WS-16-570 (2) N \
Miami Shores Village
Q�✓ M RFC',0 3 016
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 13y:
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 4��1\
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BUILDING Master Permit NO._VV�' v —T�
PERMIT APPLICATION Sub Permit No.
�ILDING ❑ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL
❑PLUMBING [:]MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: VJ ci 1 b 1n S
City: Miami Shores County: Miami Dade Zip: 7713 Y
Folio/Parcel#: 1\ -'L 1310- OOS�- 0 0 h O Is the Building Historically Designated:Yes NO
Occupancy Type:� _Load: Construction Type: Flood Zone: BFE: FFE:
Phone#: 7SOWNER:Name(Fee Simple Titleholder): VNeAr-u 7 '
Address: t-& yp(0 S'S
City: PA%-p"N C�C6�.'G� State: '�1v zip: 3713
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: 7-,J k.7 3,ai,,9Qq,& Phone#: 705) S^O b "3.74
Address: \3%A\a W 2 Y e k
City: 0"Npyl,,z VN V\ State: �1r Zip: ?16\-'L-
Qualifier
3 b\Z
Qualifier Name: D��'\-0 G.lC �j Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address City: State Zip:
Value of Work for this Permit:5 V1000 ,010- Square/Linear Footage of Work:
Type of Work: ❑ Addition Alteration New ❑ Repair/Replace ❑ Demolition
Description of Work: 3� 00 V. 0 0 1 \rv►T,G ted- W 4 1
Specify color of color thru tile:
Submittal Fee$ - CK3 Permit Fee$ 2�• CCF$ A• g CO/CC$
Scanning Fee$ W Radon Fee$ -3' 3() DBPR$ Notary$
Technology Fee$1C L4(S Training/Education Fee$—_off. 60 Double Fee$ )U
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ y
(Revised02/24/2014)
d
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 fast inspection which occurs seven (7) days after the building per is Issued. !n the sen of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature �J Signatur
NER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The fo goin instrumentt was acknowl (edbefore me this
1�e day of � .r-1 20 L ,by <t ay of Ct�+ , 20 Vo by
'(\lar-\ 'Mrw++n, ,who is personally known to :Da+n.gASacArc c!a who is personally known to
me or who has produced 'FL\-)L as me or who has produced _ L\7 as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign Sign•
9:%�
Print: ow r6-%!nv Print:
Seal: SANSANA OINETTE®RINms Seal: SANWA GINIITTI BRINOU
MV C®MMIRsim#pIrommis
EMRIFS Jmnunry 2,2018 41 ' My COMMISSION+�MPf A1®
.� �,�f4l�P!ll.l�rnt�PV 2 (D1i
�i�aw *s*�surt�ama�ss+r�►s�•a� �� ss �s �nss :��ss�w��s��ra� ssa�*eix�e•��x
X018® Fifol®IN IOW
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
h Miami Shores Village + u
10050 N.E.2nd Avenue NE
„ � a
Miami Shores,FL 33138-0000ik
Phone: (305)795-2204
� K
Expiration: 09110/2016
Project Address Parcel Number Applicant
150 NE 106 Street 1121360050040
Miami Shores, FL 33138- Block: Lot: MARY MARIN
Owner Information Address Phone Cell
MARY MARIN 150 NE 106 Street
MIAMI SHORES FL 33138-2037
Contractor(s) Phone Cell Phone
DV06
G BUILDERS INC (305)506-7308 Valuation: $ 13,000.00
Total Sq Feet: 0
Type of Work:INSTALL 11 IMPACT WINDOWS AND 1 DOO Available Inspections:
No of Openings:12 Inspection Type:
Additional Info: Window Door Attachment
Classification:Residential Final
Scanning:4 Review Building
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $7.80
DBPR Fee Invoice# WS-3-16-58882
$3.30 03/14/2016 Check#:1604 $209.40 $50.00
DCA Fee $3.30
Education Surcharge $2,60 03/03/2016 Check*1590 $50.00 $0.00
Permit Fee $220.00
Scanning Fee $12.00
Technology Fee $10.40
Total: $259.40
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,ROOFING and SWIMMING POOL work.
OWNERS 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 zon'�;"e re,I authorize the above-named contractor to do the work stated.
March 14,2016
Authogvlaturdfbwner VApplicant / Contractor / Agent Date
Buildin epartment Copy
March 14,2016 1