PLC-17-1593 Miami Shores Village N7ED
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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
F�C 20 VA
BUILDING Master Permit No.CC-5-17-1301
PERMIT APPLICATION Sub Permit No. D 1 r. 1=l `1��
BUILDING ❑ ELECTRIC ROOFING REVISION EXTENSION RENEWAL
r■ PLUMBING [:] MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 602 NE 96th'St.
City: Miami Shores County: Miami Dade Zip: 33138
y Folio/Parcel#: 11-3206-014-1410 Is the Building Historically Designated:Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
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 WirelessPhone#:954 234 7070
Email: Dylan@Verticalpropertysolutions.com
CONTRACTOR:Company Name: Secure Gas Service Phone#: 234 770'4418
Address: 6951 Saint Edmunds Loop
City: Fort Myers Sta AVL Zip:
Qualifier Name: Bradley Schehr Phone#: 234 770'4418
State Certification or Registration#: 32386 Certificate of Competency#:
DESIGNER:Architect/Engineer: Kimley-Horn Phone#: 561 845 0665
i Address: 1920 Wekiva Waypp h 1 city: West Palm Beach State: FL Zip: 33411
Value'of Work for this Permit:$ z'CA o 0 ' Square/Linear Footage of Work:
Type of Work: ElAddition ME Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work:
35KW propane generator associated gas work for emergency power for proposed antennas
and equipment.
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Specify color of color thru tile:
Submittal Fee$ Permit Fee$ d CCF$ �C$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$ 1 _
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ . ON
(Revised02/24/2014)
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Bonding Company's Name(0 applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
City State Zip
f r.
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."
Notice to Applicant As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must
i 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
I 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 Signatur
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
12 day of June -----,20-17 by 12 day of June 20 17 by
Thomas Leonard who is personally known to Bradley Schehr who is personally known to
me or who has produced as me or who has produced as
a ,
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
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P an Washburn P i , (1
aj��:Y,P10�4, DYLAN D.WASHBURN S �} fi Commission#FF 123287
µ Commission#FF 123287 Expires May 14,2018
Expires May 14,2018
•. _� ,a• Bonded Thru Troy Fain Insurance 8W385-7019
,�F r„•t,oe• Bonded Thru Troy Fain Insurence 800385,7019
APPROVED BY `f-0---Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014) i