REV-16-1569 Miami Shores Village y;
Building Department JUN 06 2016
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 rjY;_
Tel:(305)795-2204 Fax: (305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20
BUILDING Master Permit No. Z" /1. —SS
PERMIT APPLICATION Sub Permit No. i5V M -.1 69'
BUILDING F-] ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
V
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
,� �jI� CONTRACTOR DRAWINGS
JOB ADDRESS: CG,/2 / /I
om / 10 3 'S1 i7
City: Miami Shores County: Miami Dade Zip: 3/3d
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: A,Construction Type:/ llFlood Zone: BFE: " FFE:
OWNER: Name(Fee Simple Titleholder): /UIdfG `�'Ll L 1+zC4l Leto Phone#:
Address: 1TZQ
City: N(l"I 45hete( State: EL Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: E c.) b Cen51f/c/Gfroi„ Phone#:.��'� �y—
Address: 17M ./1E- t y4 S Sr
City: IV k1 ra/rn State: _FY Zip: 33
Qualifier Name: C— I Phone#:
State Certification or Registration#: G / Certificate of Competency#:
DESIGNER:Architect/Engineer: (9 SI-0 !k-� Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: K- I PN e Cepq�P`A) /STI
Specify color of color thru Idle
Submittal Fee$ ` ' Permif•Fee`$- -0 CCF$ CO/CC$
Scanning Fee$ �� Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(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 commencementFmust 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 r ' spection fee will be charged.
Signat re' Signature
t
OWNER or A T CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoin nstrument was acknowledged before me this
Co day of 20 t (.o by 6 day of /1 20 �� by
t _
knr1 L I be who is ersonally kno to 1I� �wh s personally know 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: Ysa Sig
Print: rint:
:`ell
MY COMMISSION Seal: t,,rY►�, Notary Public a of Florida
Seal: ; ;y EXPIRES:October 18,2019 `� Joanna M Fell no
tib•...• •
R;,;\.• BondedThruNotary pubNeUnaerwritan '9 � My Commission FF 082753
OF r��� Expires 01/12/2018
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(RevisedO2/24/2014)
%
µ: . *ami holes �/ i
. . . . • w •
.*. .,•. .:. Wuiiding Department
N o�
' 10050 N.E.2nd Avenue
••• ••• ••• Miami Shores, Florida 33138
. ... . . . . .. .
• •• (Tel: (305) 795.2204
•' ••• Fax: (305) 756.8972
MIAMI SNORES VILLAGE
NOTICE TO BUILDING DEPARTMENT
OF EMPLOYMENT AS SPECIAL INSPECTOR UNDER
THE FLORIDA BUILDING CODE
i
` I (We) have been retained by to perform special inspector services under
the Florida Building Code at the project on the below listed structures as of
r (date).I am a re ist red a itect or profes onal engineer licensed in the State of Florida.
PROCESS NUMBERS:
SPECIAL INSPECTOR,FOR PILING,FBC 1822.1.20(R4404.6.1.20)
❑ SPECIAL INSPECTOR FOR TRUSSES>35'LONG OR 6'HIGH 2319.17.2.4.2(R4409.6.17.2.4.2)
❑ SPECIAL INSPECTOR FOR REINFORCED MASONRY,FBC 2122.4(R4407.5.4)
❑ SPECIAL INSPECTOR FOR STEEL CONNECTIONS,FBC 2218.2(R4408.5.2)
❑ SPECIAL INSPECTOR FOR SOIL COMPACTION,FBC 1820.3.1(R4404.4.3.1)
❑ SPECIAL INSPECTOR FOR PRECAST UNITS&ATTACHMENTS,FBC 1927.12(R4405.9.12)
❑ SPECIAL INSPECTOR FOR
Note:Only the marked boxes apply.
The (lowing J'nd ' al )em toyed firm or me a authorized representa' s pert r spection
1• -U- i 2.
3. 4.
*Special Inspectors utilizing authorized representatives shall insure the authorized representative is qualified by education or
licensure to perform the duties assigned by the Special Inspector. The-qualifications shall include licensure as a professional
engineer or architect; graduation from an engineering education program in civil or structural engineering; graduation from an
architectural education program;successful completion of the NCEES
Fundamental Examination;or registration as building inspector or general contractor.
I, (we)will notify Miami Shores Village Building Department of any changes regarding authorized personnel performing inspection
services.
I, (we) understand that a Special Inspector inspection log for each building must be displayed in a convenient location on the site
for reference by the Miami Shores Village Building Department Inspector. All mandatory inspections, as required by the Florida
Building Code, must be performed by the County.The Village building inspections must be called for on all mandatory inspections.
Inspections performed by the Special Inspector hired by the Owner are in addition to the mandatory inspections performed by the
Department. Further, upon completion of the work under each Building Permit I will submit to the Building Inspector at the'time of
final inspection the completed inspection log form and a sealed statement indicating that, to the best of my knowledge, belief and
professional judgment those portions of the project outlined above meet the intent of the Florida Building Code and are in
substantial accordance with the approved plans.
gSiand Sealed EngineerlAr itect
Name
le 4-li /Address Y3 ( r Phone No.
1
Ll
(` Created on 6110/2009 '