REV-17-826BUILDING
PERMIT APPLICAT
Miami 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 ❑ ELECTRIC ❑ ROOFI
EVISI I N
RECEIVE
MAR 2 7 2017
FBC 201
mit No. RC -15-1024
rmit No. E \i1 ( -371p
EXTENSION ❑ RENEWAL
PLUMBING MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 9701 BISCAYNE BLVD
City: Miami Shores
County:
Miami Dade Zip: 33138
Folio/Parcel#:11-3206-014-3320
Is the Building Historically Designated: Yes NO X
Occupancy Type: R-3 Load: Construction Type: V Flood Zone:
OWNER: Name (Fee Simple Titleholder): JOSE G. CASTRO & MARIA G. ALE
Address:9701 BISCAYNE BLVD
X
BFE: FFE:
Phone#: 305-582-2836
City: MIAMI SHORES State: FL
Tenant/Lessee Name: N/A
Email: info@r-method.net
Zip: 33138
Phone#:
CONTRACTOR: Company Name: Al(w1 Et 1R,,....../44.c 1 �i�L✓LC(-Phone#: 0r-3- 5 -'=JJ-
Address: G1-1-1 io, a1 I 1.--e--(2-4-
City:
e-- -iZ-
City: -f AO State: Zip: 30 i v
Qualifier Name:
ilt- Phone#:
State Certification or Registration #: �•��r2_ 1' 5:1 Certificate of Competency #:
DESIGNER: Architect/Engineer: JOSE RUBEN JIMENEZ, ARCHITECT
Address: 300 OAKWOOD LANE SUITE 100
Value of Work for this Permit: $ 2,000.00
Type of Work: • Addition ❑■ Alteration
Phone#:
305-582-2836
City: HOLLYWOOD State: FL Zip: 33020
Square/Linear Footage of Work: 955 ADDITION / 655 ALT.
❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: Installing a new AHU and CU units in proposed addition as oppose to connecting to
existing AC system, as proposed in previous plans.
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ t) (2L �o CCF $ ® I • 2_i Co/CC $ 9
Scanning Fee $ 3 ' 0 Radon Fee $ 2 OD DBPR $ '. -0C.) Notary $
Technology Fee $ ' C='.Q Training/Education Fee $ • '4 c) Double Fee $
Structural Reviews $
(Revised02/24/2014)
Bond $
TOTAL FEE NOW DUE $) I v • Z
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 Signature � ��1. ,CL
g Q`�r
OWNE AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
p � day of MarriV\ , 20 (', by g3 day of c (TA', , 20 ( by
-d" 0? . C && - -N , who is per ona 1 nown to re? yyy WO it/A l t , who is pers • nown to
me or who has produced as me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
identification and who did take an oath.
NOTARY PUBLIC:
Sign: _�'� Sign:
Print: Notary:"6�•• NATHALIE CEDER_iT Print: ,.,.���,ti NATHAI IF CFPFRQ
Seal: �� Public °1a1Q °1 Florida _': � : Notary Public - State of Florida
• Commission # GG 049216 Seal: --s` Commission N GG 049216
.n ° ' n
';�, %� �; My Comm. Expires Dec 19, 2016 0-, My Comm. Expires Dec 19. 2016
%.�ac�. .. ••' ocnom,.•`
Bonded through National Notary Assn. ! ''''' Bonded through National Notary Assn.
ismowsgpmmplempoi 4
**************************. *************:*****************************************************************
APPROVED BY
(Revised02/24/2014)
OPlans Examiner Zoning
Structural Review Clerk