PL-16-3221RECEIVED
Miami Shores Village Nov 28 2016
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 7,4�
INSPECTION LINE PHONE NUMBER: (305) 762-4949 c l_
FBC 20 �� v
BUILDING Master Permit No. if 32 l9
PERMIT APPLICATION, Sub Permit No.�l- b` 322�
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION RENEWAL
❑■ PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 78 NW 107 St
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11-2136-007-0070 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): SRP TRS SUB, LLC
Address:2700 W Cypress Creek Dr
ne#: 954-671-1400
City: Fort Lauderdale State: FL Zip: 33309
Tenant/Lessee Name: Phone#:
Email
CONTRACTOR: Company Name: G & L Plumbing Service Phone#:
Address: 11021 SW 142 AV
City: Miami State: FL Zip: 33186
Qualifier Name: EIOy Arriera Phone#: 305-316-5694
State Certification or Registration #: CFC056755 Certificate of Competency #:
DESIGNER: Architect/Engineer: DDSM Cosulting, LLC Phone#:
Address:14359 Miramar Pkwy city: Miramar State: FL Zip: 33027
Value of Work for this Permit: $ 11 &Qy Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair��eplace ❑ Demolition]
Description of Work:
r I Uvie ✓l vl-� ' LV Pa-yo 6(+C't'\W 4
Specify color of (color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $_
DBPR $
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
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 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 rei pection fee will be charged.
Signature Signature
NER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
I day of 015A46� — 20 16 by
"ems CCA , who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
APPROVED BY
(Revised02/24/2014)
The forgoing instrument was acknowledged before me this
I-7 day of N�Vt�hi'301'— 20 1(a by
�},/2P:22 ( (a-- who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
JULINTA PAULA SAAL Seal:
MY COMMISSION # FF963041
EXPIRES February 21.2020
Plans Examiner
Structural Review
JULWTA PAULA SAAL
MY COMMISSION 0 FF963041
EXPIRES February 21.2020
Zoning
Clerk
BUILDING
PERMIT APPLICATION
Miami Shores Village
RECEIVED
Building Department NOV 28 2016
10050 N.E.2nd Avenue Miami Shores Florida 33138 00 ,
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20
Master Permit NO. V—o— b- 32
- L L-, Sub Permit No.
QBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 78 NW 107 St
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11-2136-007-0070 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): SRP TRS SUB, LLC Phone#:954-671-1400
Address:2700 W Cypress Creek Dr
City: Fort Lauderdale State: FL Zip: 33309
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name: DMS Contractors, LLC
Address: 19340 NE 18 CT
City: Miami State: FL
Qualifier Name: Diego Saal Phone#: 786-256-1316
State Certification or Registration #: CGC1505716 Certificate of Competency #:
DESIGNER: Architect/Engineer: DDSM Cosultirlg, LLC Phone#:
Address:14359 Miramar PkwyCity. Miramar State: FL Zip: 33027
Value of Work for this Permit: $ 3s"- 6 Do Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Specify color of color thru tile:
786-256-1316
33179
Submittal Fee $ 1 ' Permit Fee $ CCF $ CO/CC $ -EQ.
Scanning Fee $ Radon Fee $ DBPR $ Notary $_
Technology Fee $ Training/Education Fee $ Double Fee $ ,
Structural Reviews $ 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 se n (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and einspection fee will be charged. �1
Signature / % Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
C day of P( 20 by
i/ who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal: A
APPROVED BY
(Revised02/24/2014)
JUUITA PAULA SAAL
MY COMMISSION # FF963041
EXPIRES February 21, 2020
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of (%J6 �1P.YYt�.2/r , 20 / (,g_, by
J� r�rw who is pqts a n wn to
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
as
�I
Sign: 1,/ UWyQ41
Print: - Weo-lllewleara weadwal
Seal: NOTARY PUBUC
STATE OF FLORIDA
Canm# FF976M
Expires 4/12=20
Plans Examiner rJ Zoning
Structural Review
Clerk