REV-18-1493 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 "'—
FBC 20
BUILDING Master Permit No. 6 C-
PERMIT APPLICATION Sub Permit No. tey l ',i4'93
❑BUILDING P0 ELECTRIC ❑ ROOFING [2a REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: C/1 Z�Z. �!E of r
City: Miami Shores County: Miami Dade zip: 35 i 3 �S
Folio/Parcel#: Is the Building Historically Designated:Yes NO
4
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): Ovl - Phoh# 95y ZZS —Zy9
Address: ')-f%4A '>1,nn�k-� o
City: !6 �t State: rel Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: t��l�- T.GJ�e_c.-�r<< (0—Puw!j Phone#: 9'5y Z-02'4'L 19
Address: /q&(S w`-1'& civ✓
City: ` uhf (-vvcl Lim State: �Lw"J c. Zip: 33 3
Qualifier Name: �Gurd� �{�oS�a Phone#: 95`/ L"'_'3
State Certification or Registration#: E Certificate of Competency#:
DESIGNER:Architect/Engineer: i 1,L Pho��,�ne#: '14, is S9 So
Address: 2_q?,0 5o A4�st "1�, A City: "�,(ov J` "mate:�Zip: ? 3144
v•
Value of Work for this Permit:$ 400 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: 0401 c
+0 C4aJ
Specify color of color thru tile: ,s►
Submittal Fee$ )_R Permit Fee$ � / �y CCF$ CO/CC$
Scanning Fee$ E?• Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ 2
TOTAL FEE NOW DUE$ 4 '
(Revised02/24%2014)
�- `r
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. l
Signature Signattr
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The for mg.instr ment was acknowledged before me this
day of d' 20 (g ,by 2 da /NC-V 20 19 by
GD �e g hex��02 who is personally known to CtZ—Jo CS �f` 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: NOTARY PUBLIC:
Sign• Sign:
Print: Print:
l MICHAEL RAMIREZ
�: MY COMMISSION GG 169200
Seal: Seal: ;a• `1 MICHAELRAMIREZ
EXPIRES:December 18,2021 MYCOMMI9SION#GG 169200
Bonded Thru Notary pubic Undw&T m EXPIRES:December 18,2021
Bonded Thru Notary pubic Underwriters
APPROVED BY YltY )l /ItPlans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
f
i
i
3
t
I
I
t
1
PLEASE CUT OUT CARD BELOW AND RETAIN FOR FUTURE REFERENCE
r
_ E O _______
+ STATF FLORIDA i
I CES
DIVISION OF WORKERS•COMPEN DEPARTMENT OF FINANCIAL ATION I IMPORTANT I I
CONSTRUCTION INDUSTRY EXEMPTION I F Pursuant to Chapter 440.05(14),F.S.,an Officer of a corporation 3
)
CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA0
'q Who elects exemption from this Chapter by filing a Certificate Of I
WORKERS'COMPENSATION LAW ono w+"0 I election under this section may not recover benefits or I
L compensation under this chapter.
EFFECTIVE DATE: S/2 OIS EXPIRATION DATE: 5/2712020 (D pursuant to Chapter 440.05(12),F.S..Certificates of election to ( c
PERSON: RICARDO J ACOSTA EMAIL: RYACELECTRiCQ9ELIiIOUM.In I be exempt...appy only within the scope of the business or trade ( '-
I - I listed on the notice of election to be exempt. I f
FEIN: 200554171. (H - t
BUSINESS NAME AND ADDRESS: E Pursuant to Chapter 440:05(13),.F.S.,Notices of eteotion to be
I exempt and certificates of election to be exempt shall be
RYAC ELECTRIC COMPANY CORP. I R sUb}ed to revocation if,at any time after the filing of the notice.
I I Eor the Issuance of the certificate.the person named on the I
rrotice or certificate no longer meets the requirements of this
I 2943 SW 34 AVE I section for issuance of a certificate.The department shag revoke
I I a certificate at any time for failure of the person named on the I
MIAMI.O 33131 certificate to meet the requirements of this section.
I SCOPE OF 6usIRE33 OR TRADE: I
( i ———————I
{
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413=1609 s,
i
1
3
i
ti
I
a
)
t
I
I I
a
c
i
6
I
i
t
� F
4j
)
{
jk[I
}
I