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DS-14-2432BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC []PLUMBING ❑ JOB ADDRESS: 141 Miami Shores Village Building Department 10050 N_E.2nd Avenue, Miami Shores, Florida 33138 Tei: (305) 795-2204 fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (30S) 762-4949 'NOV q5 2014 FBC 20 I Master Permit No .V -TS Sub Permit No. REVISION ❑ EXTENSION ❑RENEWAL WORKS [] CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores County: Miami Dade Zip: folio/Parcel#: 11-3101-025-0110 is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Peter Goldsmith Phone#: . _11._ _ 141 NW 96 St City: Miami Shores State: FI Tenant/Lessee Name: Email: goldsmithpe@comcast.net CONTRACTOR: Company Name: Poinciana Development Group Inc Address: 697 N Miami Ave #3 City: Miami State: FI Qualifier Name: Linda Forrest State Certification or Registration #: DESIGNER: Architect/Engineer: _ CGC049650 N/A Certificate of Address: City:_ ' Value of Work for this Permit: Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration © New ❑ Repair/Replace Description of Work: Driveway - Brick Paver type Specify color of color thru tile: 305-469-5806 33136 Zip: 620 SF Demolition Submittal Fee $ 6Z Permit Fee $ CCF $ CQ/CC $ Scanning Fee $ Radon Fee $ _ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double e Structural Reviews $ Bond $ WE Now %F F1 LED TOTAL FEE NOW DUE $ (Revised02/24/203.4) Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address Zip 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. l understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, 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 ail 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 low 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 reinspgCtion fee wjAoe charged Signatur Signature..... .... ............. OWNER or AGENT X CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this X17 day of Oct 20 14 by 17 day of Oct 20 14 by l'C�"1 GIZ �a &,-M IT -I.4 who is personaily known to LTr— who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY Print: MY COMMISSION #FF002 ,.. `'•.FOFo,. EXPIRES May 16, 2017 Seal: lil 1(407) 398-0153 Fi���aN ,a •� ,: APPROVED BY Pians Examiner Zoning Structural Review Clerk iRevised02/24/2014l BUILDING Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tei: (305) 795.2204 Fax: (305) 756.8972 PERMIT APPLICATION FBC 2004 O� W C M tri V '4 k� li 1 JAN G 2 2008 �} Permit No. 0�'_Oa Master Permit No, Permit Type (circle): , uilding Electrical Plumbing Mechanical Roofing Owner's Name (Fee Simple Titleholder) �.' 1�'I �l `- c-� Phone # ?C (2 Owner's Address -77 City i , State / - Zip f s Tenant/Lessee Name Phone # Job Address (where the work is being done) k 1� City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name �W,, i Phone # Contractor's Address City Qualifier Name State Certificate or Registration Architect/Engineer's Name (if applicable) State Certificate of Zip Phone # Value of Work For this Permit $ )�lJ Square / Linear Footage Of Work: U Type of Work: ❑Addition l QAlteration [j4Ne [R Repair/Replace ❑ Demolition' Describe Work: at S Ac woad f-e..L.e P . 4C Submittal Fee $ Permit Fee $�✓ d� CCF $ CO/CC Notary $--!5 4 Training/Education Fee $ Technology Fee $ ' 26 Scanning $ f Radon $ DPBR $ Bond $ Code Enforcement $ Structural Review. $ Zoning $ Double Fee $ Total Fee Now Due $ 14,Q See Reverse side -+ Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 t Signa Owne r Agent Contractor The for going instrument was ac wledged before a this C The foregoing ins ent was acknowledged before me this day o ly 20 b�day of _, bywho is p sonalown to me or who has produced who is personally known to or who has produced Q �s identification and who did take an oaths, NOT Y PUBLIC:oy cn i i ®1/ Sign: Print: My Commission Expires: APPLICATION APPROVED BY: (Revised 02108/06) as NOTARY PUBLIC: My Commission Expires: and who did take an oath. Miami Shores Village Building Department JAN 09 2015 10050 N.E.2nd Avenue, Miami Shores, Florida 33138, Tel: (305) 795-2204 Fax: (305) 756-8972 C_' INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 2010., BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL F-] PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: # ' City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): ° s two Phone#: Address: City: Tenant/Lessee Name: Email: CONTRACTOR: Company Name: Address: City: State: State: Phone#: Qualifier Name: Phone#: State Certification or Registration #: Certificate Otompetency #: DESIGNER: Architect/Engineer: Phone#: 9 p: Address: City: State: Zip: Value of Work for this Permit: $ Square/Linear Footage of Work' Type of Work: ❑ Addition ❑ Alteration ❑New ❑ Repair/Replace ❑Demolition Description of Work: Specify color of color thru We: Submittal Fee $_ Scanning Fee $ _ Technology Fee $_ Structural Reviews (Revised02/24/2014) Permit Fee $ Radon Fee $ Training/Education Fee $ CCF CO/CC $ DBPR $ Notary $ Double Fee $ _ Bond $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, 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 ' �gnature OWNER or AGENT f CONTRACTOR The f going i day me or who has produced identification and who NOTARY PUBLIC: was acknowledged before this ) Jl-rk/_;o20 % r J by ke an oath. known to Sign: Print: Seal: Pb�PR'P e�NA GOnpI NG ** MY COMMISSION # EE 860780 1 6'." EXPIRES: February 15, 2017 "rFov f .; Bonded Thru Budget Notary Services The foregoing instrument was acknowledged before me this day of me or who has produced 20 by who is personally known to identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: as ****************************************************************************************************** APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)