WS-15-196 Miami Shores Village
Building Department JAN 2015
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY;
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 10
BUILDING Master Permit No. yyS- S- 19
PERMIT APPLICATION Sub Permit No.
OBUILDING ❑ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 90 NE 105th Street
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11 2136 012 0010 Is the Building Historically Designated:Yes NO X
Occupancy Type: SF Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):Randal Adkins Phone#:305 7519523
Address:90 NE 105th St
City: Miami Shores State: Fl Zip: 33138
Tenant/Lessee Name: N/A Phone#:
Email: albaguerrero2000@yahoo.com FBI
CONTRACTOR:Company Name: Florida Window& r -- Phone#: 561 340 4300
Address: 7108 Fairway Dr#120
City. Palm Beach Gardens State: FI Zip: 33418
Qualifier Name: Scott Berman Phone#: 561340-4300
State Certification or Registration#: CGC 1509450 Certificate of Competency#:
DESIGNER:Architect/Engineer: ✓l-e-Al it /ea5 Phone#:�Z S'y-5Jrq'0 Gab o
Address:1f-0 �� �� > + -�✓2 —City-."i State:F__!_Z(p: 't
Value of Work for this Permit:$13,000.00 Square/Linear Footage of Work:
Type of Work: ❑ Addition 0 Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: �i'JSt�. r y�.� "� �✓o N w5 �,.•^ 3 ;03'0—'-t as*s
Specify color of.�color thru tile:
Submittal Fee$ !�V �Jl� 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)
r
• Bonding Company's Name(if applicable) N/A
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable) N/A
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 fast 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 ONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 20 14 by day of Pec�2.�,�rr— ,20� ,by
14�r*C- who is personally known to 'fT' / ,who is personally known to
---------------
me or who has produced VCA—1 cewL• as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC: 00,
nis
Sign: Sig
Print: d6 es °9� — Print: Idoop
Ry pU
Seal: - _
Seal: MY COMMISS N#EE 630795
v'� cF/#mi,Ss;Qn �t�C 1 a* EXPIRES:August 27,2016
Bondi Thru Budget Notary Smim
rrn tt
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)