BP-05-938 Miami Shores Village
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Building Department 3 �
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10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel: (305)795.2204 Fax: (305)756.8972 `----- -�
BUILDING Permit No. 5FO5--�
PERMIT APPLICATION /Master Permit No.
FBC 2001
Permit Type(circle): uildi Electrical Plumbing Mechanical Roofing
Owner's Name(Fee Simple Titleholder) (�I—Q-b Phone# 30S�--
Owner's Address -9 S;_O -- q5q A J,0 oL IVV 30$-- 7 G,cD— O
City/ '1! S tinres �State rL_ / Zip 3 �(
Tenant/Lessee Name K �� [x�( "'Zh.GL / /3 '1 5 4C)A4 AJOCPhone# 3 S' I S°l— q
Job Address(where the work is being done)
City Miami Shores Village County Miami-Dade Zip 3-3/ 3
Is Building Historically Designated YES NO f
Contractor's Company Name Phone#
Contractor's Address
City State Zip
Qualifier
12 Ar
Ar
AV
State Certificate or Registration No. ifi to et y No.
Architect/Engineer's Name(if applicable) ion "
G��N1JlJ� /3 s .
$Value of Work For this Permit /00° Square Footage Of Work: 000C
10
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Type of Work: ❑Addition ❑Alteration E]New rRepair/Replace ❑Demolition
Describe Work: a O 5 Gv1u'f V V�t -��TA2 n _
On! �>y fivY Gt��.v�ez�� D wog
Submittal Fee$ Permit Fee$ CCF$ _(CC) CO/CC
Notary$ Training/Education Fee$ Technology Fee$ 2. .1=50
Scanning$ 3 • Radon$ Zoning ;Z!5-(XJ C,b 'Sand$
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 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 - �' 32Cjo
Signature
Owner or Agent Contragor
The foregoing instrument was acknowledged before me this y The foregoing instrument was acknowledged before me this
day of 20 ,by,_ day of ,20 by
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Prix. : Print:
MV Commission Expires: ; ,,, Aiuben E. Ledezma My Commission Expires:
M ommission#DD217478
xpires:
Bonded Thru
od Atlantic Bonding Co.,Inc.
APPLICATION APPROVED BY: 6OJ Plans Examiner F
Engineer
Zoning
chc 05/13/03
Miami Shores Village Building Permit
..�
10050 NE 2nd Avenue
Phone
305-795-2204 Permit Number: BP2005-938
Printed:9/16/2005 Page 1 of 1
17 tr
Applicant: RUBEN MATZ
Owner: MATZ RUBEN M0
JOB ADDRESS: 9501 NE 2 AVE JOB hT TIME
Contractor Contractor's Address: 1%SP[CT10%
Local Phone:
Parcel # 1132060133890 Legal Description: 153 41 6 53 42 MIAMI SHORES SEC 1 AMD PB 10-70 LOT 8 BLK 29 LOT
Fees: Description Amount
FEE2005-12440 Building Fee $100.00 Total Fees:$106.30
FEE2005-12441 CCF $0.60 Total Receipts: $0.00
FEE2005-12442 Training and Education Fee $0.20
FEE2005-12443 Technology Fee $2.50
FEE2005-12444 Zoning Review $25.00
FEE2005-12445 Scanning Fee $3.00
FEE2005-12572 Submittal Fee ($25.00)
Total Fees: $106.30
Permit Status: Approved Permit Expiration: 12/21/2005 Construction value: $100.00
Work: REPLACE OLD SIGN WITH WHITE VINYL TERTERING ON INTERIOR WINDOWS AND DOOR SIGN
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:
Shores VillageBuildingPermitMiami S g �.
10050 NE 2nd Avenue
Permit Number: BP2005-938
Phone. 305-795-2204 ` i
Page 1 of 1 -
Printed:9/16/2005
Applicant: RUBEN MATZ
Owner: MATZ RUBEN
JOB ADDRESS: 9501 NE 2 AVE
Contractor Contractor's Address:
Local Phone:
Parcel # 1132060133890 Legal Description: 153 41 6 53 42 MIAMI SHORES SEC 1 AMD PB 10-70 LOT 8 BLK 29 LOT
Fees: Description Amount
FEE2005-12440 Building Fee $100.00 Total Fees:$106.30
FEE2005-12441 CCF $0.60 Total Receipts: $0.00
FEE2005-12442 Training and Education Fee $0.20
FEE2005-12443 Technology Fee $2.50
FEE2005-12444 Zoning Review $25.00
FEE2005-12445 Scanning Fee $3.00
FEE2005-12572 Submittal Fee ($25.00)
Total Fees: $106.30
Permit Status: Approved Permit Expiration: 12/21/2005 Construction Value: $100.00
REPLACE OLD SIGN WITH WHITE VINYL TERTERING ON INTERIOR WINDOWS AND DOOR
SIGN
Work:
Signed: (INSPECTOR)
nances and regulations pertaining thereto
In consideration of dans,drawings,s,statemeto me of his ntspermit,I or specifications submitted t ree to perform the Vork covered the proper authorities ofunder in compliance with all Miami Shores Village. In accepting his permit I assume responisibifty for allnd in 'ct
work
conformity with the p 9
done by either myself,my agent,servants or employes.
Signed:
(Contractor or Builder) BY:
Miami Shores Village Building Permit
10050 NE 2nd Avenue
Phone: 305-795-2204 Permit Number: BP2005-938 ,
Printed:9/16/2005 Page 1 of 1
Applicant: RUBEN MATZ
Owner: MATZ RUBEN
JOB ADDRESS: 9501 NE 2 AVE
Contractor Contractor's Address:
Local Phone:
Parcel# 1132060133890 Legal Description: 153 41 6 53 42 MIAMI SHORES SEC 1 AMD PB 10-70 LOT 8 BLK 29 LOT
Fees: Description Amount
FEE2005-12440 Building Fee $100.00 Total Fees:$106.30
FEE2005-12441 CCF $0.60 Total Receipts: $0.00
FEE2005-12442 Training and Education Fee $0.20
FEE2005-12443 Technology Fee $2.50
FEE2005-12444 Zoning Review $25.00
FEE2005-12445 Scanning Fee $3.00
FEE2005-12572 Submittal Fee ($25.00)
Total Fees: $106.30
Permit Status: Approved Permit Expiration: 12/21/2005 Construction Value: $100.00
Work: REPLACE OLD SIGN WITH WHITE VINYL TERTERING ON INTERIOR WINDOWS AND DOOR SIGN
Signed: (INSPECTOR)
compliance with all ordinances and regulations pertaining thereto and in strict
In consideration of the issuance to me of this permit,I agree to perform the work covered hereunder in
conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibiiity for all work
done by either myself,my agent,servants or employes.
Signed:
(Contractor or Builder) BY:
I
Miami Shores
Village Building
,.
10050 NE 2nd Avenue
Phone: 305-795-2204 Permit Number: BP2005-938 ``
Printed:9/1612005 Page 1 of 1
Applicant: RUBEN MATZ
Owner: MATZ RUBEN
JOB ADDRESS: 9501 NE 2 AVE
Contractor Contractor's Address:
Local Phone:
Parcel # 1132060133890 Legal Description: 1 53 41 6 53 42 MIAMI SHORES SEC 1 AMD PB 10-70 LOT 8 BLK 29 LOT
Fees: Description Amount
FEE2005-12440 Building Fee $100.00 Total Fees:$106.30
FEE2005-12441 CCF $0.60 Total Receipts: $0.00
FEE2005-12442 Training and Education Fee $0.20
FEE2005-12443 Technology Fee $2.50
FEE2005-12444 Zoning Review $25.00
FEE2005-12445 Scanning Fee $3.00
FEE2005-12572 Submittal Fee ($25.00)
Total Fees: $106.30
Permit Status: Approved Permit Expiration: 12/21/2005 Construction Value: $100.00
Work: REPLACE OLD SIGN WITH WHITE VINYL TERTERING ON INTERIOR WINDOWS AND DOOR SIGN
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: