PL-07-20-1431, 77 NE 106th StMiami Shores Village �E�EIVE�
Building Department W - 0.9 1020
10
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: -
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (30S) 762-4949
FBC 20 !� --
BUILDING Master Permit No �'�c-0--10 " (9 4-G08
PERMIT APPLICATION Sub Permit No�L`U 4 -'�6 -
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
QPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [] CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 77 NE 106 STREET
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-2136-006-0310 Is the Building Historically Designated: Yes NO NO
Occupancy Type: RES Load: Construction Type: CBS Flood Zone: X BFE: FFE:
OWNER: Name (Fee Simple Titleholder):TOMAS CASTELLANOS Phone#:305-323-0481
Address:640 NE 72 TER
City: MIAMI state: FL Zip: 33138
Tenant/Lessee Name: Phone#:
Email: tomas.e.castellanos@gmail.com
CONTRACTOR: Company Name: BORKAT PLUMBING SERVICES LLC Phone#: 3052446023
Address: 810 NE 11 TH ST
City: HOMESTEAD State: FLO Zip: 33030
Qualifier Name: BORIS A INCLAN Phone#: 3052446023
State Certification or Registration #: CFC 1430105 Certificate of Competency #:
DESIGNER: Architect/Engineer:
e#:
Address: City: State:
Value of Work for this Permit: $ 2800 Square/Linear Footage of Work:
Zip:
❑� Alteration New El ❑ Demolition
Type of Work: El Addition
Description of Work: NEW PLUMBING FIXTURES AT DEN AREA, NEW ELECTRICAL TANKLESS WATER HEATER
Specify color of color thru tile;
Submittal Fee $
Scanning Fee $
Permit Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $ CO/CC $
DBPR $
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
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 tc 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 approvegf and a reinspection fee will be charged.
Signature 1 Signature
OWNER or AGENT
The foregoing instrunt was acknowledged before me this
m
�-�_ day of U n 20 1-E� by
�DIti1�S �21Alc�lo5 who is personally known tc
r. .
identification and who did take an oath.
I c CORACTFR
The foregoing instrume t was acknowledged efore me this
lJ �' day of7 v YA 20 v by
1VICk c.\!2�,�—� who is personally krown to
I`'lGr'6-�'q',v"Zv"5 t'i�h
me or who has produced Z Shy • 0 (p l • ? 3 • y tc+'��s
identification and who did take an oath.
NOTAR PUBLIC: NOTARY PUBLIC:
MM-
f`L�A1uER �s1i ••
Sign: Sign: a 2`1797
Print: UlC U% f Print: s1,i
Seal: ; j', , JACQUELINE PORTAL Seal: . ep\
,. . MY COMMISSION Il GG M595
EXPIRES: January 22, 2021
OwWad 1hru Way Public Undwfldvs
APPROVED BY 7/S1,ic. Plans Examiner
Zoning
Strucrural Review
(Revised02/24/2014)
Clerk