DS-15-2287 Permit tv ISS-g *1 -227
�suO1 y,� Miami Shores Village BPmr'tB"QIIeWa �ridewalkslSlabs
T 10050 N.E.2nd Avenue NW wotk ass,S f #pn.AddtflontAftratioh
Miami Shores,FL 33138-0030
yoPNce Phone: (305)795-2204 Permit Status.APPLIED
F
COR'lpA
Expiration: 03/07/2016
issue 08* "MSued
Project Address Parcel Number Applicant
119 NW 110 Street 1121360030550
Miami Shores, FL 33168-4320 Block: Lot: 2620 ACQUISITIONS LLC
Owner Information Address Phone Cell
2620 ACQUISITIONS LLC 600 BRICKELL Avenue
MIAMI FL 33131-
600 BRICKELL Avenue
MIAMI FL 33131-
Contractor(s) Phone Cell Phone Valuation: $ 800.00
KIS CONSTRUCTION SERVICES LLC (786)975-5750 Total Sq Feet: 700
Approved:In Review Available Inspections:
Comments: Inspection Type:
Date Approved::In Review Final
Date Denied:
Foundation
Type of Work:TILES ON GARAGE,DRIVEWAY. Additional Info: Review Planning
Bond Return: Classification:Residential Review Building �JE
Scanning:3
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60
Invoice# DS-9-15-57019
DBPR Fee $2.00 09/24/2015 Credit Card $ 139.60 $0.00
DCA Fee $2.00
Education Surcharge $0.20
Permit Fee $125.00
Scanning Fee $9.00
Technology Fee $0.80
Total: $139.60
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 conform' with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this perm4guthe
ume respo ibif for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTPLUMBIN M HANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFF I Vertify th t II t foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction an z nI horize the above-named contractor to do the work stated.
September 24, 2015
Authoriz Si r / Applicant / Contractor / Agent Date
Buil epartment Copy
September 24 2015 1
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-243071 Permit Number: DS-9-15-2287
Scheduled Inspection Date: October 07, 2015 Permit Type: Driveways/Sidewalks/Slabs
Inspector: Rodriguez,Jorge Inspection Type: Final
Owner: , Work Classification: Addition/Alteration
Job Address: 119 NW 110 Street
Miami Shores, FL 33168-4320 Phone Number
Parcel Number 1121360030550
Project: <NONE>
Contractor: KIS CONSTRUCTION SERVICES LLC Phone: (786)975-5750
Building Department Comments
TILES ON GARAGE, DRIVEWAY. Infractio Passed Comments
INSPECTOR COMMENTS False
TO CLOSE PERMIT#DS13-2531.
Inspector C" m ent's
Passed
Failed
Correction
Needed ❑
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
October 06,2015 For Inspections please call: (305)762-4949 Page 21 of 60
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� PAVEMENT
N. E. 110th STREET
1
«A'
+Accepted By:
*op"Address: 119 NM 110 STREET MOTES_ NO NOTES
M4
till Miami Shores Village
Building Department SEPO Z015
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)752-4949
FRC 2®
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
a pCONTRACTOR DRAWINGS
JOB ADDRESS: / / " # -
Com: Miami Shores County: Miami Dade Zia• -3 d '�
Folio/Parcel#: d d 1& 003 05,60 is the Building Historically Designated:Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
'jCi 1��y /!,�OE.
17
OWNER:Name(Fee Simple Titleholder): 2,&20 A Com• 1,5 l O$'l 5 I,A.�' Phone#: °7 �a `'-,3 -6
Address: ;Zr7 A 116 7
_
City: N d I I State: F1 oa i o/3Zip: 153133 -
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: �G2slJ.`i 9 SPL 6 )A! Se dyi Cc Phone S5ij
Address: rD 61 15 011 r
City: 14 671` State: L7 G'.�� Zip:
Qualifier Name:�,®Gd u Phone#: A9 6, ,6!L8 jr
State Certification or Registration#: C 6—c Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Pj®� Square/Linear Footage of Work: :7; 1) •03
Type of Work: ❑ Addition I� Alteration F-1New ❑ Repair/Replace ❑ Demolition
D�ription of Work: 0 d 3° Ill ® 0 �-r°-
Specify color of color three tile:
Submittal Fee$ _Permit Fee$ CCF$ a CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ - Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
Bonding Company's Name(if applicable)
Bonding Company's Address
City '�State Zi p
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 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 Afcommencement and construction lien law brochure will be delivered to the person
whose property is subject to attachff ent. Also, certify copy of the recorded notice of commencement must be posted at the job site
for the first inspection vyhich a s seven 7 days er the building permit is issued. in the absence of such posted notice, the
inspection will not be a rove a a reins n fe ill be charged.
.f
Signature Signature
or GENT CONTRACTOR
The foregoing ins ument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of ,, �j�S� 20 �� by -gra daily of ,20 Ir by
S2 �-��u� is personally o r1'te� -oo,, A (:e ,=who is personally known
6i r who has produced as <!fj:0r who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: D Sign:
41
Print: Y'�U � }���a �°? Print: p_6--C w A-,r
i'
Seal: Seal:
"rr Pyr'••, MYW HERNANDEZ
F;gti'F Y!'+•': pIYLAI HERNIWDEL �S MY COMMISSION#EE 221249
MY COMMISSION#EE 221249 EXPIRES:December 1,2016
EXPIRES:December 1 2016 %P, cd o;:` Bonded Thru Notary Public Undenalters
APPROVED BY �J Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)