PL-18-33 (4)Miami Shores Village
BUILDING
PERMIT APPLICATION
BUILDING ELECTRIC
Building Department'" JAN15619
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 -•
F B Z /
Master Permit No. — 32
Sub Permit No.
ROOFING REVISION EXTENSION (—]RENEWAL
QPLUMBING MECHANICAL PUBLIC WORKS M CHANGE OF [:]CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 71 NE 97 Street
Cites Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-3206-013-1010 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: 'Construction Type: Flood Zone: BFE: y FFE:
OWNER: Name (Fee Simple Titleholder): Myron C Novak Phone#:
Address: 71 NE 97 Street
City: Miami Shores State: FL Zip: 33138
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: t//l i'S oh s¢!a Phone#:
Address: 78 98 •l.'J / ? %—t-" A6 c
City: ,r7 l+L P'+
7
State: /" / Zip: 3
Qualifier Name: g:nz, :Z 109:VIAAt 1 Phone#: SOS —5"Z bStZ % 7
State Certification or Registration #: Certificate of Competency #: 0 3 P _0a 08 ' T
DESIGNER: Architect/Engineer: Phone#:
Address: City: State:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Zip:
Type of Work: Addition Alteration New Repair/Replace }^ Demolition
Description of Work: C4-t awia1 0e—' C >w—C 2,4 17T u2.
Specify color of color;thru tile:..
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Technology Fee $
Structural Reviews $
Radon Fee $
Training/Education Fee $
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ • 0D
Revised02/24/2014)
t
Bonding Company's Name (if applicable)
w
Bonding Company's Address
pity State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State
Zip
rqI
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 Yegulating
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. r.04 jut
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERLY. 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 li!/L1nt / Xou
6WWCRor AGENT
r
The foregoinginstrument was acknowledged before me this
day of .) U V 20 13 by
MV d 0 N I; A k- , who is personally known to
me or who has produced Q h nv7 - U_ as
identification and
NOTARY PUB C:
Sign:
Print: h .
an oai&y* I VasgUeZ
Commission # FF942611
Expires: December 9, 2019
i ,bonded thru Aaron Notary
Signature / /-;4
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of ktAkt 4 20 by
C,•y oL ".&4) . who is personally known to
me or who has produced DL_ in, {i'l.c as
identification and who did take an oath.
NOTARY PUBLIC:/1
Print:
RIF" a
ti
Seal: - """ Seal: ;, --'-'- --',--- Commission # FF942611
Expires: December 9, 2019
lit Bonded, thru Aaron Notary
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
Revised02/24/2014) r .%
4
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. PL /-19-33
Owner's Name (Fee Simple Title Holder): r7y 9^ C ACV A k Phone #: Owner'
s Address: -i" I PE 0' -4 S f City:
rn I&M.I Sl%iL State Zip Code: Job
Address (Of where work is being done): -41 %r 974- $1 City:
Miami Shores State: —Florida Zip Code: Contractor'
s Company Name: OPS of Phone #: 7of6' d56 g690 Address:
g015T V AV City:
14;c.I¢o, ?f State: FL Zip Code: 'Sac-/-6 Qualifier'
s Name:. )'/A/Ire / t'/A59 ei Lic. Number: Q-Fc /c%dC -7ee, Architect/
Engineer of Record Name: Address:
City:
Describe
Work: State:
Phone #:
Zip
Code: I
hereby certify that the work has been abandoned and/or the contractor/architect is
unable or unwilling to complete the contract. I hold the Building Official and the Miami
Shores harmless of all legal involvement. Signature
Ownkf
or Agent The
foregoing instrument was aknowledged before me this `
5 day of,20 b bAsjrovAk- Who is
personally known to me or who has produced L o
Notary Pu
c: Sign: Seal:
z %
III/
Suy
T. Vasquez Commission # FF942611
Expires: December
9, 2019 Bonded thru
Aaron Notary Signature n
Contractor or
Architect as indentification
The foregoing
instrument was aknowledged before me this 26
day of , 20Il by e el) P4-, nZ4 who is
personally known to me or who has produced Dl- 0.
0 6 (a as indentification. Notary Pu7c: —` / ,
Seal: „Q
Commission # FF942611
Expires: December
9, 2019 I„IISI
Bonded thru Aaron Notary
Miami Shores Village CEIVED
Building Department
JAN 04 2018
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 On
FFBC 20(-4
BUILDING Master Permit No. 1C--a-& Z
PERMIT APPLICATION Sub Permit No. P _ s3
BUILDING ELECTRIC ROOFING REVISION EXTENSION RENEWAL
PLUMBING MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 71 NE 97 ST
City Miami Shores County- Miami Dade Zip:
Folio/Parcel#: 11 -3206-013-1010 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):
MYRON C NOVAK Phone#:305-756-1000
Address:71 NE 97 ST
City: MIAMI SHORES State: FL Zip: 33138
Tenant/Lessee Name: Phone#:
Email: INC6630@BELLSOUTH.NET
CONTRACTOR: company Name: MPS PLUMBING Phone#: 305-627-0199
Address: 7955 WEST 28 AVE
City: HIALEAH State: FL Zip: 33016
Qualifier Name: //
LL /-
T Phone#:
State Certification or Registration #: /+v p 00 Certificate of Competency #:
DESIGNER: Architect/Engineer: HOLLINGSWORTH ROBERTSON Phone#: 954-630-1398
Address:2208 NE 26 ST City: FT.LAUDERDALE State: FL zip: 33305
J
Value of Work for this Permit: $ {_ Square/Linear Footage of Work: 115 SQUARE FEET
Type of Work: A Addition Alteration New Repair/Replace Demolition
Description of Work: addition of 115 sf to entend bedroom ; bathroom enlarged and reconfigured
L3 J EC leS
Specify color of -co or'thru till:'.
Submittal Fee'$ Permit Fee $' .c CCF $_
Scanning Fee $ Radon Fee $ DBPR $
Technology Fee $_
Structural Reviews $
Training/Education Fee $
CO/CC $
Notary $
Double Fee $
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
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
l day of
r
I Jam- L C ( 2017 by
who is personally known to
me or who has produced 7 as
identification and whotid take an oath.
l
Sign:
Print:
Seal:
t MNCYIGLEM
MY COMMISSION t' FF 116314
EXPIRES: May 20, 2018
AeOF FLOP\oP Bawled Thru Bu* Notary Service$
Signatii .
CONTRACTOR
The foregoing instrument was acknowledged before me this
261 day of. T) e%,ti 660" 20 11 by
I-A'a 4L&I 1"Iwho is personally known to me
or who has produced L, r> n -Gu as identification
and who did take an oath. NOTARY
PUBLIC: Sign:_
Print
Seal:
APPROVED
BY Z` Plans Examiner Suyapa
T. Vasquez It
Commission # ff942611 Expires:
December 9, 2019 Bonded
thru Aaron Notary Zoning
Structural
Review Revised02/
24/2014) Clerk