REV-16-2133BUILDING
PERMIT APPLICATION
BUILDING ❑ ELECTRIC ❑ ROOFING 0 REVISION
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
4INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 2010
Master Permit No. RC -15-1024
Sub Permit No. 2LU (b' 2133
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
JOB ADDRESS: 9701 BISCAYNE BLVD
❑ EXTENSION
❑ CANCELLATION
RENEWAL
❑ SHOP
DRAWINGS
City: Miami Shores
County:
Miami Dade
Zip: 33138
Folio/Parcel#: 11-3206-014-3320 Is the Building Historically Designated: Yes
Occupancy Type: R-3 Load: Construction Type: V Flood Zone: X BFE:
OWNER: Name (Fee Simple Titleholder): JOSE G. CASTRO & MARIA G. ALE
Address: 9701 BISCAYNE BLVD
NO X
FFE:
Phone#: 305-582-2836
City: MIAMI SHORES
Tenant/Lessee Name: NIA
State: FL Zip: 33138
Email: info@r-method.net
Phone#:
CONTRACTOR: Company Name: R -METHOD CONSTRUCTION, INC.
Address: 2541 SW 119TH TERRACE
Phone#: `305-914-5355
City: MIRAMAR
State: FL Zip: 33025
Qualifier Name: LORENA TELLO Phone#: 305-798-7620
State Certification or Registration #: CGC 1519419 Certificate of Competency #:
DESIGNER: Architect/Engineer: JOSE RUBEN JIMEIVEZ, ARCHITECT Phone#: 305-582-2836
Address: 300 OAKWOOD LANE SUITE 100 City: HOLLYWOOD ,State: FL Zip: 33020
Value of Work for this Permit: $
Type of Work: ❑ Addition Alteration
Square/Linear Footage of Work:
❑ New ❑ Repair/Replace
Description of Work: Structural revisions as required by inspections.
❑ Demolition
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Specify color of color, thu tile: r, , .r
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Submittal Fee $ "�"�=�' Permit Fee $ -'
t v15627 k /-DP? v
6bnw i M 91S%
8tOS,�r 39G asiigx'��(, . •
CCF $ 1 le:lo:tcvi n°re0/CC`$a
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ ,Double Fee $
Structural Reviews $ Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $
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 absenc o such .: :. notice, t•
inspection will not be approved and a reinspection fee will be charged.
Signature
\LAWNER or AGENT
The foregoing instrument was acknowledged before me this
day of
,20_1457_,by
who is person
Signature
CON
iLi
R
The foregoing instrument was ackho ledged befo e me this
13 day of , 20 1 i by
wn to 10124.1.A. fr v , who is pers
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
1'
I -� ,�;;FIVo�s,,, j NATHALIE CEPERO 0
•ti� s Notary Public - State of Florida `
My Comm. Expires Dec 19, 2018 I
1 N•OF �P;' CommissionFFA152862 '
'•,,? Win;,°•
owThrough
Assn.
APPROVED BY
(Revised02/24/201 4)
own to
as
Sign:
Print:
Seal:
Notary Public - State of Florida
•i My Comm. Expires Dec 19, 2018
r' Commission # FF 152862`:� Bonded Through National Notary
Assn.
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Plans Examiner
Zoning
Structural Review Clerk