RC-16-1005 (2) Petrie�C6 �
,gNX_"OvMiami Shores Village '
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050 N.E.2nd Avenue NE
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Miami Shores,FL 33138-0000 S
Phone: (305)795-2204 Fe� �Ri�
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_.. Issuet � ! _ Expiration: 11/21/2016
Project Address Parcel Number Applicant
9942 NE 4 Avenue Road 1132060171220
Miami Shores, FL stock: Lot: WARREN WILSON
Owner Information Address Phone Cell
WARREN WILSON 9942 NE 4 AVE RD
MIAMI SHORES FL 33138-2480
Contractor(s) Phone Cell Phone Valuation: $ 20,000.00
ARENAS CONSTRUCTION (305)300-3103
Total Sq Feet: 200
Approved:In Review Available Inspections:
Comments: Inspection Type:
Date Approved::In Review Window Door Attachment
Date Denied:
Framing
Type of Construction:CONVERT 1 1/2 BATH INTO 1 BATF Occupancy:Single Family Insulation
Stories: Exterior: Drywall Screw
Front Setback: Rear Setback: Final PE Certification
Left Setback: Right Setback: Window and Door Buck
Bedrooms: Bathrooms: Fill Cells Columns
Plans Submitted: Certificate Status: Review Building
Certificate Date: Additional Info: Review Planning
Review Electrical
Bond Return: Classification:Residential Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Structural
CCF $12.00 Review Mechanical
DBPR Fee Invoice# RC-4-16-59413
$9.00 05/25/2016 Check#:4069 $664.00 $0.00
DCA Fee $9.00
Education Surcharge $4.00
Notary Fee $5.00
Permit Fee $600.00
Scanning Fee $9.00
Technology Fee $16.00
Total: $664.00
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 zoning. Futh Ire,I au o ize a above-named contractor to do the work stated. y
1 �[[// May 25, 2016
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
May 25,2016 1
Miami Shores Village JBY:
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Buildin De artment
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10050 N.E.2nd Avenue,Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 .p�l
y ��1 INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 t`'1
BUILDING Master Permit No.%. - 100
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
�Q CONTRACTOR DRAWINGS
JOB ADDRESS: Z IVy7'4 � 0 &-Q u
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: ( Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): W 0.✓<-c h b onh c L; . �< < �� Phone#:
Address: qvi 7- !YC C a
n
City: � 4.01,� S� ��<s State• �- Zip: 3 3 l 3 �l
Tenant/Lessee Name: Phone#:
Email: (�� tas ( 5, (aC
CONTRACTOR:Company Name: W2-C�- NS, C Zk) (Ly , Phone#: 3M 2 C Q3
Address: El Ct
City: " • State: C— Zip: �3\3b
Qualifier Name: (IZc�—TQC Phone#:AC&,300 3
State Certification or Registration#: G'tjG. c )ij ( Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition IR Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: C-OkN'-) 9 aX 0-7- '�5CN� r>,�-714
OA Sic
Specify color of color thru tile:
Submittal Fee$ /" Permit Fee$ _ Q CCF$ CO/CC$
Scanning Fee$ Radon Fee$ -CA0 DBPR$ C Notary$ v
Technology Fee$ Training/Education Fee$ "r' 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 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 QPY14- Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The for going instrument
was acknowledged before me this
_day of ,20 ,by day of ��`' �'' 20 1 b by
who is personally known to Jfq-D ,whfokl2s5p(e�rtonal y known to
me or who has produced f:7� 0 Z`LV��-!Z as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: �q1 IIIII�III!%, NOTARY PUBLIC:
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Sign: A Sign:
Print: zit n Print:
Seal: vs�l0°� S3>j1a '• �° Seal: NotaryPub
mss 9/ �•..°°•°• \�, e
S nd a Alviarez to of Florir.a
Pg My Commission FF 15675
Qt�,, ✓�`PmyeS
APPROVED BY "T' Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)