BP-05-733Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 6/3/2005
Building Permit
Permit Number: BP2005 -733
Applicant: ALAN DOMBROWSKY
Owner: DOMBROWSKY ALAN
JOB ADDRESS: 1420 NE 102 ST
Contractor ARROW ASPHALT & ENGINERING INC Contractor's Address: 14799 NW 117 AVE
Local Phone: 305 - 556 -5702
Parcel # 1132050240220
Legal Description: MIAMI SHORES BAY PK ESTS AMD
Page 1 of 1
PB 56 -86 LOT 5
Fees: Description Amount
FEE2005 - 7167 Building Fee $125.00
FEE2005 - 7168 CCF $1.80
FEE2005 -7169 Training and Education Fee $0.60
FEE2005 -7170 Technology Fee $3.13
FEE2005 -7171 Scanning Fee $3.00
Total Fees: $133.53
Total Fees: $133.53
Total Receipts: $0.00
1(3422
Permit Status: APPROVED Permit Expiration: 11/14/2005 Construction Value: $2,500.00
Work: RESURFACE EXISTING ASPHALT DRIVEWAY
Signed:
(INSPECTOR)
In consideration of the issuance to me of this permit, 1 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:
BLK 3
D
Type Insp
Phone #
Inspection
Correction
Re- Insp'n Fee
515 4/
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Permit No. G 1.11-11°
Name Ac la n 113(D1'Yl to r - 3s i
1420 Na L C72- ST
Company A / A phcc 1 4
(3cs) 5.5G - 5 2
Date ° /23 / c
(lkitz& 6 1sjoS
Q-
-o Pick via
C
BUILDING
PERMIT APPLICATION
FBC 2001
$ Value of Work For this Permit
Type of Work: ❑Addi(.ion
Describe Work:
Total Fee Now Due $ B .��
(Continued on opposite side)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, MV iiami Shores, Florida 33138
Tel: (305)- 5 204 F ag� n �30 �� 5) 756 972
MA 1 8 2825 Permit No. 6pOJ" 1,
M ter Permit No.
Contractor's Company Name / 4fV phone # 303 5 5762
Contractor's Address / /17G/// /74Vc
City ih aide `r State ck_ Zip '3 40 /f
Qualifier Midi a 2 f M Ca. tai -le C
Permit Type (circle): Building Electrical Plumbing Mechanical Roofmg
Owner's Name (Fee S' le i e o er) A) )Qf)7b -,OWS Phone # ®5 -75b - gd 9b
Owner's Address / A 0 /02 sr
Cit /4i apy GS' /iorer state n Zip 3,3 / 21
Tenant/Lessee Name /1//A Phone #
Job Address (where the work is being done) /VA. 0 /1/e /0,2 ST
City Miami Shores Village County Miami -Dade Zip 33/ 3ef-'
Is Building Historically Designated YES NO
Architect/Engineer's Name (if applicable) Phone #
[ � DAlteration � ❑New .Re p air/R eplace
Square Footage Of Work: /g26 ‘5 /7'
❑ Demolition
d
Submittal Fee $ Permit Fee $ /2.5 - CCF $ I . $1 -� CO /CC
Notary $ Training/Education Fee $ . 6� Technology Fee $ 3,13
Scanning $ g.ct Radon $ Zoning Bond $
Code Enforcement $ e 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 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 lee&t.t.,
Owner or Agent
The foregoin instrument was acknowledged before me this /9
day of �� 200S , by / /Arl bill) SLL��
. oho is personally known to mor who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: r 441
My Commission Expires: i 1- ly
arwa n 441,44-/-
**** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
Chc 12/15/03
/4
Signature
The forego,'
day of
who is pers
1 „ p'vB,� JANY GARCIA
i i ° .'" ; Notary Public - State of Florida
G _ ,2008
Commission # DD 349724
" F `' Bunded By National Notary Assn.
(Certificate of Competency Holder)
Contractor
strument was acknowl 2d before me this / 7
200,1, by r rhi9e6 //4/0
y known to m)or who has produced
as identification and who did take an oath.
• —
°�" JANY GARCIA
� ; Notary Public - State of Florida
2008
•pis a' Commeslon # DD 349724
`,
®`'''t Bonded By National NotaryAssn.
My Commission E xpires: Z rti -Mg ' - - - " - -
Y PUBLI
Sign: T���
Print: S te/ 1 �_t�N `�+
`
State Certificate or Registration No. Certificate of Competency No.
************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Plans Examiner
Engineer
Zoning
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-, THOM S - Y , INC.
L.B. #6486
SURVEYORS- MAPPERS -LAND PLANNERS
8125 SW 120 STREET PINECREST, FLORIDA 33156
(786) 242-7692 DADE (954) 779 -3288 BRWD
(786) 242 -6494 DADE FAX (954) 779 -3260 BRWD FAX
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