RC-16-379 (2) -= Miami Shores Village
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
F�6 l 0 2016
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 -
FBC 20N y s441
BUILDING Master Permit No.f-cA (,p 3-7 C7
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: %LA„� / c� i` [=G' %_ �� %
City: Miami Shores County Miami Dade
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): Zz�} -,WAy L.Z' Phone#: 7
Address: 74 �a ,s/ _ / ��i "O
City: i a�vr i`�'7 et St te• A r ie-,/
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name:r C6 6 yL-S-rt Phone#: N,5' q 2-7
Address: -�4($D L-J 5 CY
AsJ 'e—
City: rO ' �`P�Q _—___State:
�+ /� Zip:
Qualifier Name: l� ( � �Q Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work: l 2�
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: 5j, ,,,,
c,x (
Specify color of color thru tile:
Submittal Fee$'�• Permit Fee$ CCF$ 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
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 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 Ws acknowledged before me this
day of vL 20 t & .by f 2d G by
4 h t' 'I aL rr0who is personally known to v�G — who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PU LIC:
Sign: (A Sign:
Print: U V CA_ Print:
aat; ° LAL9#A FAEM.EY LAM FAFIY
Seal: * W C�IISSIM it FF 188t�9' Seal: * W C,OMIISWIl t FF 1 A27
EXPIRES:March 16,2D19 EXPIRES:Moo%2019
''*tv AQr' dedTiw tNolarySerM:ee 00" 8abtT0V N*rykft
************************************************************************************************************
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(RevisedOZ/24/2014) -
0 OL
0.
M}ANTI-DRDE COUNTY BUILDING-DEPARTMENT
Herbert S. Saffir Permitting and Inspection Center
11305 SW 26th Street(Coral Way), --Miami,.Florida 33175-2-474!,-(786)315-2100. -
ARPL.I.CATION FOR MUNICIPAL PERMIT APPLICANTS
THAT REQUIRE* PLAN REVIEW FROM MIAMI-DADE FIRE RESCUE
AND/OR DEPARTMENT OF ENVIRONMENTAL RESOURCES MANAGEMENT
PROVIDE XUbUCIPAL PROCESS NUMBER HERE
Job Address e
to Contractor No
o z Folio (C�(R/(, ( .P�. z Last four(4)digits of Qualifier No.
9 z u Contractor Name �,lb
7 Lot Block 600 < -
o a Subdivision pg Z a Qualfier'Name�e1G9
pg = Address (,t� f0
U.
Metes anti bounds r� � • '
City (0 - �Y It State
[ ] New Construction on ] Demolish f Current use bf property
A Vacant Land [ ] Shell Only
4' [ ] Addition Attached
w meration Interior
w ], eration Exterior ;�. [ •] Addition Detached � Description of Work t/7O!-'
[ ] Relocation of Structure Re-Roof
[ ] Enclosure [ ] Fdtadation Only . l M
Sq. Ft.• Units Floors.
• [ ] Repair' - •
[ ] Repair Due to Fre Value of Work
].MELD " [ ]•Chg.-Contractor. Owner jd69!L-,7 le
Category • D 1. �, ' P,ddres C)
F [ ] Re-Issue - .
•: :[. ] IVIELE i- City T1
�.. '[ ] Re-stamp*..'.•.;•' stat ..,
r [ MLPG • �..
] �: z= Phone
[ ] MMEC [ ] Revision z:
o" : .Last four(4)digits of
[ ] FIRE [ ] Not Applicable for Owners Social Secu" No.
Fire my
o z: Name tel �(' -�"�--^.'t' .'Na*
me
a
y. Addres S: v�� �. . �-
` u w . •Address
�z _
w Y Ci State _•Zip• o City State
0.a Phone r a U'
. ( /(f tt...' Phone
I JV
am requesting a Special Request Plan-Review(SRl)to be scheduled as soon As pdss61e•at the rate of$790 for the first hour and
$65 per each addition hour in*addition to the review fees.. Minimum charge one-hour
ua
yw w .1'l Request: . '
>> Date:.;
LL.a '2"�Request:. Date:
3td Request:. Date:
'I am requesting Optional•Plarr•Review(OPR).to.6e scheduled ass oon es possible at the rate of$75 for each discipline: Additions! -
{o .review fees may apply. "
1Sr•Request. . No DERM OPR :
o tu ' d Date:
x a Request: _
Date:'
o 3`�Request: _ No expedite reviews gate:
. - •. Y:1Pomu1691 laG+ueidFat P-.k A,pA vi..dx .
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Recommended overlap pn.) 0
DETAILS
Antimicrobial No Moisture control included No
Commercial 1 Residential Commercial 1 Residential Package gage(sq.fL) 200
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Cushioning Yes Returnable wDay
Flooring Product Type Underlayment Sound absorbing Yes
Flooring types)used with Any Subflooring type Any
Material Other
WARRANTY/CERTIFICATIONS
Manufacturer Warranty To be tree from manufacturing defer
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