Rev-03-22-790, 9333 N Miami AveBUILDING
PERMIT APPLICATION
Miami Shores Village jz-V — _ d
Building Department
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
Master Permit No. f2-e- _C, 1 -2 �' ^ I � 3 )
BUILDING ELECTRIC ROOFING
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS
Sub Permit N
JRPREVISION Ej EXTENSI N RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 3'� I�-�l ► v%^� ��
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): i 61, C[' ►`\ t C Phone#: ` 7�z 77 3
Address: �J j� NA"Ie ., i�U-'
City:State: t Zip:
Tenant/Lessee Name: Phone#:
Email: .T -CV1Nc _'r=) 0o
CONTRACTOR: Company Name: Phone#:
Address: --
City: ice;, State: -- Zip: - i `-
Qualifier Name: �Oi �= 4 �` ),a Phone#:
State Certification or Registration #: p y c. Certificate of Com etenc #:
DESIGNER: Architect/Engineer: Phone#:
Address `'L City: L�
/� State: � ='4 Zip:
Value of Work for this Permit: $ "1 C 5 n Square/Linear Footage of Work: `a 75
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
w -.,.
Description of Work: d C �- _
N
Specify color of color thru the:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Lio . 03 CCF $ CO/CC $
Technology Fee $ Training/Education Fee $
DBPR $
Notary $
Double Fee $
Structural Reviews $
(Revised02/24/2014)
Bond $
TOTAL FEE NOW DUE $ �� • J
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 c ified copy of the recorded notice of commencement must be posted at the job site
for the firstJpspeet0m%g4ch ocpwTw- ken (7) dfils after the building permit is issued. In the absence of such posted notice, the
not be
OWNER dF AGENT
will be charged.
The foregoing instrument was acknowledged before me this
Z 6� day of 20 Z by
i C G PeneCt %CX2' , who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Signature ��iTi,
CONTRACTOR
The foregoing instrument was acknowledged before me this
2e);�L- day of MA("I - 20 2-- . by
i trod 19�klb l jgN , who i sonally known o
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign: qAi— Lf,, ULtl'� Sign:
l k r i
,�
Print: ► VQ�J eAt ?o w e C Print:
Seal:!�Seal:
g Comm.: NO159435
'..:.a
Expires: Sept.27,2025
Notary Pubic -State of 3rW4 #
APPROVED BY Plans Examiner
E
as
Natelee Ntt W ftW
CommAN 159135
F. Expires: Sept.27,2025
NoUry Punic • State of F*Wa
3#33#333##33#3####333#33##333##3##
Zoning
Structural Review
(Revised02/24/2014)
Clerk
Florida Building Code 7th Edition (2020)
High Velocity Hurricane Zone Uniform Roofing Application Form for Miami -Dade County
Section A (General Information)
Master Permit Number: I% C— + Z. D —) 63 , Process Number:
Contractor's
Job Address:
ROOF CATEGORY
RECEIVED
AeLow Slope ❑ Mechanically Fastened Tile ❑ Mortar / Adhesive Set Tile
❑ Asphaltic Shingles ❑ Metal Panel/ Shingles ❑ Wood Shingles / Shakoy:
ROOF TYPE
C New Roof ❑ Repair ❑ Maintenance ❑ Reroofing ❑ Recovering
ROOF SYSTEM INFORMATION
Low Slope Roofrea (ft2) Steep Sloped Roof Area (ft2) Total (� )
I
Are there gas vents on the roof? O Yes IV No If Yes what type? C) Natural 0 LPX
Is there an existing rooftop Solar System? O Yes iONo If yes will it be reinstalled? 0 Yes 0 No
Section B (Roof Plan
Sketch Roof Plan: Illustrate all levels and sections, roof drains, scuppers, overflow scuppers and overflow drains. Include
dimensions of sections and levels, clearly identify dimensions of elevated pressure zones and location of parapets.
viv,
MA
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� a
In
t t r J R
ca
i Mia ' 4 s Village ilding Department
i Zonept. Dat
'Building Dept. D
Subject to complian all F r , State
and Countv rules and regulations.
Permit#
Parapet Wall Nailable Deck
MIAMI-DiADE Miami -Dade County HVHZ Electronic Roof Permit Form
Qaumw
"Delivering Excellence ,Emery Pay„
Illustrate Components Noted and Details as Applicable:
Woodblocking, Gutter, Edge Terminations/Stripping/Flashing, Continuous Cleat, Cant Strip, Base Flashing,
Counterflashing, Coping, Etc.
Indicate: Mean Roof Height, Parapet Height, Height of Base Flashing, Component Material, Material Thickness,
Fastener Type, Fastener Spacing
Or: Submit Manufacturers Details that Comply with RAS-111 and Chapter 16.
Concrete wall
Elastomeric sealant tooled
to facilitate water run-off
Optional: compressible
Elastomeric sealant
Metal counterflashing meth.
attached 8" olc wl washer Parapet wall height: ft.
Seal top of base flashing w/ Roof Mean Height: ft.
comptable material
Termination bar meth.
attached 6" olc
Field plies turned up wall
Base flashing min.
8" above finished roof
------ Top Ply
�._ . __ Boise Sheet
,_-Roof Deck
Base Flashing:
GAF Ruberoid Mop Granule White
Surfacing:
N/A
Top Ply:
GAF Ruberoid Mop Granule White
Inter Ply Sheet:
GAF Ruberoid 20 Smooth
Base Sheet:
N/A
Roof Deck Type:
Exisiting Roof System