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BUILDING
PERMIT APPLICATION
Miami Shores Village RECEIVED
Building Department v.os 2D19
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 2
RIaster Permit No --C 1-11 ��(9
CANCELL,
0 Sub Permit No.
❑BUILDING ❑■ ELECTRIC ❑ ROOFING
❑PLUMBING ❑ MECHANICAL ❑PUBLICWORKS
JOB ADDRESS: 1271 NE 97th Street
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
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: A E BFE: 9 F+ FIFE:
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: Florida
hone#:
33138
CONTRACTOR: Company Name: Accurate Power and Technology/ A GeneLgwy 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:
hone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 4,900.00 Square/Linear Footage of Work: 2857
Type of Work: ❑ Addition 0011 Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of work: Install a 22KW Generac Generator and a 200 AMP ATS ( Automatic Transfer Switch)
— �?L A_o i c--FEL- 0 q - I q - 8 5q
Specify color of color thru tile:
Submittal Fee $,6 Permit Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Radon Fee $
Training/Education Fee $
CCF $ CO/CC $
DBPR $
Notary $
Double Fee $
Bond $ TOTAL FEE NOW DUE $ 2 ✓ .3G
(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
Zi
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 imated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and con n 1' n low brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded d f mencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is t d e absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature //J, Signatu
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of 20 1 Ct by
who is personally known to
me or who has produced
identification and who did take an oath.
NOMBLI:Sig
Print:
as
The foregoing ihs�rument was acknowledged before me this
q� day VS
20 Lq by
�k 1% who is personally known to
me or who has produced �L i�. L as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: CM"""""
Print:
`.*aY P&,, PAMELA J. CASQUILLA
Seal:
Seal: MY COMMISSION # FF 961989
J.
EXPIRES: May 9, 2020
FOF f�UP Bonded Th udget Nor Services
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APPROVED BY
Plans Examiner
`
r
e
Si�rctQrat-Review
Notary Public State of Florida
Barbara C Benjamen
CMy
C�ommii�ssiionf1GG 226347
(��ftYA7 ��aK�Y�i�!'.►f ►tfftt t►t..tf
Zoning
Clerk
(Revised02/24/2014)
CAW
.30 Miami Shores Village P�EcE1VED
2 420�
Building Department JA
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 / ^�
CANCRFBc zo�-
BUILDING Utter Permit No.
PERMIT APPLICATION Sub Permit No. 'E-�- ((- L 2698
❑BUILDING M ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING []MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1271 NE 97th Street
City: Miami Shores County: Miami Dade VD:
Folio/Parcet#: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 and Carmen Aceves Gordon phone#: 305-989-9363
Address:1271 NE 97th St.
City: Miami Shores State: Florida vp: 33138
Tenant/Lessee Name: Phone#:
Email:
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#:
State Certiflcation or Registration #: EC13007737 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address• City: State: Zip•
Value of Worts for this Permit: $ Square/linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: We wish to cancel the permit as the consumer has decided to cancel the deal.
Specify color of color thru tile:
Submittal Fee S Permit Fee $
Scanning Fee $
CCF $ CO/CC $
Radon Fee $ DBPR $ Notary $
Technology fee $ Tralning/Education Fee $
Structural Reviews S
Double Fee 5
Bond $
TOTAL FEE NOW DUE S
(RevisedO2n4MI41
Bonding Company's Name (If applicable)
Bonding Company's Address
City State Zip
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 on estimated value exceeding $2500, the applicant must
promise In good faith that a copy of the notice of commencement and construction lien low 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. A X-, A ,
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of . 20 . by
who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
The foregoing (n'strum nt was acknowledged before me this
�d ol.t C-C tri . 20 D by
l ii r1 who personal now to
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Print:
Seal:
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APPROVED BY Plans Examiner
Structural Review
(RevheW2/24JX14)
N MAIN F - ii
11#1 Ov. In ! L
%&^ Ssrb s C sots a Fiw�d.
8arbar� C Ben}3men
d MN CaSSIW GO 2Z3M�
y w�l' mrc EXplrs! 06iQ712Q22
as
ssssssass•
Zoning
Clerk