REV-17-1430Miami 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
BUILDING
PERMIT APPLICATION
(BUILDING ELECTRIC
❑PLUMBING ❑ MECHANICAL
JOB ADDRESS: 9701 BISCAYNE BLVD
RECEIVED
MAY 3 0 2017
4--(
A,
FBC 20 U
Master Permit No. RC -15-1024
ROOFING 1.1 REVISION
PUBLIC WORKS
Sub Permit No. (2.--&V n- tutS(C)
❑ EXTENSION RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores
County: Miami Dade
Folio/Parcel#: 11-3206-014-3320
Occupancy Type: R-3 Load:
Zip: 33138
Is the Building Historically Designated: Yes NO X
Construction Type: V Flood Zone: X BFE: FFE:
OWNER: Name (Fee Simple Titleholder): JOSE G. CASTRO & MARIA G. ALE
Address: 9701 BISCAYNE BLVD
Phone#: 305-582-2836
City: MIAMI SHORES State: FL
Tenant/Lessee Name: N/A
Email: info@r-method.net
Phone#:
Zip: 33138
CONTRACTOR: Company Name:
Address: % O
C S Powe/ ZtiC-
6/vi Sv,i ! /Ov
City: 80c-4 n.1 -#m State: FL
Qualifier Name: 1#)/41/1/ jiV'o 1 t
4 Phone#:
36) ?o)- 073s
State Certification or Registration #: r C / 3 OC' 17 6 5 Certificate of Competency #:
DESIGNER: Architect/Engineer: JOSE RUBEN JIMENEZ, ARCHITECT
Zip:
Phone#:
33V2'
Address:300 OAKWOOD LANE SUITE 100
Value of Work for this Permit: $ 2000.00
Type of Work: n Addition n Alteration
Phone#: 305-582-286
City: HOLLYWOOD- State: FL Zip: 33020
Square/Linear Footage of Work: 655 sf
❑ New ❑ Repair/Replace n Demolition
Description of Work: Revisions for coordination with new Kitchen layout, replacement of electrical panels, new
lighting layout in the first floor addition and new AC unit being added in the First Floor.
Specify color of color thru tile:
Submittal Fee $ 5
Scanning Fee $ • Q
Technology Fee $
Structural Reviews $
(Revised02/24/2014)
:e r,a,.
Permit Fee $ /5 ' , CC $ •'! + �(�� �,� TM,h^ ,+
CO/CC $
Radon Fee $ • 6 0 DBP $• 2-S Notary $
Training/Education Fee $ G o Double Fee $
Bond $ •
TOTAL FEE NOW DUE $ I 60 • R O
cot ;`.`.-,
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
• � d
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 �f 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
OWNER or AGENT
The foregoing instrument was acknowledged before me this
Pt.( day of N.
, 20 177 , by
-� • CCm .,-ce , who is personally known to
me or who has produced 1 Z JJ LACe*-'SCs as
identification and who did take an oath.
NOTARY PUBLIC:
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of • j 20 �— , by
7\ ho is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign.
rint:
eal:
*********
APPROVED BY
(Revised02/24/2014)
as
,6.---,-4/6-'12'Plans Examiner
DAMARIS SERNA
__ Notary Public - State of Florida
vc Commission # FF 997772
My Comm. Expires Jun 1, 2020
Structural Review
Zoning
Clerk