DS-19-2680Miami Shores Village �'e_777, '''ED
Building Department "' °\"°'
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY:
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 201
BUILDING Master Permit No. Er L—19 `
PERMIT APPLICATION UANCEI ub Permit NoDS— 1—(9 " Z�
FE-IBUILDING ELECTRIC ROOFING REVIkf E EXTENSION RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION [:]SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1271 NE 97th Street
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11 -3205-009-0430 Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Reed D. Gordon & Carmen Aceves Gordon Phone#: 305-989-9363
Address:1271 NE 97th St.
City: Miami Shores
Tenant/Lessee Name:
Email: Reed.gordon@comcast.net
State: Flori
hon
33138
CONTRACTOR: Company Name: Accurate Power and Technology/ A Generator Guy Phone#: 352-735-8285
Address: 15519 W. US Hwy. 441, Ste. 101A
City: Eustis State: Florida Zip: 32726
Qualifier Name: Jack Phillips Phone#: 407-280-7904
State Certification or Registration #: EC13007737 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: _
Value of Work for this Permit: $ 4,900.00 Square/Linear Footage of Work: 2857
Zip:
Type of Work: ❑ Addition ❑■ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: Install a 22KW Generac Generator and a 200 AMP ATS ( Automatic Transfer Switch)
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Permit Fee $
Radon Fee $
Training/Education Fee $
CCF $
CO/CC $
DBPR $ Notary $
Double Fee $
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $ 2_-) � 3
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 nd construction lien law brochure will be delivered to the person
�cQ�
whose property is subject to attachment. Also, a certified copy of//�� ded notice of commencement must be posted at the job site
c_ — — :_ n ..'";A, e e ,pn 171 rinu, nRpr rhp b iftt.,is issued. In the absence of such posted notice, the
[ne prig . r„", .— r,r --1- _...- -- ��
pection will not be approved and a reinspection fee will be charged.
Signature Signature
OWNER or AGENT If CONTI`
The foregoing instrument was acknowledged before me this
day of 20 1 Cl , by
who is personally known to
me or who has produced as
identification and who did take an oath.
The (foregoing if rument was acknowledged before me this
"6 day ollf MO -Ai 20 VT by
Ta�1� �'1 who is personally known to
me or who has produced J� as
identification and who did take an oath.
NOMBLI:
NOTARY PUBLIC:
Sign:
QJ�Q' 'o"' •
Sig
c 40a-c
Print:
Print:
Seal:
PA.MELA J. CASQUILLA
'• �
F MY COMMISSION # FF 961989ECykvft�blic
Seal:
State of Florida
s EXPIRES: May9.2020C
7Notary
BenjamenFor
F\. Bonded Thru Budget Notary Services
iissiion GG 226347wr��+l�tt######
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APPROVED BY
Plans Examiner
Structural Review
Zoning
Clerk
(Revised02/24/2014)