RC-17-2993 (7)Miami Shores Village RECEIVED
EI VEp
. Building Department AUG 23 2019
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 Q—'Q1
INSPECTION LINE PHONE NUMBER: (305) 762-4949 -��
FBC 201� to
BUILDING Master Permit No. �,C li 2--0— Z( 07,S
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ROOFING REVISION EXTENSION RENEWAL
PLUMBING ❑ MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION HOP
/'
CONTRACTOR DRAWINGS
JOB ADDRESS: 099 u" N� 1 l 4 S-�
City: Miami Shores County: Miami Dade Zip: t>3
Folio/Parcel#: 1 — `>� 'mil n —D7i`I C) Is the Building Historically Designated: Yes NO 1`
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
���� i '
OWNER: Name ((Fee Simple Titleholder): Uv IuY�� Q �"]�(' I Q` lnn�+�Phon�e#:
Address: �2 Ju �
rN& q
City: k wykl� �10 cf_, State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:��'�� I 0AYN G Phone#:
Address: T 5 S� i�,. S'� `k-f �o � p'
City: State: r1.,- Zip:
Qualifier Name: 6-�Zy\-,0 `�Q� 1 f _ Phone#:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ b7 , �J Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:
• l+
"t t •U'� t ;� 7T r*fY`Ivi N�'4!I�trb rr;.+„,,� • t�.
Speafyo�or�of color thrbile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ QD
(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 NN --vv L i, I L—" '
OWNER or AGENT
The �Jforegoing instrument was acknowledged before me this
day of Sk 20 � q , by
� yj Q C� . C�,1�/ hao T4who is personally known to
Signature alfi�tl
RACTOR
The foregoing instrument was acknowledged before me this
day of S' — 20 19 by
who is personally known to
me or who has produced as me or who has produced
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: , 4 NOTARY PUBLIC: n
` ANALUCIATILLIT
Print: Print:
MT %0JMW11QQ1%0n
Seal: `•, PV EXPIRES: April23.2023 Seal:
`•6=WTtruNoftyPJ&tk4er~
as
MY COMMISSION # GG 345033
EXPIRES: Apra 23, 2023
Bonded Tlw Nolaro Pd* ftw* «
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
A & C Portela Plumbing, Inc.
PLUMBING AND GAS PROFESSIONAL
Plumbing Contractor - Lic. # CFC1428617
2655 SW 33`d Avenue, Miami, Florida 33133
Tel. #786-953-4533 Cell 4 305-965-0775 Fax # 786-360-5905
e-mail: portelaplumbingggmail.com
LICENSED AND INSURED
THIS SYSTEM HAS BEEN MANOMETER TESTED FOR 15 MINUTES
SITE ADDRESS: 11 Al
START:
I • 0 INCHES
W.C.FINISH: . V INCHES W.C.
INSTALLER:
DATE: f t � 2 466
This installation will meet
all Florida Statutes 527.06
LP Division rule 413-1.01
The South Florida Bldg. code
NFPA54, NFPA 58 and regulations
of The State Fire Marshall
=O, %O 0%&, Notary Public State of Florida
Yheyling Y Montero Delgado
My Commission GG 146392
U'`ur w Expires 09/26/2021
QUALIFIER:
NAME: 0 Uv' d V" ,, �j "`' NUMBER:
C LL- 1U 7 � () a-