PW-16-40 N
Miami Shores Village JAN 0 gi ITIG
Building Department rO
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 ?1,
Tel:(305)795-2204 Fax:(305)756-8972 l
INSPECTION LINE PHONE NUMBER:(30S)762-4949
FFBBC 20I
BUILDING Master Permit No. w
_ � - `� L46
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION RENEWAL
❑PLUMBING [:] MECHANICAL QPUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: V s t;, q l-V` PT
City Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):RIGHT-OF-WAY Phone#:
Address:
City: State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: TECO PEOPLES GAS Phone#: 954-453-0811
Address: 5101 N.W. 21 AVE., SUITE 460
city. FT. LAUDERDALE State: FL Zip: 33309
Qualifier Name: JESUS VEGA, JR. Phone#: 945-453-0811
State Certification or Registration#: E 1608 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$2000 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition
Description of Work: E/t 6�" �C A),-5- -00;1-a�' ;&
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ 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)
a A
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 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 Signature 3�a
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of .20 ,by day of / by
who is personally known to 5Z A'S is ersonally kn to
me or who has produced as me or who has produced as
identification and who did take an oath. identification no who did take an oath. art
NOTARY PUBLIC: NOTARY PU LI J HUBER '"UNEZ
.a1PRy'Fda
1io '1
Notary Publir, -state o1120
commission 17.0
My Comm.Expires SeP 11,2
' • Com #FF 0
Sign: S m al Not Assn.
inn u„e�
Print: Print:
Seal: Seal:
APPROVED BY 1( C Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax: (305)7564972
Inspection Number: INSP-250581 Permit Number: PW-1-16-40
Scheduled Inspection Date:January 26,2016 Permit Type: Public Works
Inspector: Diaz,Osvaldo
Inspection Type: Final
Owner: SALDEN,CI AUDEEN Work Classification: Public Works
Job Address:102 NE 94 Street
Miami Shores, FL Phone Number
Parcel Number 1132060132990
Project: <NONE>
Contractor: TECO PEOPLES GAS SYSTEM Phone: (305)957-3857
Building Department Comments
NEW NATURAL GAS SERVICE LINE Infractio Passed comments
INSPECTOR COMMENTS False
TO CLOSE PERMIT#PL2002-68
Inspector Comments
Passed
Failed
Correction
Needed
Re-Inspection
Fee
No Additional Inspedions can be scheduled until
re4nspedion fee is paid.
January 25,2016 For Inspections please call:(305)762-4949 Page 14 of 41
Permit NO. PW-1-16-40
s�*O y Miami Shores Village M Permit Type:Public Works
�� 10050 N.E.2nd Avenue NE Pen m i work Classification:Public Works
Miami Shores,FL 33138-0000 Permit Status:APPROVED
Phone: (305)795-2204
Issue Date: 1/14/2016Expiration: 04/13/2016
Project Address Parcel Number Applicant
102 NE 94 Street 1132060132990
CLAUDEEN SALDEN
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
CLAUDEEN SALDEN 102 NE 94 ST
MIAMI SHORES FL 33138-2822
Contractor(s) Phone Cell Phone Valuation: $ 2,000.00
TECO PEOPLES GAS SYSTEM (305)957-3857 (305)970-1783
Total Sq Feet: 0
Scanning:3 Available Inspections:
Inspection Type:
Final
Excavation
Review Building
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.2o Invoice# PW-1-16-58262
DBPR Fee $2.00 01/14/2016 Check#:6069 $ 116.20 $0.00
DCA Fee $2.00
Education Surcharge $0.40
Permit Fee $100.00
Scanning Fee $9.00
Technology Fee $1.60
Total: $116.20
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 p I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for EL CT CAL,PLUMBING,MECHANIC L,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFF A I certify that all the r oing information i acc a and that all work will be done in compliance with all applicable laws regulating
cons on an o mg. Futh�a er�nore,I aut a the 7 ve-nam nt or to do the work stated.
(�.�\[/L January 14,2016
Authorized Signature:Owner / Ap licant / Contractor / Agent Date
Building Departme py
January 14,2016 1