CC-15-2021 (2) vt Miami Shores Village
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Buildin Department �� 'I Z91 `
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 _ --
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 15401FBC 201 q
BUILDING Master Permit No. oz" 115_ 2021
PERMIT APPLICATION Sub Permit No.
08UILDING ❑ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 11300 NE 2 Avenue-Library
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO X
Occupancy Type: Load: Construction Type: CBS Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):Barry University Phone#:305-899-3785
Address:11300 NE 2 Avenue
City: Miami Shores St FL Zip: 33161
Tenant/Lessee Name: NSA Phone#:
Email:
CONTRACTOR:Company Name: Ocean Palm Enterprise Phone#: 305-970-5505
Address: 15222 SW 25 Street
City: Davie State: FL Zip: 33326
Qualifier Name: Ramon Secades Phone#: 305-970-5505
State Certification or Registration#: CGC1514678 Certificate of Competency#:
DESIGNER:Architect/Engineer: NSA Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 4 1501 Square/Linear Footage of work:
Type of Work: ❑ Addition ❑ Alteration ❑ New Q Repair/Replace ❑ Demolition
Description of Work: Install cage on existing ladder at Library 4th Floor
Specify color of color thru tile:
Submittal Fee$ 0� Permit Fee$ k CM +Or,) CCF$ Co/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ zo i
(Rev1sed02/24/2014)
9
Bonding Company's Name(if applicable) N/A
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 cerafi of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days uilding permit is issued. in the absence of such posted notice, the
inspection will not be approved and a reinspection fee will d.
i
Signature 77 ic56= e®.
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instru nt was acknowledged before me this
day of � (�_ ,20 �� .by �/ �L�L day of ( G .20 by
who is personally known to o is ersonall kno to
N Y
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:
'r�pep,—&
Sign Sign•
Print: +� Print:
JEFFRY J.YAO Seal: BEAN MALVAFAZ
MY COMMSSION 9 EE36829 WCOMM I IEEE 191819
EXPIRES:November V,2014 EXPIRES:Apr"23,2018
14 ON34MTARY n Nowy Mown A==Co. 9aadedua PLEBaWOMItm
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APPROVED BY Plans Examiner Zoning
"V)dlo
Structural Review Clerk
IRevisedo2/24/20141