DS-15-3139 Miami Shores Village
10050 N.E.2nd Avenue NE
WorkCt ��t .rWd�rll
Miami Shores,FL 33138-0000 Vii
3 -
Phone: (305)795-2204 `
T. Issue Expiration: 07105/2016
Project Address Parcel Number Applicant
1275 NE 94 Street 1132050100090
Miami Shores, FL 33138-2946 Block: Lot: JAMES AND JANINE TURK
Owner Information Address Phone Cell
JAMES AND JANINE TURK 2020 N BAYSHORE Drive
MIAMI FL 33137-
2020 N BAYSHORE Drive
MIAMI FL 33137-
Contractor(s) Phone Cell Phone Valuation: $ 6,840.00
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:NEW 2"WATER SERIVCE AND RETIREE Additional Info: Review Planning
Bond Return: Classification:Residential Review Building
Scanning:3
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
Bond Type-Contractors Bond $500.00
CCF $4.20
Invoice# DS-12-15-58110
DBPR Fee $2.25 01/07/2016 Credit Card $674.70 $0.00
DCA Fee $2.25 Bond*2948
Education Surcharge $1.40
Permit Fee $150.00
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,DZ
,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing informationAs ae and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the abov -name r to do the work stated.
January 07, 2016
Authorized Signature:Owner / Applicant / ont ctor / Agent Date
Building Department Copy
January 07,2016 1
Miami Shores Village ---- -
Building Department DEC 18 Nis
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 20 �y
BUILDING Master Permit No.`V C'1 q ' qs j
PERMIT APPLICATION Sub Permit No.-bS IS — 313c
❑BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL
❑PLUMB)ING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: _1213 NE IV
City: Miami Shores County: Miami Dade Zip: 7317e
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Title1h�older): __/klyeP 10� Phone#:
Address: Z A15 '7 5 y
City: rlLWAIT 572OII!:� State: Zip:
Tenant/Lessee Name: Phone#:
Email: /'
CONTRACTOR:Company Name: G� ®/(� �6'(� '� Phone#:
/�
Address:-tr 04 ` _ �_ w7�
City: State: Zip:
Qualifier Name: �i! /!/'Z� ,O�LIJ�L —r Phone#: 7 2�6`qUZ r e&2.
State Certification or Registration#: Certificate of Competency or)('�
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
►Value of Work for this Permit:$ Square/Linear Footage of Work:�*e—va &9186
Type of Work: ❑ Addition ❑ Alteration /❑ New r ❑ Repair/Replace ❑ Demolition
Description of Work: ( J�� f �!/ 'e ✓1
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)
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
Mortgage Lgnder'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 b posted at the job site
for the first inspection which occurs ven (7) days after the building permit is issued. In the absence of ch posted notice, the
inspection will not beapproved an a r inspection fee will be charged.
ASignature Signature
NER or AGENT ONTRACTOR
The foregoing in tru rA was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 20 1f by day of 20 by
;?"f� who is personally known to -.AS/ ,who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY P BLIC: NOTARY PUBL C:
Sig Sign: rN
Print: Print:
c
Seal: Seal:
SUYEN MORALES
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LN SUYEN MORALES ••: MY COMMISSION 9 FF923898
'c MY COMMISRV JI FfM '
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APPROVED BY Plans Examiner Zoning
C
Structural Review Clerk
(Revised02/24/2014)
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DEC 18 2096
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