REV-18-3422r � ;,
Miami Shores Village RECEIVED
Building Department NOV 13 2018
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 aAl
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ROOFING
08 C 26 1-:3r
Master Permit No.
Sub Permit No. ZZ,
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
Folio/Parcel#:
Occupancy Type: Load: _
OWNER: m (Fee Simple Titlehol,
Address:
't. City:
Email:
CONTRACTOR: Company Name:
Address: W
City: tQ4k
Qualifier Name:
State Certification or Registration #:
Is the Building Historically Designated: Yes
Construction Type: Flood Zone: BFE: _
NO
FFE:
&P one#-A� 't7.7 J"���
Tenant/Lessee Name: Phone#:
e#: —7% 7- —11\kA
State: Zip:
Z �\6UC_ Phone#:
rtificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address:-:... ,,,, .1 : .�,;, , City: State
-• 1^.fob 'this
, � a �i i• r r
Value of Work this'Permit: $; �( .� Square/Linear Footage of Work:
�. b•v fit... � �.,�,.•.v. ... `;:,y , -
Type of Work: ❑ Addition ❑ Alteration _ ❑ New ❑ Reptir/Replace
Description of Work:
Zip:
❑ Demolition
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC�$
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
lr
(Revisedo2/24/2014)
DBPR $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
Q n ), 7
Bonding Company's Name (if applicable)
r
Bonding Company's Address
City '' _ State
Mortgage Lender's Name,(if applicable)
Mortgage Lender's Address
City
State
Zip
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 occ s seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved �d reins ection fee will be charged. I
P PP P P f 9 n_. /I
)<Signatu
or AGENT
oTh f egoing inst rum t w acknowledged before me this
Si day of �+P �known
wh is
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC �)
Print:
Seal: = my COMMSSION # GG 20W5
fi
EXPIRES: Jury 12, 2022
.+:� .... Q'•• Hooded TAru Nota'f' f�C UndeiMalMH
The foregoing instrument
me or who has produced
R
acknowledged before me this
,20 �, by
who is personally known to
identification and who di batga123
\o� Expires Jury 11, 2021
NOTARY PUBLI t.?df1ti�` oor11`�n""N'�%tr�Yw
Sign: No
Print:
Seal:
rssrsr*r*�:rrsr*ss*�sssrs�:*r**�r *w`* *s*�sr�ssssssssss:ss*s*:srrsssssrssrs�r***ar**�rssrss*s*rr*:ssssss:
APPROVED BY I �3 Plans Examiner Zoning
Structural Review
Clerk
(Revised02/24/2014)
RECEIVED • • • • • • • • ♦ •
• " • •" • • • • • "P100F ASSEM IE O OP ORES
Nov 13 2018
Ftor9da E3 IdIn Code 6th rrAtiIonUb14)
a'.11W
Hi h-Velocit H
"'"; nf)
S y ut cone Zone Uniform Perrnit Applicati 1
.. . . • .. ... •• 1
ectiorC*'A�*r:*eriLFnfoe'rmatlion)
Master Permit No. • • • • • • • • • • •
1
Process No. 1
Contractor's Name Q C9 Q c\QA N
Job Address
ROOF CATEGORY 1
Low Slope ❑ Mechanically Fastened Tile Mortar/Adhesive Set Tiles 1
❑ Asphaltic Shingles ❑ Metal Panel/Shingles ❑ Wood Shingles/Shakes 1
1
❑ Prescriptive BUR-RAS 150 1
ROOF TYPE 1
❑ New roof ❑ Repair ❑ Maintenance ❑ Reroofing ❑ Recovering 1
Steep
SYSTEM INFORMATIONt 1
Low Slope Roof Area (SF Sloped Roof AREA (SSF)_�_Wb Total (SF)_ (g� 1
1
1
Section B (Roof Plan) 1
Sketch Roof Plan: Illustrate all levels and sections, roof drains, scuppers, overflow scuppers and overflow drains. Include dimen-
sio
ns of sections and levels, clearly identify dimensions of elevated pressure zones and location of parapets.
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
r
FLORIDA BUILDING CODE — BUILDING, 5th EDITION (2014) 15.37
• t 111
1 Copyrigbt to, or licensed by, ICC (ALL RIGHTS RESERVED); accessed by Eliezer Palacio on Jun 8, 2015 10:32:12 AM pursuant to License
Agreement. No fu»her reproductions authorized.