RC-14-1512Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
1;71BUILDING ❑ ELECTRIC ❑ ROOFING
JUL 16 I"
BY: I
FBC 20 LO
Master Permit Not �.A' �;s `q'
Sub Permit No
❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: --7/✓%- 47
City: Miami Shores Countv: 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): . A ® ZZ-e-ZZ-e—V Phone#: .:A®v -9�.7 470 f
Address: 0�f�"�/. .—
City: ���®� Stater Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: ��� `��t ,®, Phone#:
Address: 0?30 yy 7
City: State: Zip: _4.901 16
Qualifier Name: F— �� l�V414e�2__ Phone#: 3®_4-- X920 �&o7
State Certification or Registration #: Certificate of Competency #: -�����
DESIGNER: Architect/Engineer:
one#:
Address: City: State: Zip:
Value of Work for this Permit: $ �' % Square/Unear Footage of Work: /O®
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: 49
Specify color of color thru tile:
Submittal Fee
Scanning Fee $
Technology Fee $
Structural Reviews $
(Revised02/24/2014)
Permit Fee $ � ()C) I CCF $ CO/CC $
Radon Fee $
Training/Education Fee $
DBPR $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ GO -
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
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 ocrs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not befgpprovg&qd a reinspection fee will be charged.
'W
Signature
OWNER or GENT CONTRACTOR
Thej foregoing instrument was acknowledged before me this
1� dacyof -� 20 , by
ru:A-q-CCho is personally known to
me or who has produced L- 41JC-(Z- as
identification and who did take an oath.
The foregoing instrument was acknowledged before
-pme this
S day of -6Lu-( , 20 1 , by
who is personally known to
me or who has produced v5N--� D as
identification and who did take an oath.
NOTARY PUBLIC:
NOTARY PUBLIC:
tt+t►tiin�Uii���
Sign:
Sign:
Print:
''g' Print:
.' : �-
ED
o oy
Seal.
V---: q,`Seal:
;�= 35 '
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unniuu
nett" 0
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l� t
APPROVED BY
Plans Examiner
Zoning
Structural Review Clerk
(Revised02/24/2014)
G
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-218005 Permit Number: RC -7-14-1512
Scheduled Inspection Date: August 19, 2014 Permit Type: Residential Construction
Inspector: Rodriguez, Jorge Inspection Type: Final
Owner: , Work Classification: Repair
Job Address: 215 GRAND CONCOURSE
Miami Shores, FL Phone Number
Parcel Number 1132060450020
Project: <NONE>
Contractor: EMD INTERNATIONAL DESIGNER CORP Phone: (305)992-8007
comments
TO CLOSE EXPIRED PERMIT BP2003-651 REPAIR
CRACKS ON WALLS AND MASONRY FENCE. STUCCO
INTO THE CRACK TO REPAIR THE SURFACE
INSPECTOR COMMENTS False
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP-217967. No permit on site
Failed
Correction ❑
Needed
Re -Inspection �.
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
August 18, 2014 For Inspections please call: (305)762-4949 Page 22 of 27