DS-15-2308 17
Miami Shores Village PbrMs I
10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000 s t\. ��'' igr
Phone: (305)795-2204 '� `. � 8
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"IM` � stat 91 � Expiration: 03/13/2016
Project Address Parcel Number Applicant
384 NE 94 Street 1132060136140
PENN DAVIS MICHELLE CANER
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
PENN DAVIS MICHELLE CANERO 384 NE 94 Street
MIAMI SHORES FL 33138-2832
.J
Contractor(s) Phone Cell Phone FValuation: � $ 6,400.00
CHAMPION CONCRETE (305)252-8055 (786)402-4802
Total Sq Feet: 1100
Approved: In Review Available Inspections:
Comments:
Inspection Type:
Date Approved: : In Review Final
Date Denied: Foundation
Type of Work:PATIO PAVERS Additional Info: Review Planning
Bond Return: Classification:Residential Review Building
Scanning:3 Review Building
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
Bond Type-Owners Bond $500.00 Invoice# DS-9-15-57040
CCF $4.20
DBPR Fee $2.25 09/10/2015 Credit Card $50.00 $624.70
DCA Fee $2.25 09/15/2015 Check#:2007 $ 124.70 $500.00
Education Surcharge $1.40 09/15/2015 Check#:3086 $500.00 $0.00
Permit Fee $150.00 Bond#:2836
Scanning Fee $9.00
Technology Fee $5.60
Total: $674.70
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 responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS, OOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accur a nd that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above-named co tra or do the work stated.
September 15, 2015
Authorized Signature:Owner / Applicant / actor, / Agent ate
BuildingDepartment
p Copy
September 15,2015 1
Miami Shores Village
Building Department SEP 0 2015
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 201
BUILDING Master Permit No-m --Q30 e
PERMIT APPLICATION Sub Permit No.
El-BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION F-1 EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [-]PUBLIC WORKS [:] CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: �(/y 51-
City: Miami Shores County: Miami Dade Zip: X3/3_'
Folio/Parcel#: A/` -;206 -03-- 1-)C qd Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): 7 1� /fti//S y� 1`16_er,4e Lie€A Phone#:
Address: 3:Y'l Me-'V jj—
City: h 4A S .SAD State: •/K Zip:
Tenant/Lessee Name: Phone#:
Email:-j&l—t-ef;fA An 2 M�f 010i*i,-L
CONTRACTOR:Company Name: M /1,01,A,J Phone#:
Address: 04), iN 4) 7 e-- 1 L i�
City: - d� State: T Zip: 3,3)7,f
Qualifier Name: j4jj-t-e-- 6,14!i, i40 Phone#:
State Certification or Registration#: Certificate of Competency#: �i�5 cwo'%S
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ � gate. Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition
Description of Work:ZA_'-7h:) 4-ii)-YON /
Specify color
--o/f�color thru the: i r
Submittal Fee$ 1 Permit Fee$ t "'` CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$0-4
(Revised02/24/2014) G1i
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 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 commencementmust posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of uch posted notice, the
inspection will not be approved and a reinspection fee will be charged.
1 l�
Signature Signature '
OWNER or AGENT iONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
13 day of 4�—IZ 'A 20 CJ by I day of '� 20 1 :7) by
MLOA4 (AI Q= �wqo is personally known to who is personally known to
me or who has produced - as me or who has produced '. uyen(
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign: r
Print: Print: ^*��+�
+ Public State of Florida :oNo
tary public State n.Florida
Seal: 40P,(k� No.ary Seal: Sindia Alvarez
$ r Sindia Alvarez t My Commission FI:156750
o< My Commission FF 156750 0E Expires 09103/2013
0,*-,d9 Expires 09/03/2018
s V
APPROVED BY I Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
ORF
15�nc.1935 Gff
l Miami shores Village
logo , all 1111111 Building Department
10050 N.E.2nd Avenue
L�arE$l,N$° Miami Shores, Florida 33138
IV 7"E
Tel: (305) 795.2204
Fax: (305) 756.8972
SURVEY AFFIDAVIT
STATE OF(FLORIDA)
COUNTY OF(DADE)
The undersigned Affiant, low does hereby attest that
(Property owner
The attached survey, performed by 19t2,10?'t) _?t+t/�� y
(Name of surveyor's company)
For address: ej-q. r
Performed on (date of survey) is an accurate representation of the existing conditions and
locations of all structures on the property as of this date.
The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property
without first providing a survey less than seven (7) years old old. The Affiant, as property owner, further agrees to
remove or obtain permits for any structures which now may exist on the property which are not permitted or which
may violate zoning or building code regulations. The Affiant further understands that the existence of any such
structures may affect final inspections as applicable to this or other permits.
Furtf�ier,Affi -s �eth naught.
Property Owner Signature Property Owner Print Name
SWORN TO AND SUBSCRIBED before me this Q� ay of
Affiant is personally known to me, produced as identi tion.
Notary
�0"` Ye. Notary Public state of Florida
Revised(6/25/12)Revised on 5/22/2009/Revised on 6/12/09 Sindia Alvarez
y My Commission FF 156750
fogµ Expires 0g(0312016