RC-15-3127 (4) Miami Shores Village
Building Department L—i
N �, 2017
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 �l
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20
BUILDING Master Permit No. RC-12-15-3127
PERMIT APPLICATION sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATIOHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 9301 N Bayshore Dr
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11-3205-027-0560 Is the Building Historically Designated:Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):Guy Kurlandski Phone#:
Address:9301 N Bayshore Dr
City: Miami Shores State: FL Zip: 33138
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: Gentile Corp Phone#:
Address: 3160 Turtle Cove
City: West Palm Beach State: FL Zip: 33411
Qualifier Name: Oscar FroZini Phone#:
State Certification or Registration#: CGC1521508 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ '50('yo Square/Linear Footage of Work: 800
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: FRONT GATE (Aluminum & wood)
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$ K62 9
(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 an a reinspection fee will be charged.
• 1
Signature Signature Olkqn
O ER or AGENT CONTRAC R
The foregoing instrument was acknowledged before me this The foregoing instrument was cknowledged before me this
1 1 day of t—xl 200 by 13 day of JQ AUQ 20 11 by
U va)( ► ho is personally known to OSC 4( ' t�Z�►n'• 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 PUBLIC: NOTARY PUBLIC:
Sign: (� Si - .,L
Print: Y Print: Q
."'•. MALUCIA 31MRA .Q��Y^i�, ANA LUCIA SIERRA
Seal: 's� Seal: '? MY COMMISSION#FF 224104
MY COMMISSION#FF 224104
a EXPIRES:April 23,2019
AdBomm a EXPIRES:April 23,2019
Thru Notary Public Underwriters Banded Thru Notary Public Underwriters
************************************************************************************************************
APPROVED BY Plans Examiner Zoning
Z�i / Structural Review Clerk
(Revised02/24/2014) `�