REV-16-1209 i
Miami Shores �p,� ���,�
Buildi BY:
10050 nd i° ` lori 38
T 5 05 - 972
L H E N R:(305)762-4949 S
FBC 2011
BUILDING Master Permit No.,
PERMIT APPLICATION Sub Permit No. gtEvl U 4
219U"ILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: -3 2- tJE i Iy L
City: Miami Shores l'-�, County: Miami Dade Zia:
Folio/Parcel#: f I e 2-f �' v�� Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: . Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Title-holder): ���P (0,-k I b Phone#:-7K,3qD-'?-f-2 D -2
Address 110 ff
City: �. OVVN( S ko',(C-6 State:
Tenant/Lessee Name: Phone#:
Email: dd t
CONTRACTOR:6 i Company Name: "t 1 C ��nef_
G-(00(2 Phone#: 3 �d
Address: LI`J 01A) 53
City: P14 �``�"` ` State:�r Zip: Jlfi
Qualifier Name: �� yfP'C-6'- Phone#:
State Certification or Registration#: I-DI D-0 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ �7, ocx)a Square/Linear Footage of Work: 610
Type of Work: ❑ Addition" Ej Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: G �s'I Z)� A'-\4;J� 4Af �� �� Y u g AAI kvrN �EV1�q
Specify color of color thru tile: r--
Submittal Fee$ /PermitS Fee$ .� ° an CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ :?,c
(RevisedO2/24/2014)
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
whoseproperty-is-suNect-to attachment-Mso,-a certified copy of the-recarded-TWice-of commenceffffnt-must b-e-p sted-d"hob 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
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrumenj was acknowledged before me this
day of 20 'by :__7 of 20 by
c c , l a O who is personally known to C4 o Ve:C o, who isersonally know o
me or who has produced �L_DL- as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: John Rogow NOTARY PUBLIC: John Roque
NOTARY PUBLIC NOTARYPUBLIC
STATE OF FLORIDA ,� STATE OF FLORIDA
Sign: Sign: Ccmm#FF946106
Print: C�fJp� 4m rmm
1 11°Nt�/17/202Q Print• S�k✓L-
Seal: Seal:
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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�:•�• ,...�� Miami Shores Village
Building Department
GDRiDA 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
RECEIPT
PERMIT#: DATE:
I,
(Name)
o Contractor
o Owner
❑Architect
Picked up 2 sets of plans and(other)
y
Address: 1 I [0
From the building department on this date in order to have corrections done to plans
And/or get County stamps. I understand that the plans need to be brought back to Miami
Shores Village Building Departmen o continue itting process.
Signature:
(SIGN RE)
PERMIT CLERK INITIAL:
RESUBMITTED DATE: 6
PERMIT CLERK INITIAL:
yBoREs y
Miami Shores Village
Building Department logo
10050 N.E.2nd Avenue yy�
Miami Shores, Florida 33138Nras
Tel: (305)795.2204 LORIDA
Fax: (305) 756.8972
BUILDING CRITIQUE
DATE: 05-12-2016
PERMIT NUMBER: 16-1209
Pending comment#2
2.Provide details of the concrete slabs.Crass required between slabs.
Ismael Naranjo, B.O, CFM
Building Director
t
♦5N°REs L
� Miami shores Village
�, � Building Department
�LpR�p�► 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
RECEIPT
PERMIT#: '.V[� �—`�' l DATE: 77
I,
d2k S
(Name)
Contractor
❑ Owner
❑Architect
Picked up 2 sets of plans and (other)
Address: 3 K, �le-
From the building department on this date in order to have corrections done to plans
And/or get County stamps. I understand that the plans need to be brought back to Miami
Shores Village Building De artmen ntinue permitting process.
Signature:
(SIGNATURE)
PERMIT CLERK INITIAL:
RESUBMITTED DATE:
PERMIT CLERK INITIAL:
yt�oREs
Miami Shores Village S yi
Building Department .....�
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204 R�A
Fax: (305) 756.8972
BUILDING CRITIQUE
DATE: 05-05-2016
PERMIT NUMBER: 16-1209
1. Health Department approval required.
2. Provide details of the concrete slabs. Grass required between slabs.
Ismael Naranjo, B.O, CFM
Building Director