ELC-17-1592 Miami Shores Village
� -= -� Building Department JUN 15 2017 �.
10050 N.E.2nd Avenue, Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20q
BUILDING Master Permit No.CC-5-17-1301 C
PERMIT APPLICATION Sub Permit No.� C F)
❑BUILDING M ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
I
❑PLUMBING [:]MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 602 NE 96th St.
City: Miami Shores County: Miami Dade Zip: 33138
11-3206-014-1410 X
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
i
OWNER:Name(Fee Simple Titleholder): Northeast Presbyterian Church Phone#:
Address:602 NE 96th St.
City. Miami Shores State: FL Zip: 33138
Tenant/Lessee Name: Verizon Wireless Phone#:954 234 7070
f
Email: Dylan@Verticalpropertysolutions.com
CONTRACTOR:Company Name: J•Crompton Electric, Inc. Phone#: 561 588 6559 �.
Address: 1290 Old Congress Ave.
City: West Palm Beach s Zip: 33409
Qualifier Name: Jonathan Crompton Phone#: 561 5886559
State Certification or Registration#: EC 13002872 Certificate of Competency#:
DESIGNER:Architect/Engineer: Kimley-Horn Phone#: 561 845 0665
Address: 1920 Wekiva Way city: West Palm Beach State: FL Zip: 33411
Value of Work for this Permit:$ Square/Linear Footage of Work: f
Type of Work: ❑ Addition ❑■ Alteration ❑ New ■❑ Repair/Replace ❑ Demolition
Description of Work: Verizon wireless to install flush mounted antennas on a steeple, associated equipment on a
platform on existing rooftop, remove and replace door access and wall.A 35KW natural gas generator will be installed for
emergency power of associated equipment and antennas.
Specify color of color thru tile: I
Submittal Fee$ Permit Fee$ /✓��� vU CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
F TOTAL FEE NOW DUE$ I ��
(Revised02/24/2014)
I
Bond -ompany'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. {
i
"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."
1
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 approv d and a reinspection fee will be charged.
Signature Signature
i
OWNER or AGENT OOV CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
12 day of June 120 17 by 12 day of June .20 17 by
11
Thomas Leonard `,who is personally known to Jonathan Crompton 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.
I NOTARY PUBLIC: NOTARY PUBLIC:
Sign gn-
ashburn Prin . Y '
S WASHBURN :^�;,; DYLAN D.WASHB
DYLAN D. 87 °.: Commission#FF 123287
9`rP 1`yA`F; CommLssl an#4 20182 Expires May 14,2018
Ex fres M y Bpp 395 7019 �f p e Brnded 1Aru T)y Fan Insurance LOOJ85 T019
p TroyFerntnstWence '
APPROVED BY P_ 04"JUA ) I Plans Examiner Zoning
I
Structural Review Clerk
(Revised02/24/2014)