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RC-12-1908 • Miami Shores Village Building Department CF 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 OCT 12 2012 Tel:(305)795.2204 Fay(305)756.8972 INSPECTION'S PHONE NUMBER:(3�762.4949 �'; �C� �v ) Z — N -- FBC 20 l� DING Permit No. PERMIT APPLICATION Master Permit No.'�C I2�--V�0� Permit Type: BUII.DING ROOFING JOB ADDRESS: 128 NE 99th Street City: Miami Shores County: Miami Dade Zip:33138 Folio/Parcel#; 11-3206-013-2270 Is the Building Historically Dem gnated:Yes NO X Flood Zone: OWNER:Name(Fee simple Titleholder).Juan Carlos Acosta phot 305.710.3702 Ad&ess:128 NE 99th Stmt City: Miami Shores Village Ste. FL Zip.33138 Tenant/I.essee Name: Phone#: Ems;juancarloslaQaol.com CONTRACTOR:Company Name: H.K. Yoshida Constructlon, phos;954.275.3969 Address:3840 W. Hillsboro Blvd, 222 city: Deerfield Beach sem; FL zin;33442 Qualifier Name: Hal YoShida phot;954.275.3969 State Certification or Registration# CGC1515030 Certificate of Competency#: Contactphone#;954.275.3969 Emau Address: hal@gccontractor.com DESIGNER:Architect/En&eer:Smith Smith Design Corporation p #;305.892.9669 Value of work for this Permit:$30,000.00 Sqn mAAnear Footage of work: Type of work: OAddition OAlteration ONew DRepair/Replace DDemolition Description of work..Structural - Replace ridge beams Color thru tile: ***************************************Fees******************************************** Submittal Fee$lEb Permit Fee$ 9 0 CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Edacatiton Fee$ Technology Fee$ Doable Fee$ Structural Review$ TOTAL FEE NOW DUE$4 Bonding Compsiny'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,MATERS,TANKS and AIR CONDITIONERS,ETC..... OWNER'S AFFMAVIT: I certify that all the foregoing information is accmft 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 app oval and a reinspection fee will be charged Signature Signature i Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 6d day of 2 by 1&,g 6faf day of 20/a,by/pj� Q 104 - , who is personally known to me who has produced who isrally wn to me or has produced d�a+hQd d take an oath. ,•• •g•., 'tt)SENBERG JANE ROSE ~ NOTARY LIC: ••`�``� N�,tx y.�,,ahc-State of]Fledft NOTARY GMy Comm Fxpires Mar 3Nary Pubk-S�of Floftn n EE 18My Gomm' �31,2016 Sign. Sign: "a Caamis EE 184297 Print- My rin�?o=sion My Expires: 45VI/L o--mission Expires: ************************************************************************************************************ APPROVED BY / d Plans Examiner Zoning Structural Review Clerk (Revised 3/12012)(Revised 07/10V97)(Revised 06/1WMXRevisei 3/15/09) Miami Shores Village g Building Department 90050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 FFC 20 BIDING Permit No. 4 PERMIT APPLICATION Master permit No. �•'�'—�Z'/y©� Permit Type:lEleChiCal JOB ADDRESS: B" J / S% City: Miami ShoresCounty: MiamiDade Zip: Folio/parcel#: Is the Building Historically Desig mated.yes . NO Flood Zone: OWNER:Name(Fee Simple Title lder): multi' e o S -A, Phone#: Address: Ci ty: State: Tp: ,331 TenanvIzssee Name: Phone#: Email: j CONTRACTOR:Company N Godly Electrical Services, Inc. Phone#: 954-560-4234 Address: 10002 NW 46th Stre City: Sunrise State: Florida !MM : 33351 Qualifier Name• John K.Vdde if State Certification or Registration A. ER13013966 Certificate of Competency#: 07E00I 245 Contact phone#: 954-560-4234 Email Address: john.Godlyelectricalservlt:es@Gmail.com DESIGNER:Architect/Engineer. Phone#: Vallee of Work for this Permit:$ Type of Work: ®Address OAlteration._ to, ¢• `�, ClDemolition Description of Work: fn i i i i Submittal Fee$ Permatt Fee$ /Sr®!�a CCF$ COICC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ I Training/F.dmmdon Fee$ Technology Fee$ Double Fee$ I Stmet:=al Review$ TOTAL FEE NOW DUE$ I I I i Bonding Company's Name(if app le) Bonding Company's Address zip City State Mortgage Lender's Name(if appli le) Mortgage Lender's Address Sta City te' �p that no work or installation has Application is hereby made to ob a permit to do the work and installations as indicated. I ' of all laws regulating or to the issuance of a permit and that all work will be performed to the standards commenced pri that a�separate permit must-be secured for ELECTRICAL WORE,PLUMBING,SIGNS, construction O this jurisdiction I TANKS and AIR CONDTnONERS,ETC..... WELLS,POOLS,FURNACES,B ILERS.HEATERS, OWNER'S AFFIDAVIT: I that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating co n and 4eWARNING TO O YOUR' FAILURE TO RECORD A NOTICE OF CON N ENCEM ENT MAY RESULT IN YOUR PAYING TO OBTAIN TWICE FOR VAPROVEMENTS T YOUR- PROPERTY. IF YOU FINANCING, CONS T WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR OTICE OF CO1�IldIENC�:1ViENT• co '' to&e issuance of a bild uing Permit wh*an enimated value exceeding$2500,the aW at me Notice to Applicant As a promise in good faith;that a copy the notice`of commencement rded notice ofom»aeracma must be posted at the j site coff seven (7)days c whose property is subject to attar n� Also,d days zed{/ter the ze building Permit4 the o is issued In the absence of such Posted notice, the for the first inspection which oc inspection will not be' proved a rtfee will be charged � � Signature Signature Owner or.. Contractor fore this T�fore ° instrument was acknowledged before me this2 Z The foregoing instrument was ac f—= 2day of ' r 20 ,by f 20 by day of -�.•- y me or ho has produced who is personally known to who has produced__ who known �s identcfi 'on and who did take an oath. as identification and who did take an oath NOTARY ;UBLIC: NOTARY PUBLIC: Sign: Sign: �e L e� Print: Printx�e • My CommissionjExpires: Tretor i� mond Wallace My Commission.Exp; t Corn,ssion#EE016026 rJedThrome� �tpires: �� G.10,2014 p7 HOIQDTiD TEutG MAN MRO.NMG CO,M. �#� 4uHi�86 �•�'�bR��8+BB8Qa Plans Examiner Zoe APPROVED BY Structural Review Clerk (Regia 3n2r2012)(evisea 07/10th oerWM)Pt 3/15/09)