DS-12-2347PERMIT #
CONTRACTOR: Pfk\lfi---(2 Alart) $(2-444.--.
SUBMITTAL DATE: 1-11 t \it_ °°
:
ADDRESS E OY 5
NAME: ', \ ■
RESUBMITAL DATES:
PROJECT + • E:1/ ‘,..K`J
,,, ,
ZONIA
FIRE
STRUCTURAL
IMPACT FEES
ELECTRICAL
HRSIDERM
PLUMBING
NOC ' ^ \,�
MECHANICAL
BL�C�__
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 182830 Permit Number: DS -12 -12 -2347
Scheduled Inspection Date: February 13, 2013
Inspector: Rodriguez, Jorge
Owner: SAMMONS, ROBERT
Job Address: 258 NE 100 Street
Miami Shores, FL
Project: <NONE>
Contractor: PAVERS AND BRICKS SERVICES CORP
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number (305)754 -2689
Parcel Number 1132060134460
Phone: (305)986 -2544
Building Department Comments
REPLACE ASPHALT WITH CONCRETE DRIVEWAY
Infractio Passed Comments
INSPECTOR COMMENTS
False
Inspector Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
February 12, 2013
For Inspections please call: (305)762 -4949
Page 7 of 30
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BL 4. itrscs SHOM'N, HERCO■ (ff .1S1 't akE REFERED TO AN 1SSt1 D .■g 3.IDIAN OF
FOR THE CENIERI. Ls/ OF
Miami Shores Village
Building Department
'10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC20k'D
Permit Type: BUILDING ROOFING
OWNER: Name (Fee Simple Titleholder): A NNE </// e /V9YE-
Address: .2 5 0 E / d® g1-►Te -e
City: // At/i / SAL®k_>= State: ,L Zip: l
DEC 112012
Permit No. 5 Q — an-
Master Permit No.
Phone #: 3 ac 7,5 2 7
Tenant/Lessee Name:
Email:
Phone #:
JOB ADDRESS: S73 A/t 5-t d P®
County: Miami Dade Zip: ,.'3 3. t
City:
Folio/Parcel #:
Miami Shores
Is the Building Historically Designated: Yes
Flood Zone:
CONTRACTOR: Company Name: 131/fle,:,5 4 a Co cis w iti (i(.5 Phone #: .705 . S qq ca 7/
Address: _I q k/ lAJ I
City: ti OM 1 State: r t zip: 169
4
Qualifier Name: .Fioi, 1 T i , A 6T /. kiCgZ Phone #: . �.,'? ', if , 1 110? I
State Certification or Registration #: Certificate of Competency #: Ew 006749
Contact Phone #: -41% "lL /, '/ & Email Address:
DESIGNER: Architect/Engineer: /° Phone #:
Value of Work for this Permit: $ 3 0 0
Type of Work: Addition ❑Alteration
Square/Linear Footage of Work: ! I s—se 17Z-1
��
Description of Work: �a��� ���(� '� %/� 1 y �
`F
ORepair/Replace DDemolition
s,
Al rIk 11 &'A
1
Submittal Fee $S V
Scanning Fee $
Notary $
Double Fee $
NEP
.)
Permit Fee $ tS 0
Radon Fee $
Training/Education Fee $
Structural Review $
**
CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $ l 1
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature ric
Owner or Agent
The foregoing instrument was acknowledged before me this IC)
day of DEC , 201? ., by `?1 i\10<G °Al
•
who is per onall known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Signature
Contractor
The foregoing instrument was acknowledged before me this 10
day of D6C , 20 , by RAJA D. F 0A/ PR
wh ersolaal known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
My Commission Expires: 4j tt$,ka5 ?o1N v ii 6iimm hope m
My Comis it
* MYCOIIJJJS$ ON 1EE 135306 * u1 COMMISSION*
* a o 1 EXPIRES: Novembef 15, 2015 EXPIRES: Nwembet 15,2015
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APPROVED BY
Plans Examiner
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)