DS-13-42PERMIT # V3 1 5 — L
CONTRACTOR:
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SUBMITTAL DATE: "' !
1 ..,7
ADDRESS:
NAME: VL,.�^^�, �i ,,
t'vi ) is A. I . f i S k.....
RESUBMITAL DATES:
PROJECT TYPE: ����J
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j��ILI `, ���IV
FIRE
STRUCTURAL
IMPACT FEES
ELECTRICAL
HRSIDERM
PLUMBING
NOC
MECHANICAL
BLDG -- -
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
a11UI� G
PERMIT APPLICATION
FBCZO�� 2
Permit No.
DS --~`�
Master Permit No.
Permit Type: BUILDING ROOFING
JOB ADDRESS: 74o74514 L I6 3 At W - /6 ! Sr-
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #: k err 15" c 25 -J)- Aar jq A'/ l 23 a Ain /A f2 )DAR K
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): Ai d t- clods. L7� Phone#36 3/0 ` % 73
Address: �0 /il n 3 s U I d/ Sr
City: / %'! tia / ,S`j bet'S State: % Zip: 33 /5-6
Phone#:.305 - 3 J n s`173
Tenant/Lessee Name:
Email: 9ec :04 y AteriSQ Ike" / /sou`2(•i�/
CONTRACTOR: Compan Name::
Address: /i- 7/ 4/`1//j 74/1
City: /d,C
////�� 4�. / �d State:
Qualifier Name: 1 !/(/ a �p � G.Ati.�'`
r' i - .r si:= Phone #a - ‘2,g
Zip: 32a $
Phone #: �7 ".,,Z7 7 -.2-15//
l
State Certification or Registration #: Certificate of Competency #: +L,
Contact Phone #:. c> 68' 95_5 r Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ , 700. CO - .. ,y Square/Linear Footage of Work:
Type of Work: ❑Addition CIAlteration Jule
Description of Work: 4tczIl_ ✓��'G /U' fl-
DRepair/Replace
si
ODemolition
Color thru tile:
*** * *** * ** : **** :*** ******** :***+x******* Fees****: x********** *+ u**** ***** ***********+x******
Submittal Fee $ Permit Fee $ CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ '3� 0
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 MR 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 d a rei pection fee will be charged.
or Agent
The foregoing instrument was acknowledged before me this
day of Q e , 20 / &. , by ,4a S
Signature L/ l MN
Con . ctor
The foregoing instrumen as acknowl9oiged before me
, day of /J e ( , 20 ! Z by At +t ' `Zc . l % r.a444
who is personally known to me or who has produced
As identification and who did take an oath.
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
*** * * * * * * * * * * * * * * * * ** * * * * * * * * * * * ** ** ****** * * * * * ** * * * *** * ** ** * * * **t *** ** **
i3
APPROVED BY A71//e- ' 4' 7 3 Plans Examiner
Structural Review
(Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09)
Zoning
Clerk
Miami Shores Viiiage
Building Department
RECEIPT
PERMIT #: (2/( DATE:
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
)
Contractor
o Owner
0 Architect
Pic 2 sets of plans an other
Address: 103 OV 1 0) St
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 Department to conti - pe ;ittiii process.
icar
Acknowledged by:
PERMIT CLERK INITIAL:
RESUBMITTED DATE:
PERMIT CLERK INITIAL:
Rick Scott
Governor
John H. Armstrong, MD, FACS
Surgeon General & Secretary
February 19, 2013
Robert Dickerson
163 NW 101 Street
Miami, FL 33150
RE: Contingency Letter
Application Document No: API096923
Centrax Permit Number: 13 -SC- 1454754
OSTDS Number:
163 NW 101 St
Miami, FL 33150
FEB 2 0 2013
l 3,� 2
Lot:15 Block:2 Subdivision: Bonmar Park
Dear Applicant:
This will acknowledge receipt of an application dated 02/08/2013 for a permit to use an
existing onsite sewage treatment and disposal system located on the above referenced
property.
From a review of your completed application, it has been determined that your existing system
is adequate for the proposed use (driveway construction).
If you have any questions on this matter, please call our office at (305) 623 -3500.
Enclosures
cc:
Sincerely,
Jose • ineer Specialist II
Miami -Dade County Health Department
1725 NW 167 St, Opa Locka, FL 33056
Phone: (305) 623 -3500 . Fax: (305) 623 -3645 . http: / /www.MyFloridaEH.com
Estate Can= Ay
Ovl° Years
We -need to take
every opportunity
pos;able to thank our
amazing clients
for theh- support-
Tha nk You I !
Mm Shores Shores Village
LOT 9
BLOCK 2 p
air
LOT 10
BLOCK 2
APPRO\JED
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sL'El_,_JECT 1.0 NCE WI (1-1 ALL FEDERAL.
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