RF-14-118Miami 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
Permit Type:
JOB ADDRESS:
BUILDING
/3
.M
yf IAN 2,4-BuIi
FBC 20 1�
Permit No. 1P`414 _ 1 113
Master Permit No.91!!� 06131-53
ROOFING
/06 5� Mf•�° �d
City: Miami Shores / County: Miami Dade ° Zip:
Folio/Parcel#:
Is the Building Historically Designated: Yes NO
Zone:
OWNER: Name (Fee Simple Titleholder): dti -�� /! �� phone#: S - $0 :'R
Address:
Awl gni CPIAWA s' �- -
City: State• Zip:
Tenant/Lessee Name: Phone#:
Email:
Cyti�v�q L• -7$6
CONTRACTOR: Company Name:
Address:
City:
Qualifier Name:
State Certification or Registration #:
Contact Phone#: 305 P89 If ".5�wEmail Address:
of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ 44 . C)Q 0 ° ® ® SquarelLinear Footage of Work: 10YA Of r
I- �'
Type of Work: OAddition DA/llttearation ONew L�Repair/Replace ODemolition
Description of Work: a /�!'� "o
Color thru t&:
Submittal Fee $ Permit Fee $
Scanning Fee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $ CO/CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $
�Bon" 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 I absence osted notice, the
inspection will no ppr¢ ed an ection fee will be charged
Signature Signature
Owner or Agent Con or
The foregoing instrument�w% s acknowledged before me this a � s
The foregoing instrument was aclenowledged before me thi
day o I , 201 1, by �1%.L" c112 day of Q4e 20 � by � FJ32'1 K ���
who is personally known to me or wh949 produced who is person y >mmm +a me nr who has produced
As identifi and who did take an oath. as iden ' cati and who did take an oath.
NOTARY P C: NOTAR 1
Jose A. GirM Jose A. Giron
CC.M WSS1oH#EE831658 : ;EC4M.t llSStOY fg831669
Sign: _ _�; tom: sFP.03.2016 Sign: : ti 'tRc : g p03,2018
Print (� oPP r yry/yy AARON- f ✓it i°"o.,s`,.
My ssion Expires: M mmission Expires:
************************************************************************************************************
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 3n2/2012)(Revised 07/10/07)(Revised 06/100W)(Revised 3/15/09)
-tail by Entity Name
it by Entity Name
REAL ESTATE, LLC
ment Number
IN Number
Filed
Event
t Date Filed
t Effective Date
L06000104152
205802423
10/26/2006
FL
ACTIVE
LC AMENDMENT
06/03/2013
NONE
001 EAST COLUMBUS DRIVE
RMPA, FL 33619
lalling Address
001 EAST COLUMBUS DRIVE
RMPA, FL 33619
registered Anent Name & Add
,ESEMYER, ROBERT J, MR.
001 EAST COLUMBUS DRIVE
RMPA, FL 33619
lame Changed: 01/05/2008
Adress Changed: 01/05/2008
►uthorized Person(s) Detail
lame & Address
'itle MGRM
,ESEMYER, ROBERT J
001 EAST COLUMBUS DRIVE
AMPA, FL 33619
'itle MGR
�7ESEMYER, CANDACE
Page 1 of 2
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Detail by Entity Name
4•,
001 EAST COLUMBUS DRIVE
AMPA, FL 33619
R"M Year contact 4511ed Da*Filing Services
2012 01/04/2012
2013 09/04/2013
2014 01/08/2014
01/08/2014 — ANNUAL REPORT
09/04/2013 -- ANNUAL REPORT
06/03/2013 -- LC Amendment
01/04/2012 -- ANNUAL REPORT
01/04/2011 —ANNUAL REPORT
01/19/2010 —ANNUAL REPORT
01/15/2009 -- ANNUAL REPORT
01/05/2008 -- ANNUAL REPORT
05/081201717 _ Aivnii JAI RPPOPT
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Coovriaht 0 and Privacy Policl
State of Florida, Department of State
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01/24/2014 09:55 3053872918 A AND D ALL LINES PAGE 01/01
ACORQTM CERTIFICATE OF LIABILITY INSURANCE 1/24/2014
PRODUDER
A&D ALL—LINES INS ASSOC INC
THIS GERPROATE 18 ISSUEDAS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THPS CERTIFICATE DOES NOT AMEND, EXTEND OR
5600 SW 135 Ave Ste 106
ALTER THE COVERAGE AFFORDED 8Y THE POLICIES BELOW.
Miami, FL 33183
(112-9) 4Aq—fi7fl-I
INSURERSAFFORDING COVERAGE NAIC#
INsuRE6 FIST CONSTRUCTION, INC.
NsuRER AI IMLMtSF LONDgN
NSuRER S! Alggp= NORTH Alffj&ICA,
2342 W. 80 ST. #1
INSURER Ca
INSURER D:
RIALEM, Tr'L . 33016
INSURER I --
COVERAGE
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ANY REQUIReMENT. PERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RIMP90T TO WHICH THIS CERTIFICA` 9 MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREN ISSUSECT TOA"TH9TBRMS, S CLUSIONBAND CONDITIONS OF SUCH
POUCIES. AGGREMTS LATS SHOWN MAY HAVE BM RSDUCEO SYPAID CWM&
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viwiFiCATL'T NouwK CANCELLA11ON
SHOULDANYOVIMASOVEDESCRIBEDPWOWN Bi!kMTHB�IRA71ON
VILLAGE. OF MIAMI SHORESMATE THEREOF, THE O WNO INSURER IMLLBNMVOR TO MAA. 30 DAYS wRI m
BUILDING DEPARTMENT NOTICE TO THR09ATIVWE 14OL M NAMED TO THE LEFT. PAILLtR11 YO DO &O SHALL
MIAMI�'0�u.�l�rO i�l�./�2MS , FIIR T 'w IMF= NO OBLIGATION OR UABRJIY Obi. NY 1� . N ' 1KSUR6R, 17S AGENTS OR
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303-736-8972
983
Ja,n..24.2014 10:53 AM FIST CONSTRUCTION 3055572334
�1•IMrIW101@Yr=r�wrwrnrnadyr=wvr�...e..�.......-....�.....,...�.....�L....,...__.�_.___..-__
kC# 63.55470' -
STATE OF FLORIDA
LIC�7
9 y�� •�0.1� �.280••9116 CR.G056.94' s••" .,_..._ ��.j•'•
The RTSIDRI&I-AL CONTRACTOR
Named below X0 CERTIFIED
Under the Viovisions of • ChapLe
Expiration date: AUG 31,
1815 W 68 ST
IIIALEAR FL 3301.4
:RICK • -SCOTT*
GOVERNOR
_DISPLAY AS REQUIRED BY L�
PAGE. 21 2
"",..• SEGS L12091102265
XEN LAWSON
SECRETARY
- - -
THIS DOCUOdENT HAS A CQLOI'iLD t3ACK(;R0LfN J .ERICROPRINTINC • LINEAAAHK ' PATENTED PAPER
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Naimed; below IS CERTIFI$D
-Under the provisions of •Chapt4)r;'•.4,:X9;
Expiration dates AUG, 31, 2014♦
.A ' .rt .♦ :: S.. .r ..
FISTACQOIaTSTRIICVION INC
181H
W68 ST
FL 33014
d V1�aOR
DISPLAY AS REQUIRED BY LA
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.Jan..24.2014 10:52 AM FIST CONSTRUCTION
3055572334
Local business Tax Receipt
Miami—Dade County, State of Florida
BLOM" RHOMPr 11M.
� INC RErlewni. g
PTEMBER 30, 2014
-Ti018 NOY A BLL -00 NOT PAY
be displayed at place of basiness
Pursuant to County coda
68'2827 \�LBTJ
Chapter IIA - Art. 9 as 10
Btl81NIVS NAMS&OCATtON MWEIPT Fla
,EXPIRES
INC RENEWAL 8
w
P"MMBER 30, 2014
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0228.11.000050
1
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aat be displayed at place of business
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Pursuant to County Cede
sr aepsritpl#6g11trjNbbsr laws ad rgdrawab Wtisi aply b
Chapter BA - Att. 9 & 10
OWNER *15e. Type or RVOIN11
FISTCONSTRUCIION INC 193 SUB -BUILDING
PAYMENT 86016tV6D
F#rM•n istat6u+tiaa,viset
Ron
8Y TAX 00=0TOR
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Local Business Tax Receipt
Miami—DadeSounty, State of Florida
-THIS i3 NOT A 6g. -DO NOT PAY �.LBT
6870951
EXPIRES
BLOM" RHOMPr 11M.
� INC RErlewni. g
PTEMBER 30, 2014
9 815 W 68 St 7'145867t
HI EAK FL 33014
be displayed at place of basiness
Pursuant to County coda
Chapter IIA - Art. 9 as 10
OWNER Me. TYPE OP RL"Um"
ias[o0N3FFd1Ci1QP1INC 188 �AVY6UILDING
PAYM>aNT R6C6NBD
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PAGE- 1/ 2
0
CLITT INGS ED G E
I N N 0 V A T I V E
Date: March 3rd, 2015
City of Miami Shores,
10050 northwest 2nd ay.
Miami Shores, Fl. 33138
State of Florida
County of Miami Dade
Dear City of Miami Shores,
The property address 137 J&106 St Miami, Shores 33150 does not have a flat roof anymore and we
need the previous roofing permit closed/cancelled. After we pulled the flat roof permit the house cough
on fire and we needed to create a brand new roof where the flat roof does not exist anymore.
General Contractor
Cutting Edge Innovative Remodeling 1 2100 NW 99' Ave Doral, FL 33172 1 305.433.6659