REV-16-1476BUILDING
PERMIT APPLICATION
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20 r
Master Permit No. 'RC I' c4` 56q
Sub Permit No. 12,E1/ [, — ltn-
❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: /205 A) c' 95 yr
City: Miami Shores County: Miami Dade Zip: ''3 38
Folio/Parcel#: / / — 3 2O to — 0 /`1 — i'C2 D Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):
Address: 124'Z /Lie 05 'r
City: "1/ 9-0i 5/to/les
/7,066,a./— t;,4
Phone#: (3aS) �-La- —3yyg
State: Zip: 33 /38
Tenant/Lessee Name: Phone#:
Email: 64-06E, rD 06G -cri * [ p r
CONTRACTOR: Company Name: �,--'57710C at-Dt-,-, _ Phone#: (3051 863- /102
Address: 28cl wZ 7.4-)/ it -,0
City: "7i // SP`L.11.i4 S State: E7--- Zip: 33 / 06'
Qualifier Name: 71'd 6,1-/0�G93 �..�eliF Phone#: (&D5) 663- i9oZ
State Certification or Registration #: CGC. — /5/27 -DO Certificate of Competency #:
DESIGNER: Architect/Engineer: OP/rA-'/‘1l7S7GA' Phone#: (3t)--)�'—gc10`/
�`/ o<
Address: a /5 Ale 3 9- Sr -City: r7'1471i State: --/--Zip: 3/ 33"
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration New ❑Repair/Replace ❑Demolition
Description of Work:
phi A/O4 DG T ✓ s rr 0004- A-7,./0 S'/ 7'L C (064-4-(j gorx
Specify color of color thru tile:
,
--
Submittal Fee $ Permit Fee $ .1 1 S ' CCF $ . CO/CC $
Scanning Fee $ 9 . lJU Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE$ 9 '
(Revised02/24/2014)
co
I
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City I 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 l approved and • reinspection f will be charged.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
2C' day of h4/ , 200 '4 , by
, who isers6jj to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
brio SS/J�mru �+
APPROVED BY
(Revised02/24/2014)
CONTRACTOR
The foregoing instrument was acknowledged before me this
a 6 day of t) 4'1
TGo�,r.clb "Zn.) r9 , who is
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
, 20 / 4' , by
to
as
Sign:
Print:
Seal:
c -47-,,q111,71
CARLOS SANABRIA
Commission # FF 37673
My Commission Expires
*, 41eY*J4*2p4147s***** *ssss**ssss*******s
Plans Examiner
Structural Review
CARLOS SANABRIA
Commission # FF 37673
My Commission Expires
*** ***********
Zoning
Clerk
FVJ JA FLORDAWORKERS'COMPENSATION
JOINT UNDERWRRINC ASSOCIATION, INC.
2420'LA1(EMONT AVENUE
P.O.BOX 3556
ORLANDO, FL 32802-3556
ABA ELECTRIC CORP
1220 SW 99 AVENUE
MIAMI FL 33174
00049 -R1
Insuring Company: FLORIDA W. C. JUA
M_SC"y /,.-_23l'-
Date
of this Notice 05/27/1 6
Account No . 6415W1188
DIRECT INQUIRIES TO:
FWCJUA
P.O. BOX 3556
ORLANDO
(800) 247-7218
FL 32802-3556
REINSTATEMENT NOTICE
We are pleased to tell you that your policy has been reinstated.
POLICYHOLDER
ABA ELECTRIC CORP
POLICY IDENTIFICATION NUMBER
7D758186 UB
TYPE OF INSURANCE
Workers Comp
POLICY PERIOD
09/03/15 To 09/03/16
We are pleased -to -inform you that the policy designated above, previously
issued to you, remains in full force as of the original date of issue.
The notice of cancellation originally sent to you is hereby withdrawn.
Receipt of funds dishonored upon presentment is not a valid means of
reinstatement.
Reinstatement will only occur when all conditions have been met. If these
conditions have not been met the reinstatement will be null and void.
648826R 2016148 8644 821 076L7F
CLDRREIN
PL -9837
PERMIT#: " /14j
IVilami Shores VilJage
Building Department
RECEIPT
11 /*'lli G i1 ///v04'
(Name)
tl Contractor
o Owner
o Architect
Picked up 2 sets of plans and (other)
Address: /2 B S N�
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
DATE: -/C/ y Col
,0(.20 .^-
',F.- sr
From
r ot.-
From the building department
And/or get County stamps. I
Shores Village Building Depa
Signature:
PERMIT CLERK INITI
nders
s date in order to have corrections done to plans
a d that the plans need to be brought back to Miami
ment
inue permitting process.
NATURE)
RESUBMITTED DATE:
(� I
PERMIT CLERK INITIAL: /L X
sA M
iami Shores Vivage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
BUILDING CRITIQUE
DATE: 06-26-2016
PERMIT NUMBER: 16-1476
Product approval provided is incomplete. Please provide product approval for the BORANO door.
Ismael Naranjo, B.O, CFM
Building Director
.M
iami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
DATE: 06-06-2016
PERMIT NUMBER: 16-1476
BUILDING CRITIQUE
Product approval provided is incomplete. Please provide product approval for the BORANO door.
Ismael Naranjo, B.O, CFM
Building Director