REV-16-632 (2)BUILDING
PERMIT APPLICATION
•BUILDING ❑ ELECTRIC
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 N
Master Permit No. --•2-:;!-7 3 c(
Sub Permit No.y ro —6_DB 0
❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
[]PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ~ "CHANGE OF ❑ CANCELLATION ❑ SHOP
' NCONTRACTOR DRAWINGS
JOB ADDRESS: 54p:>���
City: Miami Shores County Miami Dade
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee SimpleTi �tleeho1lldder): �L0 X�•,l AZIEV� � VhoI67
ne#: -q bg 1
Address: � U 61 -AJ AV CLN(%yV2-GE
City: M I AM I �t0 V-V5 State: 1 l/ Zip: _ %✓�7 7/
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: `Company Name: W� � 6 LL
Address: i q q q2 cj g) q' t ('� S-) ,
LLQ- Phone#: 7 g (o ZZ 16 4 "k �'
City: l b.V1 ( State
Qualifier Name: V.0V ELI L-0 in A Mh Phone#: `7g f-
State Certification or Registration #: (Zc�C 1 I �`�� Certificate of Competency #:
DESIGNER: Architect/Engineer: ` �► t- . LLca. fOA -4 e4 Phone#: OP 71 l
Address:2 o0y,) J�� S13 ( 2_Z4 City: Ale f�)e: . ZiP! C)
Value of Work for this Permit: $ 9)O , O o Square/Linear Footage of Work:
Type of Work: ❑ Addition
Description of Work: r--Ags►
23 Alteration ❑ New
10
❑ Repair/Replace ❑ Demolition
Specify color of color thru tile: ��,c� ^^�� 0V ,1
Submittal Fee $ Permit Fee $ (CO - CCF $ f. 'ey CO/CC
Scanning Fee $ " Q Radon Fee $� ` DBPR $ o —Notary!
Technology Fee $ 3L' Training/Education Fee $ Q -Go Double Fee $
Structural Reviews $ ��0 "Q Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
•- , 4
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
Zip
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 issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged
Signaturei Al-tI4& -746e
WNER or AGENTC—)
The foregoing instrument was acknowledged before me this
day of , J tTs,Y�� yyY�1,1(/r ' . 20 , by
� Ilia ? S , who is personally known to
me or who has produced * 20,013 3 D as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: ` /.
Print: t 1�1,��'u
(a K-)
Signature g Qwz /
CONTRACTOR
The foregoing instrument was acknowledged before me this
_ day of /)G/O!^ , 20 1 L, by
Jw RG^oo , who is personally known to
me or who has produced 1_;&a1s r' as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: ' W
Marco A. Caro
Print - (> State of Florldn
j f My Co
Seal: mmission Expires 08/18/2018
2o° `
Seal: �''� �������` Commission No. FF152135 y p�a��: IVONNE LANDERO
Notary Public -State of Florida Bonded through CNA Surety
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+ = My Comm. Expires Jun 26, 2016
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APPROVED BY Plans Examiner Zoning
Structural Review Clerk
Revised02/24/2014)
March 16, 2016
City of Miami Shores Village
Building Department
10050 N.E. 2"d Avenue
Miami Shores Village, FL 33138
Re: Revised Construction Documents
To Whom It May Concern:
Please accept this letter detailing the modifications to the Construction Documents as noted below.
Where applicable signed and sealed revised documents with all changes clouded will be submitted
accordingly. The revisions are as follows:
Architectural
A-1: Kitchen cabinetry detail revised; Room Finish Schedule modified to indicate stone flooring in lieu
of wood; note to refer to structural drawings for beam in Kitchen removed as letter previously
provided to address this issue.
Mechanical
M-1.1: Duct layout from Kitchen into Dining Room modified as noted.
Structural
S-1: Drawings provided to show plan layouts and details for new stairwell construction between
First and Second floors.
S-2: Drawings provided to show plan layouts and details for new stairwell construction between
First and Second floors.
Please feel free to contact me should you need any additional information.
1
2300 West Sample Road . Suite 214 Pompano Beach, FL 33073
Tel.954.971.1010 . www.slcarchitects.com
REGISTRATIONAR006819 I CORPORATIONAA26001642