DS-10-403BUILDING
PERMIT APPLICATION
FBC 20
Owner's Name ,p `tr�.: a older)
Owner's Address S30 1•.) (CO kit elk
City 7Z chat/j State FeCnioiw
Tenant/Lessee Name
Email i P /4 T, ra- - e
City Miami Shores Village
FOLIO / PARCEL #
Is Building Historically Designated YES NO X
Miami Shores Village IEVMIId
Building Department A �'
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 ':
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
Permit 5
No. 1)5 10 4(Y3
Master Permit No. 6 q — 11C
Zip
County Miami -Dade
Architect/Engineer's Name (if applicable) Phone #
Phone # l ®Cr " — 0 +3‘8
33/.‘f
Phone #
Job Address (where the work is being done)
Zip 13/1
Flood Zone
Contractor's Company Name Phone # (5Z/) - 1- 33 7)
Contractor's Address 30 G 5 t J t L/ 3/
City / r+ k r k E GL State FI- Zip 3 33/ 2_
Qualifier Name )4/I K c& r P Phone #
State Certificate or Registration No. e 6 [`... / 5 D'78- 3D Certificate of Competency No.
Contact Phone E -mail
Value of Work For this Permit $ 4P Square / Linear Footage Of Work: 11, 00
Type of Work: ❑Addition ['Alteration ❑New J ❑ Repair/Replace ❑ Demolition
Describe Work: r i' . _ ... ,' yews /f9 '1i& . r!i e / 67,cr d
********* * * * * * * * * * * * * **** * * * * * *,x * * * * * ** F ees * * * * ** ** * * * * * * * * * ** * * * * * * * * * * * * * * * ** * * * * *r
Submittal Fee $ • 03 Permit Fee $ /21" CCF $ 3 0J CO /CC $
Training/Education Fee $ ,_lxJ
Radon $ DPBR $
Violation date:
Technology Fee $ 400
Notary $ -^
Scanning $ °L•OD
Double Fee $
Structural Review. $ Total Fee Now Due $ f4 Of
Bond$
See Reverse 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, PLUM BING, 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.; i!In the absence of such posted notice, the
inspection will not be , ..roved and a reinspection fee will be charged.
Signature
Sign:
Print:
The fore trument was acknowledged before me this ,1 �' The foregoin instrument was acknowledged before me this oil
day o 1 ,1, 20(� , by � day o , 2010, by
who is personally known. to me or who has produced who is personally known to me r whys prod ced
As identification and who did take an oath. "i as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
My Commission Expires:
! n ,•ti; p: •., Valeria Sim Oe
- C.'. 11S
��COMMISSIOlY #DD809582
* * * * * * * * * * * * * * * * * * * * * * ** 4 ee► JttYmIP1* * * * * * * * * * * * * * * * * * * **
WVVW.AAR0NN0TARYcom
APPROVED BY 4 J 4 Jb Plans Examiner
(Revised 07 /10 /07)(Revised 06/10/2009)
Engineer
Sign:
Signature 7 LP /_
Contractor
Print:
My Commission Expires: 0�.,��+l.•,y Vai Sine
. ° 8115
?: r; x:eCOMMISSt0N#D0809582
i •`= EXPIRES: JULY 29 2012
title ****9:** **:�'Sha� aY 1r ;.;.,., ...r'. MN*
Clerk checked
in and Zoning Criteria
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Owner's Name: BENJELLOUN HASSAN
Job Address: 230 107 Street
Miami Shores, FL 33161-
Contractor(s)
AJ'S CONSTRUCTION GROUP INC
Planning and Zoning Criteria and Comments
Approved: Yes Date Approved: 4/7/2010 : Yes
Comments: DIMENSION PLAN SHOWING DISTANCE FROM WATERS EDGE AND POOL DECK TO ALL LOT LINES
CAN NOT PLACE POOL DECK OVER SEPTIC SYSTEM
REQUIRES HRS REVIEW APPROVAL
Phone
(954)562 -3371
Permit NO. DS -3 -10 -403
Pam T : Dr sidewalk tl bs
", Work a :�tcl to i /Alteratlor
d Expires:NOt Issued
Folio Number:1122310130670
Owner's Phone:
Total Square Feet: 1600
Total Job Valuation: $ 4,800.00
Primary Contractor
Yes
3/22/10
SECURE HRS APPROVAL IN WRITING THAT THEY ARE ALLOWING PAVERS OVER THE SEPTIC DRAIN FIELD.
4/7/10
NEW PLAN OK ZONING APPROVAL IS FOR POOL DECK ONLY.
PERMIT #:_t1.5/ DATE: � /a
I-14s< odd (Sevretwotu
❑ Contractor
Ns Owner
❑ Architect
Picked up 2 sets of plans and (other)
Address: 2 3 0 J E (/ c'� ? Ch t r—
rie dA.: tilt/1.4 •
From the building department on this date in order to have corrections done to plans
- And/or get County stamps. I understand that the plans need to be brought back to Miami
Shores Village Building Depa ent to continue permitting process.
Acknowledged by: \
jei ilk o
t
PERMIT CLERK INITIA,= � � /
RESUBMITTED DATC1� )
PERMIT CLERK INITIAL:
RECEIPT
Miami Shores Viiiage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Planning and Zoning Criteria
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Owner's Name: BENJELLOUN HASSAN
Job Address: 230 107 Street
Miami Shores, FL 33161-
Contractor(s)
AJ'S CONSTRUCTION GROUP INC
Planning and Zoning Criteria and Comments
Approved: No Date Denied: 3/12/2010
Comments: DIMENSION PLAN SHOWING DISTANCE FROM WATERS EDGE AND POOL DECK TO ALL LOT LINES
CAN NOT PLACE POOL DECK OVER SEPTIC SYSTEM
REQUIRES -REVIEW APPROVAL
?i - /0 Sr•tc c7t c
f %'pc., k 2 1%°4-f;� a ri.( f -/er y 20.xt
Issue Date: Not Issued
Folio Number:1122310130670
Owner's Phone:
Total Square Feet: 1600
Total Job Valuation: $ 4,800.00
Job Address: 230 107 Street
g Criteria
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Owner's Name: BENJELLOUN HASSAN
Miami Shores, FL 33161-
Issue Date: Not Issued
Permit NO. DS- 3- 10-403
Expires:
Folio Number:1122310130670
Owner's Phone:
Total Square Feet: 1600
Job Valuation: $ 4,800.00
Contractor(s)
AJ'S CONSTRUCTION GROUP INC
3 y13
rr Ocia• ( a A e
Phone Primary Contractor
(954)562 -3371 Yes
Planning and Zoning Criteria and Comments
Approved: No Date Denied: 3/12/2010
Comments: DIMENSION PLAN SHOWING DISTANCE FROM WATERS EDGE AND POOL DECK TO ALL LOT LINES
CAN NOT PLACE POOL DECK OVER SEPTIC SYSTEM
REQUIRES HRS REVIEW APPROVAL
3/22/10
SECURE HRS APPROVAL IN WRITING THAT THEY ARE ALLOWING PAVERS OVER THE SEPTIC DRAIN FIELD.
Inspection Number: INSP- 137805
Scheduled Inspection Date: July 29, 2010
Inspector: Bruhn, Norman
Owner: HASSAN, BENJELLOUN
Job Address: 230 NE 107 Street
Miami Shores, FL 33161-
Project: <NONE>
Contractor: AJ'S CONSTRUCTION GROUP INC
Building Department Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
July 28, 2010
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
For Inspections please call: (305)762 -4949
Permit Number: DS- 3- 10-403
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1122310130670
Phone: (954)562 -3371
Page 3 of 25