PL-16-2797 (5)Miami Shores Village;c,I
Building Department PR o Zoos
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 T
INSPECTION LINE PHONE NUMBER: (305) 762-4949 � ` t
FBC 20
BUILDING Master Permit No7vQ- (6— I)) JI—]
PERMIT APPLICATION Uih Permit NnC_ I A
❑ BUILDING ❑ ELECTRIC ❑ ROOFING ❑ R ISION ❑ EXTENSION [:]RENEWAL
E2/CHA
LUMBING
❑ MECHANICAL ❑PUBLIC WORKS GE OF ❑ CANCELLATION
❑ SHOP
CONTRACTOR
DRAWINGS
JOB ADDRESS:
I Z'��
n 1 r
J v r 1(� 6 O �z t
City:
Miami Shores
County: Miami Dade Zip:
Folio/Parcel#:
-32 oG - ,c> i
`f 63z) Is the Building Historically Designated: Yes
NO
Occupancy Type:
rZ- Load:
Construction Type: Flood Zone: BFE:
FFE:
OWNER: Name (Fee Simple Titleholder): �ot' ke Phone#: _20E, _q9O2-763
Address: /% C>1 PC c -�G 4
City: 9IOtt "A i' �J�cState:zip: 33) 3
Tenant/Lessee Name: Phone#:
Email: Q ZC1Z_In1yznt!'- M-W
CONTRACTOR: Company Name:
Address:
Phone#: -1 66 .2S I -`k L7
City: �j? �� LtA tA'c90 � �� ( State: � Zip:
Qualifier Name: )UCH` lv \_a 0 ✓t Phone#: -78c �S iB (5
State Certification or Registration #: Gi-C z 6Z2J( Certificate of Competency #:
DESIGNER: Architect/Engineer: �t 1 a Phone#: 3 b5 -2S 3 - S-7 ,6
Address: ��(�(�� Jew _)-} C_ City: I 1 State:' Zip: ? ; (6> G
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace
Description of Work: ]11-�:� L,-k V-)— I r 0'j— S , b--
Specify color of color thru tile:.
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Permit Fee $
Radon Fee $
Training/Education Fee $
CCF $
❑ Demolition
CO/CC $
DBPR $ Notary
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address:
- na.i
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 c mencement must be posted at the job site
for the first inspection which occurs seven (7) days t e i 1ding permit is issued n he absence of such posted notice, the
inspection will not be approved and a reinspectio ee will be-cJrtfged. _ A
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of i 1 GrtrC.� 20 16 by
CL�G who is personally known to
me or who has produced as
identification and who did take an oath.
i Sign
The foregoing instr ent was acknowledged before me this
day oA ov> 20 16' , by
U(,tn a- v LA 'who is personally known to
me or who has produced T� �� as
identification and who did take an oath.
NOTARY PU C:
NOTARY PUB
C:
Sign:
Sign:
Print: �n�n
1 r
-
Paint:
-V� \�
Seal:
Seal:
1d� °
=o �
NotaryPublic State of Florida
oar °�y Notary Public State of Florida
`(�
Dennis Lefton
? �% Dennis Lefton
My Commission GG 073635
'7 � My Commission GG 073635
of t�
Expires 02/15/2021
gip, Flog Expires 02/1512021
*************
*************************
****
4A7
APPROVED BY
Plans Examiner
Zoning
Structural Review Clerk
(Revised02/24/2014)
6
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CHANGE OF CONTRACTOR / ARCHITECT
Permit N. PL12172913
Owner's Name (Fee Simple Title Holder): BKT HOLDINGS LLC Phone #: 305-904-1608
Owner's Address: 2694 E. OAKLAND PARK BOULEVARD SUITE 201A
City: FORT LAUDERDALE State : FL
Zip Code: 33306
Job Address (Of where work is being done): 1201 NE 96 STREET
City: Miami Shores State: —Florida Zip Code: 33138
Contractor's Company Name: ALDAN PLUMBING INC Phone #: 305-829-3031
Address: 2527 AMBASSADOR AVENUE
City: COOPER CITY State: FL Zip Code: 33026
Qualifier's Name: ALFREDO CARMONA JR Lic. Number: CFC1428171
Architect/ Engineer of Record Name: SEBASTIAN EILERT AIA,LEED Phone #: 305-253-5786
Address: 13063 SW 133 CT
City: MIAMI State: FL Zip Code. 33186
Describe Work: GAS LINE ADDITION
hereby certify that the work has been abandoned and/or the contractor/architect
is unable or unwilling to comp e t contract. I hold the Building Official and the
Miami Sho es h less of all legal involvement.
Signature o 7—c4t71 Signature
Owner or Agent Contractor or Architect
The foregoing instrument was aknowle ed before me The foregoing instrument was aknowledged before me
this 15 day of MARCH ,20 by 2G, r -1 t this 15 day of MARCH 2O18by �� Q �� CU rntia+►
Who is personally known to me or who has produced who is personally known to me or who has produced
ALEXANDRE BURKI tRDT A as indentification. ALFREDO CARMONt Jq as indentification.
Notary Pu ri
c:
Sign:
Seal:
:eY °oe Notary Public State of Florida
`h Dennis Lefton
My Commission GG 073635
1� OF n°° Expires 02/15/2021
Seal: ; ,,.` '= Commissio g'GG 161158
or: My Comm. Expi s Mar 13.2022
,,,,,, fiorxled:hrojghNa na No:aryAssn,
Miami Shores Village
Building Department
10050 N.E. 2ND Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Change of Contractor/Architect or Engineer
A change of contractor, architect or engineer must be done under a permit number. There is a $75.00 charge
for a change of contractor. The owner will submit a Change of Contractor Form completed with notarized
signatures. If the signature of the previous contractor cannot be obtained the owner must send a certified
letter/return receipt notifying the previous contractor, architect or engineer the reason for the change. The
owner must allow 10 business days for the contractor, architect or engineer to respond. A permit application
must accompany the change of contractor form, with the information and signature of the new
contractor. The new contractor must be registered with the Village or must submit the required documents
to register with the Village.
I. Change of Contractor form completed, signed and notarized.
2. Permit application by new contractor.
3. Required fees.
4. Copy of original letter sent via certified mail along with the returned receipt.
In addition to the requirements above the architect or engineer of record must authorized the new architect
or engineer to reproduce his documents. The authorization must be in writing and must be signed and sealed.
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