REV-12-20-2886, 77 NE 106th StRECEg�J�,�
Miami Shores Village 7
Building Department BY:
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20
BUILDING Master Permit No. RC-10-19-2603
PERMIT APPLICATION Sub permit No..m'��" �v-IZ-2m2$�b
BUILDING ❑ ELECTRIC ROOFING Q 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 x
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Tomas E Castellanos Phone#: 305-323-0481
Address: 640 NE 72 Terrace
City: Miami State: Florida Zip: 33138
Tenant/Lessee Name: N/A Phone#: N/A
Email: tomas.e.castellanos@gmail.com
CONTRACTOR: Company Name: Borkat Plumbing Services LLC Phone#: 305.244.6023
Address: 810 NE 11th St
City: Homestead State: Florida Zip: 33030
Qualifier Name: Boris A Inclan Phone#: 305.244.6023
State Certification or Registration #: CFC1430105 Certificate of Competency #:
DESIGNER: Architect/Engineer:
Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 1,000.00 Square/Linear Footage of Work:
Type of Work: ❑ Addition Al Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: Relocation of existing electric tank -less water heater into closet. Replace two VTR
with AAV.
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $ _
CCF $ CO/CC $
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ Q�
(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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature _
OWNER or AGENT
The foregoing instrument was acknowledged before me this
Za daayof4/04tit' pf3i- 20 L0 by
I n'$ C9644 Lw► aS . who is personally known to
me or who has produced - as
identification and who did take an oath.
Signature
~ ~ �yJCONTRACTOR
The fore ing instrument was acknowledged before me this
day of f 20 , by
,—ho is personallyy known to
me or who has pro uced ` as
identification and who did take an oath.
NOTARY PUBLIC: NOTAR
t
n:
Sign- Sign:
Print:n
Seal: ALEJANDROFA131ANPONTI C�I:
o My COMMISSION # GG 079445
-o EXP1REla May S. 2024
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APPROVED BY ~ �Plans Examiner
Structural Review
G
JOSE R.ARRAZCAETA
EXQiRES:Ahb12.2M
Zoning
Clerk
(Reviseda2/24/2014)