REV-17-1146 � v y �...
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Miami Shores Village -�-Y -b
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Building Department ` APR 2017
10050 N.E.2nd Avenue,Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 =�_
INSPECTION LINE PHONE NUMBER:(30S)162-4949
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FBC 20
BUILDING - Master Permit No.C((CC�-12-15-3013 �I (
PERMIT APPLICATION Sub Permit No._�_1��I J -1\4 l7
❑BUILDING ❑ ELECTRIC ❑ ROOFING Q REVISION ❑ EXTENSION ❑RENEWAL
'F-]PLUMBING ❑E MECHANICAL ❑PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
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106 ADDRESS: Barry university- 11300 NE 2 Avenue- Fine Arts Quandrangle
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:1121360010160-06 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: i FFE:
OWNER:Name(Fee Simple Titleholder):Barry University Phone#:
Address: 11300 NE 2 Avenue
City: Miami Shores State: FIL Zip: 33161 `
Tenant/Lessee Name: Jeffrey Yao Phone#:
Email: Jyao@barry.edu j
CONTRACTOR:Company Name: Southeast Mechanical Contractors Phone#: 9547360036
Address: 2120 SW 57 terrace
City: Hollywood State: FL Zip: 33029
Robert Macklin 9547360036
Qualifier Name: Phone#:
State Certification or Registration#: Florida#CMC1250173 Certificate of Competency#: F
DESIGNER:Architect/Engineer: Harvard Jolly Phone#:-5614784457
Address:2047 Vista parkway, Suite
e7�7,,0,,0��,,,, City: WPalm Beach State: FL Zip: 33411
Value of Work for this rmit:$�l'� ._/� Square/Linear Footage of Work:
Type of Work: Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: Addition of Fan Coil Unit and ductwork distribution
Specify color of color thru tile:
Submittal Fee$_kPermit Fee$ CCF$ CO/CC$ i
Scanning Fee$ Radon Fee,$ DBPR$ Notary$
I Technology Fee$ Training/Education Fee$ Double Fee$ r
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ CA
i (Revised02/24/2014)
Bonding Company's Name(if applicable)
Bonding Company's Address r
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.
.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."
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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 thi absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
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OWNER or AGENT CONTRACTOR
The foregoing instrumentwasacknowledged before me this The foregoing instrument was acknowledged before me this
x ft day of /tf l/A J/ 20 17 by �jj day of -�4 Il— 120. ( by
' Sal �a� AL ,who is personally known to 8 6Y)Di` {7�1G Cf/ wh :personally kno 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: Sign:
I Print: A Print:
Seal:
Notary PubNc Stab of Florlds Seal: EXPI�Fobftmq 12,2019
J8"J Yao ���► �� mm
My Commission FF 188481
Expires 11112/2018
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APPROVED BY PNans xaminer Zoning
Structural Review Clerk
(Revised02/24/2014)