The URL can be used to link to this page

WS-13-492 (2)Inspection History Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores FL 33138-0000 Phone: (305)795-2204 Fax: (305)756-8972 W -3-'1 -4 2 Windows/Shutters Project: <NONE> Owner: Phone: Job Address: 289 NE 104 Street Miami Shores, FL 33138- Parcel: 1121360130610 Block: Lot: Scheduled Insp # Inspection Type Inspection Status Inspector Date Completed 01/01/2999 INSP-187248 Final NONE Default Inspector Not Complete 03/12/2013 INSP-187249 Review Building DENIED Norman Bruhn 3/19/2013 The work on the plans does not match the permit application. Remove all work not associated with new windows and doors from plans. Provide the wind load design criterion. Openings 10, 11 and 12 all call for a door with sidelights, is this one opening or three. The product approval is for one. Mark 19 on the plan does not show an opening. NB 06/11/2013 INSP-187247 Window Door DENIED Jorge Rodriguez 6/12/2013 A"-6-4- TAP CONS NOT PER NOA. JR 03/28/2013 INSP-187652 Review Building APPROVED Norman Bruhn 4/2/2013 CREATED AS REINSPECTION FOR INSP-187249. The work on the plans does not match the permit application. Remove all work not associated with new windows and doors from plans. Provide the wind load design criterion. Openings 10, 11 and 12 all call for a door with sidelights, is this one opening or three. The product approval is for one. Mark 19 on the plan does not show an opening. NB 06/14/2013 INSP-193482 Window Door PARTIAL APPROVED Jorge Rodriguez 6/17/2013 A K..w1...... w� CREATED AS REINSPECTION FOR INSP-187247. TAP CONS NOT PER NOA. JR EXLUDING REAR ROOMS. JR 02/17/2016 INSP-253066 Review Building APPROVED Ismael Naranjo 2/19/2016 PERMIT EXTENSION 04/12/2016 INSP-253261 Window Door APPROVED Jorge Rodriguez 4/12/2016 A♦4 wM 6 CREATED AS REINSPECTION FOR INSP-193482. CREATED AS REINSPECTION FOR INSP-187247. TAP CONS NOT PER NOA. JR EXLUDING REAR ROOMS. JR Tuesday, July 31, 2018 Page 1 of 2 WOOD FE ❑ Shadow Box ❑ Vertical Picket ❑ Board on Board Fences < = 6' high posts spaced at Fences < = 5' high posts spaced at Fences < = 4' high posts spaced at Fence must not exceed Parcel Owner Report Parcel Number: 1121360130610 289 NE 104 Street Miami Shores FL 33138- Tax ID: 1121360130610 Owner Information MARGARET JENSEN Current Owner: No Phone: Current Owner: Yes Company: ROC ACQUISITIONS LLC Phone: Related Permits Permit Number Application Date Expiration Date Status Driveways/Sidewalks/Slabs DS-3-13-479 03/11/2013 01/01/2999 CLOSED Electrical - Residential EL-7-14-1411 07/01/2014 08/15/2016 EXPIRED Fence/Wall FW-3-13-478 03/11/2013 01/01/2999 CLOSED Paint PT-3-13-476 03/11/2013 01/01/2999 CLOSED Plumbing - Residential PL-9-14-2084 09/24/2014 08/15/2016 EXPIRED Z Re -Occupancy REOC-12-12-2318 12/07/2012 01/01/2999 CLOSED Residential Construction RC-7-14-1410 07/01/2014 08/15/2016 EXPIRED Residential Construction RC-5-13-911 05/01/2013 05/11/2014 CANCELLED Roof RF-4-07-701 04/10/2007 01/01/2999 CLOSED 'Windows/Shutters WS-3-13-492 03/12/2013 10/09/2016 EXPIRED3Sa` Windows/Shutters WS-11-13-2654 11/22/2013 01/01/2999 CLOSED Related Code Cases Case Number Case Status Case Date Compliance Date Lot Clearing CASE-11-08-5091Case Closed 11/04/2008 11/17/2008 Lot Clearing CASE-9-09-6216 Case Closed 09/16/2009 9/28/2009 Ordinance Violation CASE-7-10-7444 Case Closed 07/16/2010 9/17/2010 Ordinance Violation CASE-9-12-10460Case Closed 09/27/2012 12/5/2012 Ordinance Violation CASE-2-13-10947Notice of Lien - Fines Accruing/Lien file 02/26/2013 Not Compliant Ordinance Violation CASE-3-13-11007Case Closed - Admin. Fee Pending 03/01/2013 8/1/2013 Zoning Violation CASE-3-13-11005Case Closed - Admin. Fee Pending 03/01/2013 8/1/2013 Zoning Violation CASE-3-13-11006Case Closed - Admin. Fee Pending 03/01/2013 8/1/2013 Zoning Violation CASE-2-14-12306Case Closed 02/03/2014 2/18/2014 Zoning Violation CASE-7-14-12963Case Closed 07/31/2014 12/19/2016 Ordinance Violation CASE-4-18-17630Case Closed 04/11/2018 4/19/2018 IM S--- '7'�) r Thursday, May 10, 2018 Page 1 of 1 C ry copySTRUCTURAL CALCULAONS REMODELING FOR RESIDENCE LOCATED AT 289 NE 104TH STREET MIAMI SHORES, FLORIDA. REVISION 2 JOSE L. GUZMAN P.E. 4869 SW 75Tfi Ave, Miami, FL 33155 Tel. 786.338.1082. October 2, 2013 \�\S Gu2M W= .: r R�� • L'`(j ` Jose L. Guzman, P.E. FL P.E. # 56138 MECAWind Version 2.1.0.7 per ASCE 7-10 Developed by MECA Enterprises, Inc. Copyright 2013 wwc:-.mz�,.enterpr.ses.aom Date 10/2/2013 Project No. Company Name Designed By Address Description City Customer Name State Proj Location File Location: C:\l-projects\l-2013\1319-MIAMI SHORE PETER\WIND LOAD.wnd Directional Procedure Simplified Diaphragrm Building (Ch 27 Part 2) All pressures shown are based upon ASD Design, with a Load Factor of .6 Basic Wind Speed(V) = 175.00 mph Structural Category = II Exposure Category = C Natural Frequency = N/A Flexible Structure = No Importance Factor = 1.00 Kd Directional Factor = 0.85 Damping Ratio (beta) = 0.01 Alpha = 9.50 Zg = 900.00 ft At = 0.11 Bt = 1.00 Am = 0.15 Bm = 0.65 Cc = 0.20 1 = 500.00 ft Epsilon = 0.20 Zmin = 15.00 ft Slope of Roof = 3 : 12 Slope of Roof(Theta) = 14.04 Deg Ht: Mean Roof Ht = 13.65 ft Type of Roof = Gabled RHt: Ridge Ht = 16.20 ft Eht: Eave Height = 11.10 ft OH: Roof Overhang at Eave= 1.50 ft Roof Area = 2797.00 ft^ 2 Bldg Length Along Ridge = 55.00 ft Bldg Width Across Ridge= 46.83 ft Gust Factor Category I Rigid Structures - Simplified Method Gustl: For Rigid Structures (Nat. Freq.>l Hz) use 0.85 = 0.85 Gust Factor Category II Rigid Structures - Complete Analysis Zm: 0.6*Ht = 15.00 ft lzm: Cc*(33/Zm)^0.167 = 0.23 Lzm: 1*(Zm/33)^Epsilon = 427.06 ft Q: (1/(1+0.63*((B+Ht)/Lzm)^0.63))^0.5 = 0.92 Gust2: 0.925*((1+1.7*lzm*3.4*Q)/(1+1.7*3.4*lzm)) = 0.88 Gust Factor Summary Not a Flexible Structure use the Lessor of Gustl or Gust2 = 0.85 Table 26.11-1 Internal Pressure Coefficients for Buildings, GCpi GCPi Internal Pressure Coefficient = +/-0.18 Topographic Adjustment 0.33*z = 4.50 Kzt (0.33*z): Topographic factor at elevation 0.33*z = 1.00 Vtopo: Adjust V per Para 27.5.2: V * [Kzt(0.33*z)]^0.5 = 175.00 mph Net Wind Pressures on Walls (Table 27.6-1) Wall Pressures do not include effect of internal pressure MWFRS-Wall Pressures for Wind Normal to 46.83 ft wall L/B = 1.17 ph: Net Pressure at top of wall (windward + leeward) = 37.82 psf p0: Net Pressure at bottom of wall (windward + leeward) = 37.82 psf ps: Side wall pressure acting uniformly outward = .56 * ph = 21.08 psf pl: Leeward wall pressure acting uniformly outward = .36 * ph= 13.65 psf pwh: Windward wall pressure acting uniformly outward = ph-pl = 24.18 psf pw0: Windward wall pressure acting uniformly outward = p0-pl = 24.18 psf MWFRS-Wall Pressures for Wind Normal to 55 ft wall L/B = 0.85 ph: Net Pressure at top of wall .(windward + leeward) = 38.70 psf p0: Net Pressure at bottom of wall (windward + leeward) = 38.70 psf ps: Side wall pressure acting uniformly outward = .54 * ph = 20.90 psf pl: Leeward wall pressure acting uniformly outward = .38 * ph= 14.71 psf pwh: Windward wall pressure acting uniformly outward = ph-pl = 23.99 psf pw0: Windward wall pressure acting uniformly outward = p0-pl = 23.99 psf See Pig 27.6_22 for Parapet wired Roof Pressures pressures See Table 27.6 2 Mean roof ht. Wind Nall Pressures. See Table 27.6-1 h Flan Pa Elevation Net Wind Pressures on Roof (Table 27.6-2): Exposure Adjustment Factor = 1.000 Zone Load Casel Load Case2 ---- Psf ---------- Psf 1 -35.31 ---------- 5.16 2 -24.34 -7.20 3 -36.05 .00 4 -32.18 .00 5 -26.37 .00 Note: A value of '0' indicates that the zone/load case is not applicable. Gabled Roof Roof Overhang Loads (Figure 27.6-3): Load Case 1: Povhl: Overhang pressure for zone 1 Povh3: Overhang pressure for zone 3 Load Case 2: Povhl: Overhang pressure for zone 1 Povh3: Overhang pressure for zone 3 Roof e+; c is--- tczhl- _ -26.48 psf _ -27.03 psf = 3.87 psf _ .00 psf Developed by MECA Enterprises, Inc. Copyright 2013 M, c<, ;t;.,r;; Date 8/27/2013 Project No. Company Name Designed By Address Description City Customer Name State Proj Location File Location: C:\1-projects\1-2013\1319-MIAMI SHORE PETER\WIND LOAD.wnd Root llot Wind Pressure on Components and Cladding (Ch 30 Part 1) All pressures shown are based upon ASD Design, with a Load Factor of .6 Width of Pressure Coefficient Zone "a" = 4.683 ft Description Width Span Area Zone Max Min Max P Min P -------------------------------------------------------------------------- ft ft ft^2 GCp GCp psf psf W1-4--8 2.33 4.30 10.0 4 1.00 -1.10 40.05 -43.44 W1-4-8 2.33 4.30 10.0 5 1.00 -1.40 40.05 -53.62 W3--9 1.67 3.33 5.6 4 1.00 -1.10 40.05 -43.45 W3-9 1.67 3.33 5.6 5 1.00 -1.40 40.05 -53.63 W10-15 3.50 7.00 24.5 4 0.93 -1.03 37.72 -41.11 W10-15 3.50 7.00 24.5 5 0.93 -1.26 37.72 -48.96 W16-17 2.50 7.20 18.0 4 0.95 -1.05 38.52 -41.92 W16-17 2.50 7.20 18.0 5 0.95 -1.31 38.52 -50.57 W18 3.00 2.00 6.0 4 1.00 -1.10 40.05 -43.45 W18 3.00 2.00 6.0 5 1.00 -1.40 40.05 -53.63 W19 3.33 2.50 8.3 4 1.00 -1.10 40.05 -43.45 W19 3.33 2.50 8.3 5 1.00 -1.40 40.05 -53.63 D2 2.67 6.67 17.8 4 0.96 -1.06 38.55 -41.94 D1 3.00 7.00 21.0 4 0.94 -1.04 38.12 -41.51 D3 3.33 6.67 22.2 5 0.94 -1.28 37.97 -49.47 WALL 1.00 11.00 40.3 5 0.89 -1.19 36.42 -46.37-<-' wall 1.00 11.00 40.3 4 0.89 -0.99 36.42 -39.82 Khcc:Comp. & Clad. Table 6-3 Case 1 = 0.85 Qhcc:.00256*V^2*Khcc*Kht*Kd = 33.94 psf Title : Job # Dsgnr: Date: 5:23PM, 2 OCT 13 Description Scope : UserkO-0603515,Ver5.8.0,1-Dec-2003 Masonry Wall Design Page 1 (c)1983-2003 ENERCALC Engineering Software Description General Information Code Ref: ACI 530-02 Wall Height 8.70 ft Seismic Factor 0.3300 fm 1,500.0 psi Parapet Height 0.00 ft Calc of Em = fm * 900.00 Fs 24,000.0 psi Duration Factor 1.000 Special Inspection Thickness 8.0 in Wall Wt Mult. 1.000 Grout @ Rebar Only Rebar Size 5 Normal Weight Block Rebar Spacing 32 in Equivalent Depth to Rebar 3.810 in @ Center Solid Thickness 4.900 in Loads Uniform Load Concentric Axial Load Wind Load 46.400 psf Dead Load 0.000 #/ft Dead Load 0.000 #/ft Live Load 0.000 #/ft Live Load 0.000 #/ft Load Eccentricity 0.000 in Roof Load Roof Load Design Values E 1,350,000 psi Rebar Area 0.116 in2 np 0.05462 j 0.90654 n : Es / Em 21.481 Radius of Gyration 2.487 in k 0.28038 2 / kj 7.86864 Wail Weight 58.000 psf Moment of Inertia 363.660 in4 Max Allow Axial Stress = 0.25 fm (1-(h/140r)^2) * Spinsp 341.28 psi Allow Masonry Bending Stress = 0.33 fm * Spinsp = 495.00 psi Allow Steel Bending Stress = 24,000.00 psi Load Combination & Stress Details Summary Axial Bending Stresses Axial Moment Load Steel Masonry Compression Top of Wall in-# Ibs psi psi psi DL + LL 0.0 0.0 0.0 0.0 0.00 DL + LL + Wind 0.0 0.0 0.0 0.0 0.00 DL + LL + Seismic 0.0 0.0 0.0 0.0 0.00 Between Base & Top of Wall DL + LL 0.0 252.3 0.0 0.0 4.29 DL + LL + Wind 5,268.0 252.3 13,120.3 238.0 4.29 DL + LL + Seismic 2,173.1 252.3 5,412.1 98.2 4.29 8.70ft high wall with 0.00ft parapet, Normal Block w/ 8.00in wall w/ #5 bars at 32.00ino.c. at center Max. Bending Compressive Stress ......... 242.26 OK Allowable .................... 495.00 OK Max. Axial Only Compressive Stress ......... 4.29 psi Allowable .......... 341.28 OK Max Steel Bending Stress .............. 13,120.25 psi Allowable .......... 24,000.00 OK KW-0603515, Ver 5.8.0, 1-Dec-2003 Q-2003 ENERCALC Engineering Software Description Title : Dsgnr: Description Scope : Masonry Wall Design Job # Date: 5:23PM, 2 OCT 13 Final Loads & Moments Wall Weight moment @ Mid Ht 252.30 Ibs Wind Moment @ Mid Ht 5,268.02 in-# Seismic Moment @ Mid Ht 2,173.06 in-# Dead Load Moment @ Top of Wall 0.00 in-# Dead Load Moment @ Mid Ht 0.00 in-# Total Dead Load Total Live Load Live Load Moment @ Top of Wall 0.00 in-# LiveLoad Moment @ Mid Ht 0.00 in-# Maximum Allow Moment for Applied Axial Load = Maximum Allow Axial Load for Applied Moment = 9,636.44 in-# 20,067.40 Ibs 0.00 Ibs 0.00 Ibs Page 2 JOB -7, 3 � U T, Lo q 1 5 r k. I N mt., JOSE L. GUZMAN P.E. 4869 SW 75" AVENUE MIAMI, FLORIDA PHONE 786 338 1082 SHEET NO. OF CALCULATED,yT-6A DATE CHECKED BY DATE Ql- , . . . . . . . . . . ....... ..... ........ . ........... . ........... ..... ....... ....... .......... .K r --- ---- . ........ ..... .. .... ............. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - . . . . . . . . . . . . . ..................... ...... . . . 7016 1370 0001 5883 8336 � � se❑OOOg®$ gCL "| _ i C->i ,O saw ivi <� ■\ �� / � ,ertified Mail service provides the following benefits: 1 A receipt (this portion of the Certified Mail label)., for an electronic return roceipt, see a retail r A unique identifier for your mailpiece. associate for assistamt. To receive a duplicate r Electronic verification of delivery or attempted return receipt for no additional fee, prUsent this delivery. USPS®-postmarked Certified Mail feceipt to the ■ A record of delivery (Including the recipient's retail associate. signature) that is retained by the Postal Service- - Restricted delivery service, which provides for a specified period. delivery to the addressee specified by name, or to the addressee's authorized aoent. Important Reminders. ■ You may purchase Certificd Mail service with First -Class Mail®, First -Class Package Service®, or Priority Mail® service. ■ Certified Mail service is notavailable for international mail. ■ Insurance coverage is notavailable for purchase with Certified Mail service. However, the purchase of Certified Maul service does not change the insurance coverage automatically included with certain Priority Mail items. ■ For an additional fee, and with a proper endorsement on the mailplece, you may request the following services: - Return receipt service, which provides a record of delivery (including the recipient's signature). You can request a hardcopy return receipt or an electronic version. For a hardcopy return receipt, complete PS Form 3811, Domestic Return Receipt attach PS Form 3811 to your mailpiece; Adult signature service, which requires the signee to be at least 21 years of age (not available at retail). Adult signature restricted delivery service, which requires the signee to be at least 21 years of age and provides delivery to the addressee specified by name, or to the addressee's authorized agent (not available at retail). ■ To ensure that your Certified Mail receipt is accepted as legal proof of malting, it should bear a USPS postmark. If you would like a postmark on this Certified Mail receipt, please present your Certified Mail Item at a Post Office- for postmarking. If you don't need a postmark on this Certified Mail receipt, detach the barcoded portion of this label, affix it to the mailpiece, apply appropriate postage, and deposit the mcilpiece. IMPORTANT. Save this receipt for your records. Ps Form 3800, Apra 2015 (Reverse) PSN 7530-02.000.9W Miami Shores Village Building Department 10050 NE 2 Ave, Miami Shores, FI 33138 Tel: (305)795-2204 9 Fax; (305)756-8972 1/18/2018 To: Current Owner 289 NE 104 Street Miami Shores, FL33138- Final Notice Permit: WS-3-13-492 Address: 289 NE 104 Street Miami Shores FL33138- Dear Sir or Madam, Our records indicate that the above referenced permit has expired without obtaining the proper final inspection. In order to serve you better, we need to keep our files up to date. As per section 105.4.1 of the Florida Building Code, "Every permit issued shall become invalid (expired) unless the work authorized by such permit is commenced within six months after its issuance, or if the work authorized by such permit is suspended or abandoned for a period of six months after the work is commenced, or completed without obtaining the final inspection of the work performed..." Please be advised that open permits will hinder your ability to obtain new permits, refinance or sell this property. Please contact the Building Department, within 15 days of receipt of this letter in order to take care of this matter. Sincerely, Ismael Naranjo (CBO) Building Director Cf-a-Tlri%.0 M41 -I oltb 131 a coo 1 5'&T3 V 53fa %)10111t- 0 I lam. pop - DRIVER LICENr B452-853-5';32.0 aALD0 MARIO 13LANCO = " 437 GOLDEN ISLES DR APT&F HALLANDALE, FL 3300E-ODOG DOB 09-12 1950 SEY„ ISSUEr• EXPW RES UA r1 ENE r.. .. a ewax +eMeh sax�awwes• •ornsai ±r. ...v �.,®r,e:r .. ,�.o-� . _,.. STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD �2W 1940`90RTH MONROE STREET TALLAHASSEE FL 32399-0783 BLANCO, UBALDO UBALDO BLANCO G C INC 437 GOLDEN ISLES DR #8F HALLANDALE BEACH FL 33009 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers.' Thank you for doing business in Florida, and congratulations on your new license! RICK SCOTT, GOVERNOR KEN I AWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUMNESS AND PROFESSIONAL REGULATION CONSTRUCTION imni ICTpv r rr•ctrcisu_ nnw nn (850) 487-1395 STATE OF FLORIDA DEPARTM OF BUSINESS AND PR0FESSI. L"."REGULATION CCC056705 07/31/2014 a..i CERTIFIED BLANCO; UBA - - UBALDO SLA IS CERTIFIED under the provisions or Ch.488 FS. Expkatimdate : AU031, 2016. L1407310001678 DETACH HERE CCC056705 'he ROOFING CONTRACTOR I.QI„c�.uaiv„w w.t,crclmcu - . Under the provisions of 'Chapter 489 Expiration date: AUG 31, 2016 BLANCO.- UBALDO U1 ALD0 BLA 1CO- G: C- •#8F HALLANDALE b8ACFF309,� ;. ISSUED: 07/31/2014 nISPi AY AC Pl=()] IIRFtI OV r AW a 002394 Local Business Tax Receipt Miami —Dade County, State of Florida —THIS IS NOT BILL — DO NOT PAY 5509261 LBT BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES UBALDO BLANCO GC INC RENEWAL' . SEPTEMBER 30, 2016 DOING BUS IN DADE CO 4883030Must be displayed at place of business MIAMI FL 33000 Pursuant to County Code Chapter 8A — Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED UBALDO BLANCO GC INC 196 SPECIALTY BUILDING CONTRACTOR BY TAX COLLECTOR Worker(s) 1 CCC056705 $75.00 09/29/2015 FPPU09-15-007208 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holders qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles — Miami —Dade Code Sec Ba-276. For more information, visit www.miamidade.gov/taxcollector ; Miami Shares Village FXI17 0 Building Department FEB Ij 20A 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 nV: IVA Tel: (305) 795-2204 Fax: (305) 756-8972 �T I INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 BUILDING Master Permit No. V� S— - `i 2, PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION Rg EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP JOB ADDRESS: h� r� �� `r l� 1 `�[( l lJ T CONTRACTOR DRAWINGS City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name a Simple Titleholder): L�-O e Phone#: Z(� zx -46� q Address: d �S "/ A)&'_ ) 0`i St v\.AA ,(4 Imo, ( S 4Tc-S City:y`yV V,,,A Tenant/Lessee Name: Email: rVUIP_A R. CONTRACTOR: Company Name: Address: A-5 7 00 Lite City: h+ L 7r Qualifier Name: State Certification or Registratii )Act Pjcwao C-.. c_ 10 c CAS -0c -=V- O F ----Alp: _ one#: 7 ZO - 97 hone#: -0-05-1pm yq T (I Zip: �3 3 c) 0 p hone#: :S a " 7 n #: C'C-r C �"t `�1 7 __Certificate of Competency #: _r A or-)W DESIGNER: Architect/Engineer: 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: Az__j_ - Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ 16 Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ _71G 00 (Revised02/24/2014) bonding Company's Name (if applicable) 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 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 44X�-- 4-A C9V �If /r-jo ou'r Z CC OWNER or AGENT The foregoing instrument was acknowledged before me this deO day of 36F✓1 Ull ✓o , 20 10 by who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: APPROVED BY Signature Q&V !m#e CONTRACTOR The foregoing instrument was acknowledged before me this day of !%ll 20 by who is personally known to as me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: s944099 Print: *= Seal: �{,YaBonded Thnr Notary Pudic Underwriten as Zoning (Revised02/24/2014) Structural Review Clerk