REV-19-505BUILDING
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
a INSPECTION LINE PHONE NUMBER: (305) 762-4949
PERMIT APPLICATION
BUILDING Q ELECTRIC ROOFING
CE1VXED
all
16MIIM
FBC 20
Master Permit No. RC -1 8-1927
Sub Permit No. l , V -3 —19 sUS
REVISION EXTENSION RENEWAL
PLUMBING MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1421 NE 104 ST
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11 -2232-032-0060 is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): HENRY DOW Phone#: 305-586-5109
Address: 1421 NE 104 ST
City: Miami Shore State: FL Zip: 33138
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: INDUSTRIAL ELECTRICAL SYSTEMS, CORP phone#: 305-388-4648
Address: 14050 SW 84 ST SUITE 206
City: MIAMI State: FL Zip: 33183
Qualifier Name: NESTOR I CORVEAPhone#: 305-388-4648
State Certification or Registration #: EC 13002182 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 1, 000.00 Square/Linear Footage of Work:
Type of Work: Addition Alteration New Repair/Replace Demolition
Description of Work: Plan Revision `A,i
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ tow • CO CCF $ 0' 0ti CO/CC $
Scanning Fee $ 3 ' Radon Fee $ 2 DBPR $ CD Notary $ 22
Technology Fee $ 2 ' Training/Education Fee $ 0' 2-0 Double Fee $ —2
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
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
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.
7 u--? Signature'1
OWNE or AGENT
Signature t& -Ay- .7- -
CONTRACTOR
The foregoing instrument wasacknowledgedbefore me this The foregoing instrument was acknowledged before me this
dray, of 120 P9 by 05th day of 1*vbmh 120
19 by
e who is personally known to NESTOR I CORVEA who is personally known to
me or who has produced as
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NOTARY PUBLIC:
as
FRANCISCO POPM— ORALES
Notary Public — State of Florida
ry' Commissior. 9 GG 158509
My Comm. Expires Nov 17 2021
50rded :hrough Na:iona No:ar. Assn.
Print:
Seal: Seal:
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APPROVED BY 3 Plans Examiner Zoning
Structural Review Clerk
Revised02/24/2014)