CC-11-227512-124 tt-6t(CA41%-s
BUILDING
PERMIT APPLICATION
FBC 20
Miami. Shores Village DECEIVED
DEC 07 2011
BY:
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
Permit No.
Master Permit Na Ce--?. t -15
Permit Type BUILDING ROOFING
OWNER: Name (Fee Simple V Titleholder): , ° 9 i 1 Phone# 16 ^ 15:,'5111
Address: V 0 Nil_ *),ri--A ai(%
City: MiCaYY1i(,tY,P_Cm• State: , zip: 331:4'
Tenant/Lessee Name: Phone#:
Rmail:
OB ADDRESS 5 n 1 .. c15ut N.E. a ()Nee_
J � �
City: Miami. Shores County: Miami Dade
Folio/Parcel#: 1 \ -?, 4(0- ol -3aoo
Is the Bu tiding Historically Designated: Yes NO Flood Zone:
Zip: S5V555
CONTRACTOR: Company Name: \V)V- e_o r r IJk.CiO f t , \lr t'_
Address: \ 01 05 5 \'s/ . d►�t.� e . uA
City: 1 y tO0mi `, +� State: V :.-
Qualifier Name: ?UCY"1, 1- I ej AA ''-�"' t�
State Certification or Registration#: Qt lJ. 0(0 0� (en
Contact Phone#: -1$(t) :5110 St Email Address:
DESIGNER: Architect/Engineer: �0
7&4O'2& '
. Phone#: 305--Q3(.1-051q
331'10
Phone#: On •1 (a- moo
-� Certificate of Competency #:
a'. Mt. R • I . 6,
Phone#: ?O5 -1614- D31cZY
Value of Work for this Permit $ `j? Sgaare/Linear Footage of Work: �'
Type of Work: C]Addition DiAlteration C]New C]Repair/Replace C]Delition
t5iNI stt$15-0s rl s ,'-
t
cfI - ( Zo f ,t cn4 r/ 3
Description of Work:
L l' MZ S
* * * ** axe * *** x** ** ** **** ** ** * * *** ** * * *** Fees************* * **** * * * ** ** * ** * * * * * * *** * ******
Submittal Fee $ r i r Permit Fee $ YQt'7 a CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ ' Structural Review $
TOTAL FEE NOW DUE $ 1 b - OD
Bondi g Company's Name (if applicable)
Bonding Company's Address
City State Tip
Mortgage Lenders Name (if applicable)
Mortgage Lender's Address
City State Tap
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 0,, : ,a a reinspection fee will be charged
Si
Owner Agent
The foregoing instrument was acknowledged before me this -Id" The foregoing instrument was acknowledged d jbefore me this 1 th.
day of , , t ! by �up ✓e S 4- (TO C ,9 -r7-7 day of , ,y , 2011, by `)U(' n 1 cJ)#1P'%^,
personally known to me who has produced who is2eisonalh� known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Signature
Fotk 6411(7
As identification and who did take an oath.
NOTARY PUBLIC:
Sign: .777-
Print l / vi , cif
My Commis.�iod rst n. y i tIe.NT9'X Op FLORIDA
y i : Yaniv Ofiir
I Commission #DD795680
Expires: AUG. 22, 2012
BONDED THRII A 41. .14P. !�,. ♦� �.
Structural Review Clerk
(Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15119)
u L-( A (J a-PC-AS Sf/fr*fl
r-ctO APv_ 'Tr-4/0204-
■.■
Total Due: $137.00 II
Invoice
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
For Inspections please call: (305)762 -4949
!Return to:
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Bill To
DVS LLC
9400 NE 2 Avenue
MIAMI, FL 33138-
Date Fee Name
12/07/2011 Scanning Fee
12/07/2011 Technology Fee
12/07/2011 DCA Fee
12/07/2011 Education Surcharge
12/07/2011 DBPR Fee
12/07/2011 CCF
12/07/2011 Permit Fee
Invoice Number: CC -12 -11 -42773
Invoice Date: December 07, 2011
Permit Number: CC -12 -11 -2275
Bond Number:
Comments:
Fee Type
Calculated
Calculated
Calculated
Calculated
Calculated
Calculated
Percentage
Fee Amount
$12.00
$8.00
$4.50
$2.00
$4.50
$6.00
$300.00
Total Fees Due:
$337.00
Payments
Date Pay Type
Check Number Amount Paid Change
12/07/2011 Check
1098 $200.00
$0.00
Total Paid: $200.00
Wednesday, December 7, 2011
• -r�®P C',:- FLORIDA, 001!:1-71 OF DADE
original .#
NOTICE OF COMMENcEMENT
A MONIED =PT i I3E POSTED WERE •IliSUE Arm OF RRSIINSPECTION
PERMIT NO. • • aq-1 5 TAX FOLIO NOM -MQ(G' O r SCIlO
STATE OF FLORIDA:
COUNTY OF MIAMI -DADE:
THE UNDEPOIGNED hereby gives notice that •;
property, and In accordance with Chapter 713, Florida E :-
is provided in this Nonce of Conunencement
wfl be made to certain real
thefoilowing irrformatfon
:•.
111111111111111111111111111111111111111111111
CFN 2012R00034-87
OR Bk 27949 Ps 16671 (fps)
RECORDED 01/04/2012 09:09:17
HARVEY Ri1VINr CLERK OF COURT
MIAMI -DADE COUNTY? FLORIDA
LAST PAGE
Space above reserved for use of recording office
33•315
10
description of property and � " • D e.� V • i I a
ct. eta
A,t t
rr.
2. Description of improvement S
3. Owner(s) name and address:
Interest in property: ‘00 /.
Name and address of fee simple titleholder.
4. s name, ., pie number.
enux Icxmi 331'i
6: Surety: Payment bond required by from
Name, and phi number: N R
Amount of bond $ O. 00
6. Lender's name and address:
7. Persons within the State of FIo ida designated by
Section 713.13(lXa)7., Rorida Statutes,
address and number:
33 '34s 005115(D - 3'7
8.1n addition to himself, Owners designates the fotg
713.13(l)(b). Florida Statutes...
Name, address and phone number:
LL
d�
ON Caw A
whom notices or other doecurrents may be served as provided by
) to twelve a copy of the Uenor's Notice as provided in Section
9. Expiration date of tits Notice of Commencement
WARNING TO OWNER ANY PAYMENTS MADE BY THE OWNER
IMPROPER PAYMENTS UNDER CHAPTER 713, PART I,
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
FIRST INSPECTION. IF YOU INTEND TO OBTAIN LNG,
OR RECORDING YOUR NOTICE OF
Signature(s) of Owner(s) or Owner(s)' Authortthd
Prepared By
Print Name
Title/Office
STATE OF FLORIDA
COUNTY OF MIAMI -DA DE
The for oing instrument was acdsnowiedged befor+e'me
By -r he-r CA-c-c"..yrnise-
espkation chiefs 1 year kern the dateof reeae:ft untessa different date Is specified)
THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED
713.13. FLORIDA S"IMMS, AND CAN RESULT IN YOUR PAYING TWICE FOR
MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
SULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK
Irxiividually, or O as
Personally known, or CI produced t e following type of
Stiplittfleof Notary
Print
Name By
Print Narne
Title/Office
day of__ s ro-n va-r
for
inP.26i li *if_ Y ..!`. s "1;11,0- . _`1 L.rI
Un • of . I d tere that = read the and
i a, ' 'r c:o �/ true, toth@ •.:;v, Qf my ,<<
8 L1L-i •. • , s . ,...,erfsi's 1 .v� edOfticer
and belief.
«;„`,,'�:�
Yaniv Offir
%, �: Commission #DD795680
Expires: AUG. 22, 2012
O
'B Q ATLANTIC BONING
BODED DED THR
/Manager who signed atone:
3rM