6
Name ind address of licensed contractor. _42
Location and legal description of lot to be builslp:
r
Lot ------ Block. 7 Subdivision \
Street and Number where work is to be done_
4.
State work to be done and piirpose of building (by floors)
New Building_ Remodeling__
To be constructed of_ _ _ Kind yf foundation Roof Cov.lring
Estimated 1 - ,tal cost of improvements $__. 11 6r°
`-------rlti of Permit $
Zone cubage required _Plan Cubage
Distance to next nearest building__ _ Size of Building Lot
Maximum live load to be borne by each floor
. 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 unde signed applicant for this building permit does hereby certify that he understands and accepts his i.bligations as an employer
of I; bor under he Florida Workmen's Compensation Act being Section 5966, Col - pled Gen al Laws of Florida. P. r anen. Supple tient,
and has complied with the provi.ions thereof, and will require similar compliance from all contractors or sub-contractors emplo-ed 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 su.th ublic noti-e
or notices as are required by the Act. The undersigned agrees to employ only such bcont c
permit, as are licensed by Miami Shores Village.
Remarks__ (Signed)._
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally Pp-
peared
and who, being by me first duly sworn, upon oath deposes and says that he is the
of th abov. described • oistruction. ti-.:t hi has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are trie.
Date_ / l
Read, Sworn to and Subscribed before me.
Date_
ii ri Date Jo- g,5- , 19
No
Street.
Addition . Repairs.
PLANNING BOARD ........ DATE
Chairman Member
Member Member
Member _ Member
Council Approved. _Date Disapproved
NOTE: A charge of $1.00 will be made for making corrections or changes to this application .ift'r approval his been obtained from
the Planr:ng Board.
A re-inspection fee of $1.00 will be charged when such re-inspection is male necessary by improper notice for inspeti or fa. ity
materials and/or workmanship.
Notary Public State of Florida
My Com:nission Expires.
an
No. of Stories. ..
IA
s, on work to be petforni a . der this
r no other purpose.
.to me well known,
Date