94 NE 100 St (4)Date
Fl I GU i NO WS
Permit No. `l LVU V/w
Name 5.)Wr
Address 0 1 t +-
Type Insp'n
Company &(LC
Phone # j
Inspection Date
Correction
MIAMI SHORES VILLAGE ( k.
BUILDING DEPARTMENT /6
305 -795 -2204
Buijding Inspection Request
Re- Insp'n Fee ❑
City Ana Ad 4 ,kees State /,C
Tenant/Lessee Name A/q
Miami Shores Village
Building Department
10050 N.F n d Avenue, Miami Shores, Florida 33138
Tel a 1 756.8972
BUILDING N WY 2 2004
PERMIT APPLICATIO
FBC 2001
Permit Type (circle): t uild' Electrical Plumbing
Permit No. 6) (.* — (OS3
Master Permit No.
Owner's Name (Fee Simple Titleholder) 0 i ao..)9�1r # 6U,Q Phone # ( %) 751- 9795
Owner's Address 77' �G /o ' 5
Zip .33/33'
Phone it
Mechanical Roofing
Job Address (where the work is being done) 94 /ye /gar* J/
City Miami Shores Village County Miami -Dade Zip ,33/38
Is Building Historically Designated YES NO X
Contractor's Company Name Aid 6,�Q,ss Gdi,/L�i a Phone # (d..5) ,,,34 _.„2/
Contractor's Address 'f /. *57' 8`" ' 't
City kd,4QGi State /7 Zip ..9,30/1 1
,
Qualifier /OW r7 �C # 97/15M 2ij
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Permit i 8' 2 , 00
Type of Work: EAddition
Describe Work:
Submittal Fee $
Notary $
Scanning $ /5'^
Code Enforcement $
(Continued on opposite side)
['Alteration
❑New
Square Footage Of Work: 220 S, 9/f'
XI Repair/Replace
7-
Total Fee Now Due $ 1 is 1s
1 /Joe sj • 1&'
X
9 aw - t 3.4/94 #l9'!
****************************F
Permit Fee $ i..7 e �' CCF $ 7 ea co.
Training/Education Fee $
Radon $
' . 6 0 Technology Fee $ ! 7
❑ Demolition
Zoning Bond $
Structural Plan Review. $ �'
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 constriction 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
Owner or Agen
The foregoing instrument was acknowledged before me this
day of , 200`{, by
who is personally known to me or who has produced
NOTARY PUBLIC:
Sign: I.Jet:kJ
Print:
LOIS E. LINDLEY
COMMISSION If CC978568
* * *tE **
My Commission Expires:
**************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
Chc 12/15/03
)
As identification and who did take an oath.
State Certificate or Registration No. Certificate of Competency No.
Contractor
The foregoing instrument was acknowledged before me this /3'
day of g , 200 Y , by ecw / 7 &) err e,-0
who i
to me or who has produced
as identifica ' en and who did take an oath.
NOTARY P
1
Sign:
Print:
My
mpetency Holder)
ommission Expires: /a
d`" "'ll Rosa I. Palados
uI,w.',.i 1IOTA I$
rztg, Bxpires Dec. 28, 2005
dr
% %`% Atlantic Bonding Co, me.
*********************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
MAY 2 6 2004
Plans Examiner
Engineer
Zoning
1
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 5/27/2004
Applicant: DONALD
Owner: SALTZBURG
JOB ADDRESS: 94
Parcel # 1132060131190
NE 100
Signed: (INSPECTOR)
Building Permit
Permit Number: BP2004 -683
SALTZBURG
DONALD
ST
Contractor YAMILL GLASS & WINDOW INC Contractor's Address: 480 W. 84 St. #107
Local Phone: (305) 826 - 2121
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 1 2 3 LESS W35FT BLK 9 LOT SIZE
Fees: Description Amount
FEE2004 -5344 Building Fee $150.00
FEE2004 -5345 CCF $4.80
FEE2004 -5346 Technology Fee $3.75
FEE2004 -5347 Training and Education Fee $1.60
FEE2004 -5348 Scanning Fee $15.00
Total Fees: $175.15
Permit Status: APPROVED Permit Expiration: 11/17/2004 Construction Value: $8,000.00
Work: REPLACE IMPACT GLASS WINDOWS 15 WINDOWS
Page 1 of 1
Total Fees ^$1 x I JP
Total Receipts: OMQ
)a iS
S
I D'
MAY 2 7 PAID
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:
NOTICE OF COMMENCEMENT 11111111111111111lUhl11111111111111111111111
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO. T A X FOLIO NO. 1'320 t 3 1 1 ) D
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.
Mt4►:.9.D Fi, ��3s'
1 Legal description of property and street/address:
S L Apr
M r,ci w► ros 1 Awn) PIQ �1 h l /�
3 1-o- - 70 I_o4s 1
q Oc' i ltvis — L(9 - 1 Z Ohs bDeb I l
2. Description of improvement: . -
3. Owner(s) name and address: P114 i n ,. /7j ,P
9g iffe /0 'I/ ,57 /tau/ 5 o nes , / .33/.3?
Interest in property: O■-.> V\Qf'S 4 (ICGv ti.0
Name and address of fee simple titleholder: 5ri1Y)? i95 ,(,JC
Q�f �C �y �/ Q � „Mae
L/ /ggr O 7 r# S ?'�O/ //,Q � rA t uttrl. arr� T�71 , GOh�NT DAtDE
cuuu C`
4. Contractor's name and address:
5. Surety: (Payment bond required by owner from contractor, 4 pply) ? y CL : rtrti a a: this ms a true co
orngmnar fitcd m t.ts office on _ Cay of
Name and address:
Amount of bond $
6. Lender's name and address:
Name and address:
diffe
Notary Public
Print Notary's Name
My commission expires:
123.01-52 PAGE 4 8/02
, AO 20
hj•d anti 0. Kitt Sear.
HARVEY F. nflN, GLEN:., or an County Courts
IBy
7. Persons within the state of Florida designated by Owner upon whom notices or other documents may be served as
provided by Section 713.13(1)(a)7., Florida Statutes,
Name and address:
Signature of Owner
Print Owner's Name ' 0 10 14L SLLT _ t 0 EG
Sworn to and subscribed before me this ji day of r0 (I L
CFN 2004R0356502
OR Bk 22297 P9 2249; t1P9)
RECORDED 05/13/2004 15:22:39
HARVEY RUVINv CLERK OF COURT
MIAMI -DADE COUNTY, FLORIDA
LAST F'AGE
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 Stat_t4e .
r Pr
9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a
Prepared by .
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