EL-13-1037 snoA Miami Shores Village
BuildingDepartmentISEP p 6 2014
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 201/0
BUILDING Master Permit No2,,-' 1 2 kD [ 6
PERMIT APPLICATION Sub Permit No. 4�- /-r - le".>.
BUILDING ELECTRIC ❑ ROOFING REVISION EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLICWORKS CHANGE [:] CANCELLATION SHOP
L CO TRACTOR DRAWINGS
JOB ADDRESS: �� Iy ti/ ✓�� sT
City: Miami Shores County: Miami Dade Zip: _-73145;-Z
Folio/Parcel#: 112)1.36042,304®0 Is the Building Historically Designated:Yes
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): ,GYI Phone#: 71�?6
Address: 5e5_!5 /y iv
City: HG 3^'» State: ` Zip:
Tenant/Lessee Name: Phone#:
Email: { 1 l �7 q �7
CONTRACTOR:Company Name: S' C C Phone#: `3 ® `-1 a� l �U
Address: k4x 'l3 A 3
City: fi'ltc�a�; tate: ` X31
Zip-
Qualifier Name: � �X'Q (2-OL-y- ,zck Phone#:
State Certification or Registration#: 0 LAS Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 11000-X Square/Linear Footage of Work:
Type of Work: ❑Addition ❑ Alteration ❑New ❑ Repair/Replace ❑Demolition
Description of Work: U c (Z)OAVAS
01-7 011 -��
Specific color of color thru tile:
Submittal Fee$ Permit Fee CCF$ CO/CC$
Scanning Fee$ `QIP Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$ ��
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
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 delivere tothe person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be post d t the job site
for the first inspection which occurs seven (7) days after the building permit is issued. in the abse e f such p to notice, the
0 inspection will not be oved and a reinspection fee will be charged.
Signature -- Sign
Owner or Agent Contractor
The fore;oing instrument was acknowledged before me this The foregoing instrument was acknowledged before me
-a Y -� �, Y ✓Gy► C O1r day of .. ,C ^�� 20 j�j by �1 ) (?
this a of .Gw 0 1 b V
who is personally known to me or who has produced who is personally known to me or who has produced
L D� As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
JA_ cl�at
Sign: Sign:
Print: 4 Ion Print: c• MARIA DEL PILAR ROBLEDO
' CHERYLLANDMDE
My Commission ExpMY COMMISSION#EE220559
' WCOMMIMM EE84324 My Commission Ex i EXPIRES August 13,2016
EXPIRES:Oc Wtw 15,2016 "
• Bonded Thou Pubf Ups ( 398A763 FlaldaN aom
6/
APPROVED BY �S�'/� Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)(Revised 5/2/2012)(Revised 3/12/2012))(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007)
Miami Shores Village MAY 131013
Building DepartmentBY )
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
FBC 20
BUILDING Permit No. 4�
PERMIT APPLICATION Master Permit No. ;(7(f (
Permit Type: Electrical
JOB ADDRESS: 51 N W I n *x'9_1
City: Miami Shores County: Miami Dade Zip: '731
/
Folio/Parcelt
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fede°Simple Titleholder): � n Phone#:
Address: / /V- 141 Le
City: State: Zip: 3i 3/5
Tenant/Lessee Name: N 1A Phone#:
Email:
CONTRACTOR:Company Name: �� lam/ A L� Phone#: • E!b-2,3D
Address: v
City: A-'�11 / State: Zip: 3-;T1?4f
Qualifier Name: Z42 _L/ 9,ef h r- �t Phone#•
State Certification or Registration#:e'd 001 U 722 --_Certificate of Competency#:f f_
Contact Phone#: 5' 2, !6 )_ 1 l Email Address:
Of
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: DAddress OAlteration XNew ORepair/Replace ODemolition
Description of Work:
Submittal Fee$ Permit Fee$ lmd CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$
,, :5 A ga ,
fi nding,Cox*ny'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
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 TICAL WORK,PLUMBINfi,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
fur the fist i ttri�e-wlte�k-a' ' - seven (7) days after the building permit is4ssued. In the absence of such posted notice, the
inspecti be proved an n ection fee will be charged.
Signature - Signature
Owner or Agent tractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me is-
day of M b ,20 L�,by h (:Q,�b U Z day of M(, 2013,by �✓K 2
who is personally known to me or who has produced who is personally known to me or who has produced
T-1- 1 1) As identification and who did take an oath. --E6- I as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
6 t
Print. Print: 1r
•"' ' (HEIYlLAN1giADE
My Commission Exp My Commission _ IN COMMSION#EE 843924
CHETALAN) ' EXPIRES:October 15,2016
R W� I EE�843.9'L4 '•• Bonded Thtary ru NoPublic W&W t m
EXPIRES:October 15,2016
N PUbIiCUndgWbM skikekshnIsHaksAbka�skikdaka==kik'kskk =kIaskHaskskskd='ksk'ktknk'kkdaoknkak ekakkd=sksksktk daskdsHa
$asp�dsgc��$ea$=k$eskakkdsgaa:s$e�ak
APPROVED B Plans Examiner Zoning
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06110/2009)(Revised 3/15/09)