REV-17-2077Miami 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
ILDING ❑ ELECTRIC ❑ ROOFING
❑PLUMBING ❑MECHANICAL PUBLICS
JOB ADDRESS: I0c N= lDSTI-Y 1
City: Miami Shores
Folio/Parcel#:
RECEIVED
T272017
FBC 20 (NQS
Master Permit No. U} ' 1(.52-01
Sub Permit No.2J 14
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
County:
Miami Dade Zip: 3313$
Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): tV' I^A-�/3THP t7_
Address: l 0 SS W& IDS- -04-
'City:
City: M f 1`4 l SHatz $ Zip: 33 13 C
Tenant/Lessee Name: Phone#:
Email:
Phone#: 3o 1 - 4-61 - q t Z3
State: Ft -
CONTRACTOR: Company Name: Phone#:
Address:
City: State: Zip:
Qualifier Name: •Phone#:..•_
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City:
State: Zip:
r
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration
Description of Work: 01 .L,L,AIO N
❑ New ❑ Repair/Replace n Demolition
I't7-1—(Z---
Specify
l—(Z---
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Permit Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
CCF $ CO/CC $
DBPR $
Notary $
Double Fee $
Bond $
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. f r , 1
"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." ti , v
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 deliveredto 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 X Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
c---4 day of G 6r2— , 20 (; by day of , 20 , by
AK U k— ��i-{on2 who is personally known to , 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:
Sign: Sign:
Print:
Seal: Seal:
Print: S(ND(.Q 4 jJ1.
Na6 Notary Public State of Florida
.Sindia Alvarez
************************ *N+bjrai *� P s1ireS 9/0 ARI1 8*****k***************************************************
Plans Examiner Zoning
APPROVED BY
(Revised02/24/2014)
Structural Review Clerk
Tb i44 utA fut etki toi4 two
Wel4 1 ;14,R -1-1N tAIAG-e( r-owcro-
6-tot um eAket.14.5-e-d y VIN 44 a .
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REV 17 20 7-7
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BUILDING
PERMIT APPLICATION
BUILDING ❑ ELECTRIC
PLUMBING ❑ MECHANICAL
JOB ADDRESS: 1055 NE 105th St
City: Miami Shores
Folio/Parcel#:11-2232-028-0810
Occupancy Type:
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
❑ ROOFING
❑PUBLIC WORKS
RECEIVED
U 72017
FBC 20
Master Permit No. ) —2011
Sub Permit No. Rtv 1 i — -1 1
❑ REVISION ❑ EXTENSION ❑ RENEWAL
CHANG
CONTRA
F ❑ CANCELLATION ❑ SHOP
TOR DRAWINGS
County: ,r+. Mi. -Dade Zip:
he Bui ding Historically Designated: Yes NO X
Load: Construction Type L ) Flood Zone: X BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Nakul Jathar
Address: 1055 NE 105th St
City: Miami Shores Sta
1 �a
L Zip: 33138
Tenant/Lessee Name: Phone#:
Email: nik.jathar@gmail.com
i
Phone#: 301 461 9823
CONTRACTOR: Company Name: f 4
OM E- 011
Phone#:
Address:
City: Staff Zip:
Qualifier Name: Phone#:
State Certification or Registration #: '? Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ ' es} � Square/Linear Footage of Work:
Type of Work: ❑ Addition 11 Alteration n Demolition
Description of Work: On the left si•e •arage wall, r
❑ New ❑■ Repair/Replace
ve the concrete design window and replace with an impact glass window.
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 $ i • Ga
(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 and a reinspection fee will be charged.
Signature
Jegt,
Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
11 day of 4146144 e, 20 1 1 by day of , 20 i by
No u- ij Q Thorwho is personally known to , who is personally known to
produced_` t.\� `� produced or who has as me or who has as
identification and who did take an oath. identification and who did take an oath.
BLI NOTARY PUBLIC:
Sign:
Print:
Seal:
************************************************************************************************************
APPROVED BY Plans Examiner
(Revised02/24/2014)
Zoning
Structural Review Clerk