RF-12-1754��I z1�2--lXt
BtJI DING
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
PERMIT APPLICATION
Permit Type: BUILDING
FBC 20
Permit No.
Master Permit No. Y4--
ROOFING
JOB ADDRESS: � �e
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated: Yes
OWNER: Name (Fee Simple Titleholder):
NO %V` Flood Zone:
City: e v 1 `� L2, 2-1" State: _E� Zip: J&/
Tenant/Lessee Name:
9
Email: 4-,-
CONTRACTOR: Company Name: y
Address: 1001 0-S /
City: r State: Zip: ITT
Qualifier Name: Phone#: .� DL
State Certification or Registration #: A Certificate of Competency #: �7 7 15SC �
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ 40 ® C3 Square/Linear Footage of Work:
.Type of Work:, DAddition DAlteration r QNew
Description of Work: S6 ,
Ir
Color thru tile:
Submittal Fee $ SU 100 Permit Fee $
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF
CO/CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $
ODemolition
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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 -t& absence of such posted no 'ce, the
inspection aot-bZ proved a.0 a44hspection fee will be charged. -,-
sr orent
The foregoing instrument was aclowledged before me this
day of M/ , 20 &, byi,
r ow
who is personally known to me or who has producedJf�
As identification and who did take an oath.
NOTARY PUBLIC:
Contractor
The foregoing instrument was acknowledge efor me this
day of l , 201 , by 1
who is personally known to me or who has p du F't-11 PZ'
as identification and who did take an oath.
aotPR::;BG� PATRIOIAOMML
• W00MMNONtDD9W5
Sign: EXPIRES: A rN 4, 2014
kMedTlratlu Nd1yft"
Print:
My Commission Expires: l� %I
APPROVED BY
Plans Examiner
Structural Review
NOT
Sign:
Print:
My
(Revised 5/2/2012)(Revised 3/12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007)
Zoning
Clerk
Section R ( oof 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.
FLORIDA BUILDING CODE — BUILDING -41
ROOF ASSEMBLIES AND ROOFTOP
STRUCTURES
OCT o 2016
Florida Building Code Edition 2007
Z0
High
Q O F
-Velocity Hurricane Zone Uniform Permit Application For m.
v g
\
SeCtion 8 (General Information)
a
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art o.
¢¢
Process No.
!
y ator' I me
O
�o
J dtlbsf'c
2ROOF
CAXEGORY
ow o ❑ w Slo '
13Mechanically Fastened Tile 13Mortar/Adhesive Set Tile
z w❑ &s haltic
❑ Metal Panel/Shingles ❑ Wood Shingles/Shakes
ngles
°D "' `"
❑ Prescriptive BUR -RAS 150
ROOF TYPE
❑ New Roof .
❑ Reroofing ❑ Recovering ❑ Repair
0 Maintenance
ROOF SYSTEM
- INFORMATION
Low Slope Roof Area (SF)
Steep Sloped Roof Area (SF)
Total (SF)
Section R ( oof 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.
FLORIDA BUILDING CODE — BUILDING -41