DS-05-1046 (2)BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type (circl Building Electrical
Owner's Name (Fee Simple Titleholder) ^� N
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida. 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Plumbi g
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Owner's Address t24 A 1\ 0 S ��•as)
Tenant/Lessee Name
Job Address (where the work is being done)
City Miami Shores Village
FOLIO / PARCEL #
Is Building Historically Designated YES
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $ P, Zb 0
J ._
Submittal Fee $
Type of Work: ['Addition ['Alteration
Describe Work:
Permit Fee $
'r
Notary $ Training/Education Fee $
Scanning $ Radon $
County Miami -Dade
DPBR $
Bond $ Code Enforcement $
Structural Review. $
Double Fee $
Permit No. 10 to
Master Permit No.
Phone #
CCF $
hone #
a
City � n-gba: SV.-'•`^ State Zip
L2Q �1 Ile, simoLV"
Mechanical
OCT lacmciuml
at o s coos !J
B
Roofmg
Zip
Contractor's Company Name Q0V0-(OL c Q)¢ Phone #
Contractor's Address t`o` S 1 g Cho -A'
City • J
h' � eSta.n.. State * Zip
Qualifier Name a,.../.• n• •6 Phone #
State Certificate or Registration No. Ct ,Ch 32. 2 Certificate of Competency No.
Pe Y
Phone #
Square / Linear .Footage Of Work:
['New 1J Repair/Replace
CIA) 32 ‘ -21.4
`a33 1S
(.7g -326_4041
* * *** * * ** ** * * * * * * ***** * * * * * *, * *, **** F * ** *4** * *** ** * **, *** * * * *,r, * ** * * * *;r* * * ***
CO /CC
❑ Demolition
*
Technology Fee $
Zoning $
Total Fee Now Due $
See Reverse side -3
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 Ls subject to attachment. Also, a certified copy of the recorded notice of commence ent must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued In the t of such posted notice, the
inspection will not be approved and a reinspection fee will be charged
Signature
Sign
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
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 Comnission Expires: My Commission Expires:
7
APPLICATION APPROVED BY:
(Revised 02/08106)
Plans Examiner
Engineer
Zoning
Inspection Date: 10/18/2006
Inspector: Grande, Claudio
Owner: BERMUDEZ, LINA
Job Address: 124 110 Street NE
Project <NONE>
Miami Shores Village, FL 33161-
Contractor: RELIABLE CONCRETE CORP.
Building Department Comments
Tuesday, October 17, 2006
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit Type: Driveways /Sidewalks/Slabs
OCT 1 9 2006 Inspection Type: Foundation
Work Classification: New
Block:
Phone Number (305)758 -1427
Parcel Number 1121360040420
Lot:
Phone: 305/229 -4945
Page 2 of 2
L
Passed
°
Inspector Comments
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Inspection Date: 10/18/2006
Inspector: Grande, Claudio
Owner: BERMUDEZ, LINA
Job Address: 124 110 Street NE
Project <NONE>
Miami Shores Village, FL 33161-
Contractor: RELIABLE CONCRETE CORP.
Building Department Comments
Tuesday, October 17, 2006
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit Type: Driveways /Sidewalks/Slabs
OCT 1 9 2006 Inspection Type: Foundation
Work Classification: New
Block:
Phone Number (305)758 -1427
Parcel Number 1121360040420
Lot:
Phone: 305/229 -4945
Page 2 of 2
Bill To I
LINA BERMUDEZ
124110 Street NE
Return to:
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Date Fee Name
10/11/2006 Scanning Fee
10/11/2006 Revision Fee
Wednesday, October 11, 2006
Invoice
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Invoice Number: DS -10 -06 -26373
Invoice Date: October 11, 2006
Permit Number: DS -12-05 -1046
Permit Type: Driveways /Sidewalks/Slabs 'E' Work Classification: New
Fee Type
Calculated
Calculated
Fee Amount
$3.00
$35.00
Total Fees Due: $38.00
OCT 16 PAID
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ACCORDING TO TI-E NATIONAL FLOOD UNSURANCE PROGRAM THE SUBJECT PROPERTY
commturt No.: PAWL. SUFFIX- DATE OF FRM FIRM
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