PL-04-231Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2001
RECEIVED
.�J�
Permit No.91 04 6 r3 1
Master Permit No.� 64— 4 &
Permit Type (circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder)t Phone #
Owner's
Address lgo / Al c Cb (s—r �2c� tf -
City /�//® d�l�� State _ jg?— Zip �✓ `�,�
Tenant/Lessee Name Phone #
Job Address (where the work is being done) Z�z oue-�-
City Miami Shores Village County Miami -Dade -Zip
Is Building Historically Designated YES NO
Contractor's Company Name Phone #
Contractor's Address
City /-Oo / State
Qualifier
State Certificate or Registration No. FFA 3212 % 46 Certificate of Competency No.
Architect/Engineer's Name (if applicable) 0� // Phone #
$ Value of Work For this Permit Square Footage Of Work:
Type of Work: ❑Addition ❑AlterationN, ewIt
ElRepair/Replace ElDemolition
Describe Work• �� Vl(
Submittal Fee $ 5 - y ® Permit Fee $ _ A6V �f CCF $ 1 ► 0 CO/CC
Notary $ Training/Education Fee $ • W Technology Fee $ 6.2-S
Scanning $ 5 • CO Radon $ Zoning_. Bond $ .
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $
(Continued on opposite 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
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, BEATERS, 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
Owner or Agent
The foregoing instalment was acknowledged before me this
day of , 20 _, by ,
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
APPLICATION APPROVED BY:
Signature
/ Contractor
The foregoing 'uptrument was acknowledged before me this
day of 20 &, by ,
who is personal](known to me or who has produced
who did take an oath.
NOTARY
Sign:
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s
4 MY CmMftlm Ems, � z3
BMW ByNatianaliiot . >,.,
Plans Examiner
Engineer
Zoning
Chc 05/13/03
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305-795-2204
Printed: 11/5/2004
Applicant: ROBERT
Owner: VICKERS
JOB ADDRESS: 1401 NE 101
Contractor PIPE SET CORP.
Local Phone: 786-426-0875
Plumbing Permit
Permit Number: PL2004-231
VICKERS
ROBERT
ST
Contractor's Address: 9501 S. W. 81 ST.
Page 1 of 1
Parcel # 1132050230140 Legal Description: M SHORES BAY PK ESTS PB 55-83 LOT 3 BLK 3 LOT SIZE 99.500 X
Fees:
Description _
Amount
FEE2004-10895
Building Fee
$250.00
FEE2004-10897
CCF
$1.80
FEE2004-10898
Training and Education Fee
$0.60
FEE2004-10899
Technology Fee
$6.25
Total Fees:
$258.65
Permit Status: APPROVED Permit Expiration: 2/6/2005 Construction Value: $3,000.00
Work: WORK FOR ADDITION
Signed:
(INSPECTOR)
Total Fees: $258.65
Total Receipts: $6.60
C TIETT �1
ro1 8 2u
BY:
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict
conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305-795-2204
Printed: 11/5/2004
Applicant: ROBERT
Owner: VICKERS
JOB ADDRESS: 1401 NE 101
Contractor PIPE SET CORP.
Local Phone: 786-426-0875
Plumbing Permit
Permit Number: PL2004-231
VICKERS
ROBERT
ST
Contractor's Address: 9501 S. W. 81 ST.
Page 1 of 1
Parcel # 1132050230140 Legal Description: M SHORES BAY PK ESTS PB 55-83 LOT 3 BLK 3 LOT SIZE 99.500 X
Fees: Description Amount
FEE2004-10895 Building Fee $250.00 Total Fees' $25$.65
FEE2004-10897 CCF $1.80
FEE2004-10898 Training and Education Fee $0.60 Total Receipts: ;ou.uu
FEE2004-10899 Technology Fee $6.25
Total Fees: $258.65
Permit Status: APPROVED Permit Expiration: 2/6/2005 Construction Value: $3,000.00
Work: WORK FOR ADDITION
Signed: (INSPECTOR)
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict
conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
Contractor: PIPE SET CORP. Phone: 786-426-0875
Buildina Deuartment Comments
2 STORY ADDITION MASTER BEDROOM AND UNDER 2
STORY FAMILY ROOM
JUL 8 200W
I s o Com ents
Passed
Failed El
Correction
Needed
Re -Inspection
Fee
($75)
No Additional Inspections can be scheduled until
re -inspection fee is paid.
Monday, July 16, 2007 Page 2 of 2