REV-19-171Miami Shores Village
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
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS
JOB ADDRESS:
Folio/Parcel#:IL
0
C
JAN�2
s
FBC 20
Master Permit No. l� — 3102-
Sub Permit No. R-0 l — I 1
/,,REVISION ❑ EXTENSION ❑RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): w S A2 ' O Phone#: 305 3-`le) O S Z aJ
Address: Y3 1 N/ES7
City: !A'-7 I State: Zip:
Tenant/Lessee Name: O Gc'k'P 1,G-�
Phone#:
Email: z"-- L✓tS • -A./4'-f c` for-�iL•
CONTRACTOR: Company Name:
Address:
City:
Qualifier Name:
State Certification or Registration #:
- Zip:
Phone#:
of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: ,P j , ),M I ^, � Cat w )VAI GA
�n _ _ .. _
Specify color f color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $
Structural Reviews
Training/Education Fee $
Double Fee $
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $
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,
inspection will not be approved and a reinspection fee will be charged.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
_ day of CAA, 20 by
wh Cis n to
me or who has p oduced as
identification and whoslid take_an.oath- _ .�
NOTA P U DANIELPEREZ
Notary Public - StateofFlorida
Commission GG 44769
MvrnmmcxoiresNov 3,2020
Pri
Seal
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of 120 by
11 M-0 who i personally own,. �knme or who has produced as
identification a
NOT
Pri
Seal:
U � U
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
ROOF ASSEMBLIES AND ROOFTOP ST
C�
g Florida Building Code 5th Edition (2014)
AN2
High -Velocity Hurricane Zone Uniform Permit Application FormfW.-_ I
19-
Q
0
Section A (General Information)
er it No. Process No.
n
Contractor's Name—oome � q—
NVJ Address
[� Low Slope
❑ Asphaltic Shingles
❑ New roof ❑ Repair
Low Slope Roof Area (SF)
1
1
1
1
1
je
...J%
• 1•
.r
• 1'
1
1
Section B (Roof Plan) 1
h Roof Plan: Illustrate all levels and sections, roof drains, scuppers, overflow scuppers and overflow drains. Include dimen- 1
of sections and levels, clearly identify dimensions of elevated pressure zones and location of parapets. 1
ROOF CATEGORY
❑ Mechanically Fastened Tile
❑ Metal Panel/Shingles
❑ Prescriptive BUR-RAS 150
❑ MortarAfifsSjye Set Its •
....
❑ Wood $rUvin�s/Shakes •
• • ••.•
•• •. •
ROOF TYPE :**:a: �•
❑ 9
Maintenance Reroofing . • ❑ Re • �R
ROOF SYSTEM INFORMATIO • • • ..
Steep Sloped Roof AREA (SSF) Total (SF)
•.:..'
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FLORIDA BUILDING CODE — BUILDING, 5th EDITION (2014) 15.37
1 t I 11:1911111
Copyright to, or licensed by. ICC (All, RIGHTS RESERVED); accessed by Eliczer Palacio on Jun 8, 2015 10:32:12 AM pursuant to license
Agreement. No further reproductions authorized.
1
1
1
1
ROOF ASSEMBLIES AND ROOFTOP STRUCTURES
Florida Building Code 5th Edition (2014)
High -Velocity Hurricane Zone Uniform Permit Application Form.
1
1
1 Section C (Low Slope Application)
1 Fill in specific roof assembly components and identify
manufacturer
(If a component is not used, identify as 'NA")
1 System Manufacturer. h
1 �
1 Product Approval No.: S- l Q Zo - 0 j 1
! Design Wind Pressures, From RAS 128 or Calculations:
1
P1: P2:_ P3: O
Max. Design Pressure, from the specific product C
1 approval system: J
1 Deck:
1
I Type. Q
Gauge/Thickness: I)
1 lI�1 Slope: `I
Anchor/Base Sheet & No. of Ply(s):
1 Anchor/Base Sheet Fastener/Bonding Material:
I
Insulation Base Layer.
Base Insulation Size and Thickness: /
Base Insulation Fastener/Bonding Material -
Top Insulation Layer: /
1
Top Insulation Size and Thickness: /
1 Top Insulation Fastener/Bonding Material -
Base Sheets) & No. of Ply(s):'�� s =W), L
I Base Sheet Fastener/Bondi g Mat rial:
Top Ply Faste er/Bo in at rial:
1
� 1
Surfacing:
Fastener Spacing for Anchor/Base Sheet Attachment: 1
Field: -�-" oc @ Lap, # Rowsoc .' • • •
Perimeter: " oc @ Lap, # Rows (0 .. • .'
.•• Via. •
Comer: " oc @ Lap, # Rows ^I• • " oc •
• •• • .�. •• `•••••
•
Number of Fasteners Per Insulation 8oeki . • •
•••••• •••• • •
Field Perimeter .. I..* Com r • "• •
00
Illustrate Components Noted and Retails as Applicable: I •
Woodblocking, Gutter, Edge TemynatioD�StrippinssaGlashing, ,••• •
Continuous Cleat, Cant Strip, Baso Flashing, Codnterflashing, •
Coping, Etc. • • • • 0 • .....
Indicate: Me R-Ruat a8tght-Pa apet Height, Heighlt•ef Base
F g, omponent Material, M a I ess, Fastener 1
j ype, astener Spacing or Submit Manufacture Details that
C ly with RAS 111 and Chapter 1
cv
C
Nlj I 0 C FT. {� ;
o Parapet A
�10 Height i
1' 1
FT. Z 1
1
Mean 1
Roof I
�11 Height 1
q 1
S
Ply Sheet(s) & No. of Ply(s): ' 1
Ply Sheet Fastener/B din aterial: !
Top Ply: iQ` Q IJ 1
1
15.38 FLORIDA BUILDING CO DING, 5th EDITION (2014)
Copyright to, or licensed by, ICC (ALL RIGHTS RESERVED); accessed by Eliezer Palacio on Jun B, 2015 10:32:12 AM pursuant to License
Agreement. No further reproductions authorized.