RF-15-2376 n� o
Miami Shores Village
10050 N.E.2nd Avenue NE sr f
Miami Shores,FL 33138-0000
Phone: (305)795-2204
"I. Expiration: 03/20/2016
Project Address Parcel Number Applicant
10555 NE 6 Avenue 1122310120040
VIVIAN MEDINA
Miami Shores, FL 33138-2049 Block: Lot:
Owner Information Address Phone Cell
VIVIAN MEDINA 10555 NE 6 Avenue
MIAMI SHORES FL 33138-2049
10555 NE 6 Avenue
MIAMI SHORES FL 33138-2049
Contractor(s) Phone Cell Phone Valuation: $ 250.00
PERKINS ROOFING CORPORATION (305)687-6521 (786)277-8486
_..... _... .. Total Sq Feet: 8
Type of Work:Repair Available Inspections:
Additional Info:REPLACE SMALL PIECE OF DAMAGED FASC inspection Type:
Classification:Residential Roof Repair
Scanning:3 Final Roof
Review Roof
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60
Invoice# RF-9-15-57129
DBPR Fee $2.00 09/22/2015 Check#:2550 $64.60 $50.00
DCA Fee $2.00
Education Surcharge $0.20 09/17/2015 Check#:2533 $50.00 $0.00
Permit Fee-Repairs $100.00
Scanning Fee $9.00
Technology Fee $0.80
Total: $114.60
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS 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. Futhermore,I authorize the above-na ontract the work stated.
September 22, 2015
Authorized Signature:Owner / Applicant / Contra r / Agent Date
Building Department Copy
September 22,2015 1
Miami Shores Village
Building Department SEP 1 7 A 5
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 -�H S - 2i3-�&
PERMIT APPLICATION Sub Permit No.
XBUILDING F-1 ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING F-1 MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:_YI ®s ss
A4 ,
City: Miami Shores County: Miami Dade Zip:31 t _3C)
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE:
OWNER: Nam
}�(Fee Simple Titleholder): Phone#:—
Address:—. L1�
City:— �s-L<,,S 0 Ef_ Stater_ — Zip .
Tenant/Lessee Name: / I _Phone#:
Email: s rC) r i✓ ��� `` __�_
CONTRACTOR:Company Na i: t !] _ - P� Phone#:t1�"'�,cff 7
n
Address: 7S r �� �L�,
City:_ State: _ Zip:
me:
Qualifier Na �C%►s�1 '� - _Phone#:�=&9-741
State Certification or Registration#( .- - =X-7 tJ�--Certificate of Competency#:
DESIGNER:Architect/Engineer: __Phone#:
Address: City: _ State: Zip:
Value of Work for this Permit:$_ �. _Square/Linear Footage of Work:
Type of Work: ❑ Ad ition ❑ Alteration ❑ New Repai Repl ce ❑ Demolition
t "
Description of Work: l (2, L C
Specify color of col�o"r�thru tile:
Submittal fee$_ ="` 1 Permit Fee$ [ _.- ,� _- CCF$—_____m __ CO/CC$
Scanning Fee$__._- Radon Fee$.—.___. DBPR$ Notary
Technology Fee$ Training/Education Fee$ _ _Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE
(Revised02/24/2014)
Bonding Company's Name(if applicable)
Bonding Company's Address _
City State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
City State 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
come.menced prior to the issuance of a permit and that all work wiil 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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature _ Signature_
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 20�5 by _ tk_day of 120 S , by
1Nl��I ISI who is personally knownto1J 2 it who is personally known to
me or who has produced FI. b - 35�" 73"�,►I�D�SS�) me or who has produced __as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: s:%z ;. rY:nt 1. Adams NOTARY PUBLIC:
� 3iAniISSION#FF007880
FX ;GS:APR.14,2017
,c �/.AARONNOTARY.cem �~
Sign:- �— Sign:_' L)6
Print: ' / 6�/I,� `' �.., / Print: G+�'� t
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Seal: Seal: -,°� 8f$talti` J. Adams sCOMMISSION#IFF 007880
SIRES:APR.14,2017
www.AAR0NN0TARyxPm
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APPROVED BY 1 �iPlans Examiner T�Zoning
--
Structural Review Clerk
(Revised02/24/2014)
R OOFTOP STRUCTURES
,. SEP 17 2015
Florida Building Code Edition 2010
High-Velocity Hurricane Zone Uniform Permit Application Form.
Section A(General Information? I �
stere en it 0. Process No.
Contractor's Name_ �a n
• Job AddressROOF CATEGORY
CATEGORY
IJ Low Slope ❑ Mechanically Fastened Tile ❑ Mortar/Adhesive Set Tile
❑ Asphaltic Shingles ❑ Metal Panel/Shingles ❑ Wood Shingles/Shakes
❑ Prescriptive BUR-RAS 150
ROOF TYPE
❑ New Roof ElReroofing ElRecovering Repair ❑ Maintenance
ROOF SYSTEM
INFORMATION
Low Slope Roof Area(SF) Steep Sloped Roof Area(SF) To�(
Section B Goof Plan)
Sketch Roof Pian: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.
6060
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15.34 2010 FLORIDA BUILDING CODE—BUILDING