PW-18-1627BUILDING
PERMIT APPLICATION
Miami Shores Village RECEIVED
Building Department APR 2 6 2019
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 $Y:
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 44
FBC 20 0
Master Permit No. PW -6-18-1627
Sub Permit No.
❑ BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION Q EXTENSION [—]RENEWAL
PLUMBING ❑ MECHANICAL QPUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 9801 NE 2nd Ave
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11 -3206-013-4380 Is the Building Historically Designated: Yes NO X
Occupancy Type: A-2 Load: 150 Construction Type: 111 Flood Zone: X BFE: FFE: 10.35'
OWNER: Name (Fee Simple Titleholder): 9801 Park LLC Phone#: 305 252 1584
Address: 10820 SW 200 Dr #100
City: MiamiState: FL
Tenant/Lessee Name:
Email:
Phone#:
33157
CONTRACTOR: Company Name: JC and Associates Group Phone#: 305 742 3199
Address: 7741 SW 122 Ave
City: Miami State: FL Zip: 33183
Qualifier Name: Juan Carlos Lago Phone#: 3057423199
State Certification or Registration #: CGC 057500 Certificate of Competency #:
DESIGNER: Architect/Engineer: Yan Luis Solis PE Phone#: 305 484 5596
Address: 14245 SW 21 Terr City. Miami State: FL Zip: 33175
Value of Work for this Permit: $ 5000 Square/Linear Footage of Work: 2,500 SF
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑■ Repair/Replace ❑ Demolition
Description of Work: Additional pavers to reduce planters on sidewalk and concrete replacement and new pavers in rear courtyard area.
Specify color of color thru the:
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
(Revised02/24/2014)
Permit Fee $
Radon Fee $
Training/Education Fee $
CCF $ CO/CC $
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ C�
bonding Company's Name (if applicable) N/A
Bonding Company's Address N/A
City State _
Mortgage Lender's Name (if applicable) N/A
Mortgage Lender's Address N/A
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. I-,—)
Signature Signature
OWNER or AGENT
The toregoing instrume
t was acknowledged before me this
The foregoing instrument was acknowledged before me this
_ day of
20 L / by
_J� day of 20, by
who is personally known to
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: �YYWyS LAR,[
Seal: ANA GO
Seal:
teary Public - State of F:oridd
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Commission=GG 246__3 cn
. Vc:_ti Pubnc - State of Florida
i .. Vy Comm. Expires Oct U. 2@22
LPC tnrough Nationale r a-� ASS'.
; `T [ �. --ission c GG 246553
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` �` M Ca—r. Expires Oct 26. 2022
ocecec inrcLg^ Natlonai Notary Assn,
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014) � 1� PW
JC & ASSOCIATES GROUP INC.
7741 SW 122 AVE MIAMI FL 33183/ PHONE 305 742 3199 / jclago@pagroup.cc
April 26th 2019
Miami Shores Village Building Department
10050 NE 2"d Ave Miami Shores FL. 33138
Property Owner: 9801 Park LLC
Location: 9801-9845 NE 2nd Ave & 211-217 NE 98 St, Miami Shores FL. 33183
Folio: 113206 013 4380
Permit # PW -6-18-1627
REQUEST FOR TIME EXTENSION FOR PAVERS AND CONCRETE
We respectfully request a time extension for the above mentioned Permit. The scope consists of pavers
at sidewalk planters on NE 2nd Ave and at rear courtyard replacement of concrete slab on grade and
asphalt for new concrete and pavers. The work has been delayed as a result of changes at DERM during
the sewer connection to new City system. Specifically, new grease traps for two proposed restaurants,
under FOG 2.0 DERM upgraded the requirements for the previously approved system. This came up
after obtaining sewer Permits and had commenced the work on site, as the plans for the two proposed
restaurants were submitted for review and approval by DERM.
Thankyetrfjr your consideration.
JC anti Associates Group Inc.
Certified General Contractor CGCO57500
cc. Maria Fuentes
Shawn Chemtov
Julio Lago