BPP-15-2601 (3) Miami Shores Village - � - '
Building Department artment DEC 22 2015
.est:
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
-2204 Fax:(305)756-8972
INEwtWOM"NE PHO UMBER:(305)762-4949
Moo Ewa 1111%6
lq� 110
��VIWRVR& N
FBC 20�`�
BUILDING Master Permit No.��r Zw �
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade zio:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): l�ur� I ,P's a Phone#:
Address Z /O 57
City: I'Oft' 154afef State: Zip:
Tenant/Lessee Name: Phone#:
Email:
L
CONTRACTOR:Compan Name: Ao0vt1kei /ls Phone#:
Address: _ /,V/
City: �YI'G // State: �L zip: 3333
Qualifier Name: r1 Phone#• 7U6 �� 98 fU
State Certification or Registration#: Glg e- 1 Z 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: ❑ Addition /❑ Alteration ❑ New ElRepair/Replace ❑ Demolition
Description of Work: 6g4i 6&n- h
elSpecify color of color thru tile: �t
Submittal Fee$ Permit Fee$JS -M CCF$ CO/CC$ X�
Scanning Fee$ C.0 Radon Fee$ DBPR$ Notary$ Q�
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ , r
TOTAL FEE NOW DUE$
(RevisedOZ/24/2014)
t
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 iWinsence of such posted notice, the
inspection will not be a proved 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
Z Z day of20 l ,by day of .20 C ,by
� bSLoSo ,who is rsonally nown to Z- Autn who I ersonall 4 wn 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 PUBLIC:
Sign � Sign• —.�/
Print: byqvtGt�i `� �o`n. Print:
S Seal: »»»
DAVID M DIPUGLIA =a: , DAVID M DIPUGLIA
*'• ,' MY COMMISSION#FF069M =' I*` MY COMMISSION#FF089668
o, 7 t°� �/
`' ' ..•. P, EXPIRES November 11.2017
(07) 15****iPisI*da*#,eta*R*Vgervfc�`ee��e tea* s**e*�►s+�
(407)398-0153 FloridafttaryService.00
APPROVED BY QeN3'� �°�Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
®A VILA
Associates Services, 1KEVIS
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TOTAL R/W 8Y PLAT):::
18' ASPH PVMT.'
�: ..... NE 104th STREET:: ::
8
InTILE 12' PARKWAY '6 1k in
[ON
75.00'(R&M)
e.CORN •. ilwA wM O
Ul 297. Fd 19.
LOT b
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BLOCK 2
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4f-
4!
LOT 4 g I 14'70 c 3xS, LOT 6
BLOCK 2o BLOCK 2-.
b ONE STORY
RES.B 1298 3xa'
DEC2 2015
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4
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MIAMI SHORES SECTION S REVISED 31.41�fi CY"' • •
• • • • • •
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SURVEYOR NOTE • • • ••
•'';u -THERE ARE NO VISIBLE ENCROACHMENTS • • •
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SCALE 29'
. .. ti.+'f FIELD AM 02-W2014
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