REV-19-2034�a'C 0", q *-Otl Miami Shores Village
Building Department RECEIVED
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 AUG 3 0 2019
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 / .�,�
FBC 2� � b
BUILDING Master Permit No. RC-02-19-306
PERMIT APPL ON Sub Permit No. &_y-n�-R -201
❑BUILDING X❑ ELECTRIC ❑ROOFING Q REVISION ❑EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [--]PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 671 NE 105 St.
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11-2231-012-0100 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): UNAM 671, Inc. Phone#:
Address: 671 NE 105 St.
City: Miami Shores State: R. Zip: 33138
Tenant/Lessee Name: Phone#:
Email
CO
Address
Company Name:
City: L. 11
Qualifier Name:
Phone#:
—Zip:
5 SSAS / p
hone#: /J / — 456— �O `P(7
State Certification or Registration #: d4 - I > n f�_% 202Certificate of Competency #:
DESIGNER: Architect/Engineer: Victor Bruce Phone#: (305) 310-5030
Address: 370 NE 101 St. city: Miami Shores State: Fl. Zip: 33138
Value of Work for this Permit: $ 600.00 Square/Linear Footage of Work: 30 U.
Type of Work: ❑ Addition ❑ Alteration ® New ❑ Repair/Replace ❑ Demolition
Description of work: Electrical service for generator change from original plan
0
SS
T�
State:
6
Specify color 11"ru tile:
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 $ `t- az)
(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. 1 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.
Marco Br i (VP- UNAM-671, Inc.)
Signature AAA 441
OWNER or AGENT
Theforegoinginstrument was acknowledged before me this
-C 7 day of A14 U6+ 20 10 by
Marco Bruzzi who is rsonally kno n to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Print: LUC49iL IC105J...
Seal. ;a"!u LUCIAG.ISASI
MY COMMISSION # GG 247475
EXPIRES: December 10. 2022
roF W BOnrled TAru Notary Public Underwriters
as
:7,�t-j
alker
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
Q1 day of ff 20 G by
��P.✓Wn ��fr^Z who is pe sonally kno to
me or who has produced nYirJe VS 1 c /t^ G'L' as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Seal: raR<:ir LUCIAG. ISASI
,. MY COMMISSION # GG 247475
;a• o EXPIRES: December 10, 2022
Bonded 71n Notary Public Underwhrs
*****************
APPROVE A� ee Plans Examiner
Structural Review
*********************
Zoning
Clerk
(Revised02/24/2014)