Loading...
SGN-12-1408Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 176439 Permit Number: SGN -7 -12 -1408 Scheduled Inspection Date: November 15, 2012 Inspector: Rodriguez, Jorge Owner: PROPERTIES LLC, SHORE SQUARE Job Address: 9031 -9069 BISCAYNE Boulevard 9037 Miami Shores, FL 33138 -0000 Project: <NONE> Contractor: ABLE ELECTRIC OF SO FLORIDA INC Permit Type: Sign Inspection Type: Final Work Classification: New Phone Number (305)779 -8040 Parcel Number 1132060110051 Phone: (305)778 -8340 Building Department Comments SING FOR NEW URGENT CARE, MEDICAL CENTER OFFICE (DOCTOR TAMAYO) Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. November 14, 2012 For Inspections please call: (305)762 -4949 Page 4 of 30 PERMIT # I- - I4a6 CONTRACTOR: A a €CX c, SUBMITTAL DATE: ,(1 2C0 got 2 p� ADDRESS: (710-N )SG ' , C0-5-1) I NAME: RESUBMITAL DATES: STRUCTURAL E ECTRICAL / IMPACT FEES HRSIDERM PLUMBING MECHANICAL NOC 6\4 taWo1/491 B DING PERMIT APPLICATION Miami Shores Village Building Department 90050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 FBC 20 ta— ��Og Permit No. Master Permit No. Permit Type: BUILDING ROOFING JOB ADDRESS: 0/ 03 q Z Z &7 S C/ Et% 3 Li i/L City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: !/`32067 -- 0 (/ — 0 (25 Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder)6 ie 3Diunfe -Prootirlie3 , �,.�. °(� Phone#:, 305- Kis " 1 Address: Ckftni 1p NE t25 54- City: Nt • N 1 a M t State: • Zip: 3.3 I tp' Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: n -e t/ (C °V/ `S ,F • Phone#: 1 60 48 (0 0 ! b 0 Address: 20/o -Ca) r3 City: / • -ry ( State: lam. zip: 33 I 4'4-- Qualifier Name: ti)/-S A yA Lam} Phone #: State Certification or Registration #: 0 Z ZQ 0 -6 Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ //`rBQ0 Square/Linear Footage of Work: Type of Work: ❑Addition ` C�/dteration tBiQew URepair/Replace C)Demolition Description of Work: \. -A-C6 V4-2- (r� t \ �d �► N 0 Color thru tile: * *a *a********** **** a *** *** * ** **s+*******F,es**** **** ��x�x� +m�+sx� *a��x****�a**** ****** ** r ***** Submittal Fee $ Permit Fee $ /00° /° CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ t ,Bbridink Company's Name (if applicable) Bonding Company's Address City State Tap 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 whose property is subject to attachment. Also, a certified copy of the recorded notice of for the first inspection which occurs . even (7) days after the building permit is issue inspection will not be approv r a reinspection fee will be charged. / Signature f 1/ or Agent 1l Contractor The foregoing instrument as acknowledged before me this 2-"{m The foregoing instrument was ackno ledged before me this 2 .) day of 6__, 20 12-, by \\t (C ' .-Z th-- , day of L , 20\? , by v: s f L who is personally known to me or who has produced who is personally known to me or who has p brochure will be delivered to the person ncement must be posted at the job site he absence of such posted notice, the As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: ********* ************* APPROVED BY ./FAZia • Notary Public State of r'to' oa Jacqueline Ortiz My Commission Ft: 10637 Expires 04115:2o � a NO Sign: Print: w tiVce tPu ;„t. atY pa tanaMan • My commis on''' nC off° exp+teso3J My Commissio ******* ***********b** ifs** * das&* ***** ***N *********** I i jil Plans Examiner Structural Review (Revised 3 /12/2012)(Revised 07 /10!07)(Revisei 06/IO/2009)(Revised 3115/09) 7()1 [ I Zoning Clerk SHORE SQUARE PROPERTIES, LLC 696 N.E. 125th Street Miami, Florida 33161 July 24, 2012 Re: Edmundo R. Tamayo, MD PA 9037 & 9027 Biscayne Blvd. Miami Shores, FL 33138 To Whom It May Concern: Please be advised that Shore Square Properties, LLC as owner of the above referenced property, hereby authorized USA Signs, Inc. to apply for permits, and acknowledges that new signage will be installed at the above referenced location under the following conditions; (a) Contractor acquires the required permits and performs the work to code and in a professional manner; (b) Contractor acknowledges that Landlord has no financial obligations to USA Signs, Inc (contractor) or its subsidiaries or to Edmundo R. Tamayo, MD PA (Tenant) shall be solely responsible for all expenses pursuant to this job. This authorization is subject to approval by the appropriate governmental municipalities. STATE OF FLORIDA ) COUNTY OF MIAMI -DADE ) I HEREBY CERTIFY that ` L)v r \ - z1\Gk- who has /have produced who did take an oath., this day acknowledged before foregoing document this °Ir day of , 2012. My Commission Expires: , to me personally known or as identification and me that they executed the Notary Public State of Florida Jacqueline Ortiz j My Commission EE 189637 or Or Expires 04/16 /2018 Miami -Dade My Home My Home ade.g Show Me: Property Information Search By: Select Item IJ Text only Property Appraiser Tax Estimator Property Appraiser Tax Comparison Summary Details: Folio No.: 11- 3206 -011 -0051 Property: 9031 BISCAYNE BLVD Mailing Address: SHORE SQUARE PROPERTIES LLC 696 NE 125 ST MIAMI FL 33161- Property Information: Primary Zone: 6200 ARTERIAL BUSINESS CLUC: 0011 RETAIL OUTLET Beds /Baths: 0/0 Floors: 1 Living Units: 0 Adj Sq Footage: 47,749 Lot Size: ,2.90 ACRES Year Built: 1962 Legal Description: 6 53 42 ASBURY PARK PB 4 -110 BEG 30FTW OF SE COR LOT 5 RUN W272.08FT N177FT W260.97FT TO E RMI /L BISC BLVD NELY139.58FT E290.02FT N124.93FT E152.16FT ALG Assessment Information: Year: 2011 2010 Land Value: $1,394,008,$1,394,008 $1,964,101 $1,991,477 Building Value: Market Value: $3,358,109 $3,385,485 Assessed Value: $3,358,109 $3,274,989 Taxable Value Information: Year: 2011 2010 Taxing Authority: Applied ETax ben/ Value: Applied ETaxab en/ Value: Regional: $Ol $3,358,109 $Ol $3,274,989 County: $0/ $3,358,109 $0/ $3,274,989 Page 1 of 2 ACTIVE TOOL: SELECT Aerial Photography - 2009 My Home 1 Property Information 1 Property Taxes 1 My Neighborhood 1 Property Appraiser 0 159 ft Home 1 Using Our Site 1 Phone Directory 1 Privacy 1 Disclaimer If you experience technical difficulties with the Property Information application, or wish to send us your comments, questions or suggestions please email us at r M *r at;# Web Site CO 2002 Miami -Dade County. All rights reserved. http: / /gisims2.miamidade.gov /myhome /propmap.assp 7/23/2012 www.sunbiz.org - Department of State . O'RI D i' `DIVIS1 ?,► Off; w,yye� „_ Tsx Previous on List Page 1 of 2 Next on List Return To List No Events No Name History Entity Nam Sut Detail by Entity Name Florida Limited Liability Company SHORE SQUARE PROPERTIES, LLC Filing information Document Number L11000075982 FEIIEIN Number 452672348 Date Flied 06 /30/2011 State FL Status ACTIVE Effective Date 06/28/2011 Principal Address 696 NE 125TH STREET NORTH MIAMI FL 33161 US Mailing Address 696 NE 125TH STREET NORTH MIAMI FL 33161 US Registered Agent Name & Address ROBERT A. BRANDT, PA 696 NE 125TH STREET NORTH MIAMI FL 33161 US Manager /Member Detail Name & Address Title MGR IZHAK, YORAM 696 NE 125TH STREET NORTH MIAMI FL 33161 US Title MGR UPTON, ALAN 649 OCEAN BLVD GOLDEN BEACH FL 33160 Annual Reports http: / /www.sunbiz.org/ scripts /cordet.exe? action= DETFIL &ingdocnumber= L110000759... 7/23/2012 Permit No: 12 -1408 Job Name: August 6, 2012 Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Building Critique Sheet 1) The plans must be signed and sealed by a licensed architect or engineer. 2) Provide the wind load design criterion. Page 1 of 1 Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Norman Bruhn CBO 305 -762 -4859 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Date: Date: �/ -7 //2- Permit #: (Z" Ny 0 r Planning & Zoning Critique Sheet fr (52_) 7 //2- Review Completed by: David A. Dacquisto CUSTOMER INFORMATION URGENT CARE TAMAYO MEDICAL CENTER 9037 Biscayne Blvd. Miami Shores, FL APPROVAL: ESTIMATE /CONTRACT #02 02 7793 LAYOUT #02 7793 - JULY TYPE OF SIGN: FACE LIT CHANNEL © WALL DATE: 7.11.2012 CONTRACTOR DESIGNED BY: SB DESIGN, FABRICATION & INSTALLATION ACCORDING TO ALL LOCAL, STATE & NATIONAL CODE REQUIREMENTS NEC 2008 CODE; FBC 2010 MEMBER il IS UNITED STATES SIGN COUNCIL MEMBER NTERHATIONAL THE DRAWINGS, CONCEPT, SPECS AND /OR RENDERINGS DEPICTED HEREIN ARE THE EXCLUSIVE PROPERTY OF USA SIGNS, INC., AND MAY NOT BE SHOWN TO ANY PERSON /CORPORATION OUTSIDE THE CUSTOMER'S COMPANY NOR ARE THEY TO BE REPRODUCED IN ANY WAY, SHAPE OR FORM WITHOUT EXPRESSED WRITTEN CONSENT OF USA SIGNS, INC. DESIGNED & PRODUCED BY: USA SIGNS Inc, The right image for your business... 1601 NW 97th Street, Bay C Miami, FL 33175 Ph. 305,470.2333 - 305.436.9544 Fax. 305.470.2320 - 305.436.9543 EAST ELEVATION # 9037 MOUNTING DETAIL .040 ALUM. BACK 8 RETURNS I "JEWELITE TRIM CONCRETE WALL L.E.D. ILLUMINATED CHANNEL LETTER -* 118 "ACRYLIC FACES U.L. L..E.D. LIGHT SEALTIDE FLEXIBLE CONDUIT 'A" X 2M' TAPCON SCREWS MIN. 4 PER LETTER EXCEPT 18 I (3 REQ'D). APPROVAL # 02 -0503.07.00 - 1201.01 EXTERIOR DISCONNECT SWITCH SCONNECT SWITCH U.L. L..E.D. POWER SUPPLY 114" X2 'W TAP CON SCREWS (NON-CORROSIVE) DRAIN HOLES W PVC LETTERS 3/16' X 3" METAL STUDS 110 VOLT PRIMARY POWER (BY OTHERS) ELECTRICAL INFORMATION ALL ELECTRICAL COMPONENTS ARE U.L. LISTED. (02) U.L.POWER SUPPLY ,12VI60HZ - EA SIGN 110 VOLTS WI#12 THWN WIRE (BY OTHERS) GFCI PROTECTION REQUIRED FOR SECONDARY AS PER NEC 600.23 (B) SIGN GROUNDED ACCORDING TO NEC 250 = BONDED DEDICATED 20 AMPS, CIRCUIT #6 ELECTRICAL PANEL EXTERNAL DISCONNECT SWITCH TIME CLOCK (20 AMP) NEAR ELECTRICAL PANEL OR SWWEL MOUNT LIGHT CONTROL. L.E.D. ILLUMINATED FACE -LITE CHANNEL LETTERS ON RACEWAY Qa WALL WALL SIGN AREA "LOGO ": 3' -0" H X 3' -0" W = 9 s.f. "URGENT CARE ": 1' -8" H X 17' -6" W = 29 s.f. "TAMAYO MEDICAL CENTER ": 1' -0" H X 17' -6" W = 17.5 s.f. 6` Gehl AR A APPROVED -� a2- -1.LiOY 1 55'I totes Vi!I C BY ZONING DEPT l% 91...P( DEPT DATE S CT I 0 CC: MPI JANCE Wl f'ri ALL FEDERAL i H(_,LFS AND FG IIATONS 4'-6 EC VE AUG 0 9 1 IN COMPLIANCE WITH 2010 FBC /ASCE -7 -10 WIND SPEED: / i 5M.P.H. EXPOSURE: "C" CATEGORIA: ' EMILIANOA. OROZCO P.E. #66341 817 S.W. 122 AVE., MIAMI FL, 33184 CUSTOMER INFORMATION URGENT CARE TAMAYO MEDICAL CENTER 9037 Biscayne Blvd. Miami Shores, FL APPROVAL: ESTIMATE /CONTRACT #02 02 7793 LAYOUT #02 7793 - JULY TYPE OF SIGN: FACE LIT CHANNEL © WALL DATE: 7.11.2012 CONTRACTOR DESIGNED BY: SB DESIGN, FABRICATION & INSTALLATION ACCORDING TO ALL LOCAL, STATE & NATIONAL CODE REQUIREMENTS NEC 2008 CODE; FBC 2010 MEMBER a as 41. _ UNITED STATES SIGN COUNCIL MEMBER ENTERWATI0P AL S GH MSSOC(AT(ON THE DRAWINGS, CANCEPT, SPECS AND /OR RENDERINGS DEPICTED HEREIN ARE THE EXCLUSIVE PROPERTY OF USA SIGNS, INC., AND MAY NOT BE SHOWN TO ANY PERSON /CORPORATION OUTSIDE THE CUSTOMER'S COMPANY NOR ARE THEY TO BE REPRODUCED IN ANY WAY, SHAPE OR FORM WITHOUT EXPRESSED WRITTEN CONSENT OF USA SIGNS, INC. DESIGNED & PRODUCED BY ,,. %USA SIGNS Inc. The right image for your business... 1601 NW 97th Street, Bay C Miami, FL 33175 Ph. 305.470.2333 - 305.436.9544 Fax. 305.470.2320 - 305.436.9543 EAST ELEVATION # 9037 4'- 6., MOUNTING DETAIL 5" .040 ALUM. BACK & RETURNS 1" JEWELITE TRIM __ CONCRETE WALL L.E.D. ILLUMINATED CHANNEL LETTER-0' 1/8 "ACRYLIC FACES U.L. L..E.D. LIGHT W XTA TAPCON SCREWS MIN. 4 PER LETTER EXCEPT L & I (3 REQ'D). APPROVAL # 02- 0503.07.00- 1201.01 EXTERIOR DISCONNECT SWITCH DRAIN HOLES ''A" PVC LETTERS 3116" X 3' METAL STUDS 4 /4' X 2 W TAP CON SCREWS (NON- CORROSIVE) 110 VOLT PRIMARY POWER (BY OTHERS) ELECTRICAL INFORMATION ALL ELECTRICAL COMPONENTS ARE U.L. LISTED. (02) U.L.POWER SUPPLY ,12V160HZ - EA SIGN 110 VOLTS WI#12 THWN WIRE (BY OTHERS) GFCI PROTECTION REQUIRED FOR SECONDARY AS PER NEC 600.23 (B) SIGN GROUNDED ACCORDING TO NEC 250 = BONDED DEDICATED 20 AMPS, CIRCUIT#6 ELECTRICAL PANEL EXTERNAL DISCONNECT SWITCH TIME CLOCK (20 AMP) NEAR ELECTRICAL PANEL OR SWWEL MOUNT LIGHT CONTROL. L.E.D. ILLUMINATED FACE -LITE CHANNEL LETTERS ON RACEWAY @ WALL WALL SIGN AREA "LOGO ": 3' -0" H X 3' -0" W = 9 s.f. "URGENT CARE ": 1' -8" H X 17' -6" W = 29 s.f. "TAMAYO MEDICAL CENTER ": 1' -0" H X 17' -6" W = 17.5 s.f. TOTAL SIGN AREA: 5 SUBJECT TO COMPLIANCE WITH ALL FEDERAL STATE AND COt1NTY RULES AND REGULATIONS X 7e/1)' CUSTOMER INFORMATION URGENT CARE TAMAYO MEDICAL CENTER 9037 Biscayne Blvd. Miami Shores, FL APPROVAL: ESTIMATE /CONTRACT #02 02 7793 LAYOUT #02 7793 - JULY TYPE OF SIGN: FACE LIT CHANNEL @ WALL DATE: 7.11.2012 CONTRACTOR DESIGNED BY: SB DESIGN, FABRICATION & INSTALLATION ACCORDING TO ALL LOCAL, STATE & NATIONAL CODE REQUIREMENTS NEC 2008 CODE; FBC 2010 MEMBER as m UNITED STATES SIGN COUNCIL MEMBER INTERNATIONAL 7P l( bS EST iA1 0N. THE DRAWINGS, CONCEPT, SPECS AND /OR RENDERINGS DEPICTED HEREIN ARE THE EXCLUSIVE PROPERTY OF USA SIGNS, INC., AND MAY NOT BE SHOWN TO ANY PERSON /CORPORATION OUTSIDE THE CUSTOMER'S COMPANY NOR ARE THEY TO BE REPRODUCED IN ANY WAY, SHAPE OR FORM WITHOUT EXPRESSED WRITTEN CONSENT OF USA SIGNS, INC. DESIGNED & PRODUCED BY: ,- ..,US.A SIGNS Inc. The right image for your business... 1601 NW 97th Street, Bay C Miami, FL 33175 Ph. 305.470.2333 - 305.436.9544 Fax. 305.470.2320 - 305.436.9543 EAST ELEVATION # 9037 4' -6 MOUNTING DETAIL .040 ALUM. BACK & RETURNS 1 "JEWELITE TRIM L.E.D. ILLUMINATED CHANNEL LETTER -'6' 1/8 "ACRYLIC FACES U.L. L..E.D. LIGHT Y." X 2%' TAPCON SCREWS MIN. 4 PER LETTER EXCEPT L & I (3 REQ'D). APPROVAL # 02 -0503.07.00 - 1201.01 EXTERIOR DISCONNECT SWITCH DRAIN HOLES W PVC LETTERS 5" CONCRETE WALL DISCONNECT. SWITCH U.L. L.E.D. POWER S 3/16" X 3° METAL STUDS 110 VOLT PRIMARY PO4MER. (BY OTHERS) ELECTRICAL INFORMATION ALL ELECTRICAL COMPONENTS ARE U.L. LISTED. (02) U.L.POWER SUPPLY , 12V/60HZ - EA SIGN 110 VOLTS W/#12 THWN WIRE (BY OTHERS) GFCI PROTECTION REQUIRED FOR SECONDARY AS PER NEC 600.23 (B) SIGN GROUNDED ACCORDING TO NEC 250 = BONDED DEDICATED 20AMPS, CIRCUIT #6 ELECTRICAL PANEL EXTERNAL DISCONNECT SWITCH TIME CLOCK (20 AMP) NEAR ELECTRICAL PANEL OR SWIVEL MOUNT LIGHT CONTROL. L.E.D. ILLUMINATED FACE -LITE CHANNEL LETTERS ON RACEWAY @ WALL WALL SIGN AREA O "LOGO ": 3' -0" H X 3' -0" W = 9 s.f. "URGENT CARE ": 1' -8" H X 17' -6" W = 29 s.f. "TAMAYO MEDICAL CENTER ": 1' -0" H X 17' -6" W = 17.5 s.f. TOTAL SIGN AREA 55.5 s. 4' -6_ ,,_ JUL 2. n 2.0 12 Miami Shores ilia SUBJECT TO COMPLIANCE WITH AU. FEDERAL. STATE AND COI UN__TT�Y RULES AND REGULATIONS Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: I NS P- 176440 Permit Number: ELC -7 -12 -1409 Scheduled Inspection Date: November 14, 2012 Inspector: Devaney, Michael Owner: PROPERTIES LLC, SHORE SQUARE Job Address: 9031 -9069 BISCAYNE Boulevard 9037 Miami Shores, FL 33138 -0000 Project: <NONE> Contractor: ABLE ELECTRIC OF SO FLORIDA INC Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Sign Phone Number (305)779 -8040 Parcel Number 1132060110051 Phone: (305)778 -8340 Building Department Comments ELECTRICAL WORK FOR NEW SIGN (DOCTOR TAMAYO MEDICAL CENTER) Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments c/L /3 ,je/, ',/ November 13, 2012 For Inspections please call: (305)762 -4949 Page 7 of 42 k Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: Electrical J O B A D D R E S S : 9 3 4 0 2-4 jsc vtit City: Miami Shores County: Folio/Parcel #: 1/- 3W( -- 0 (1- V-051 Is the Building Historically Designated: Yes r Aa JLPL (cL b L, e�9 FBC 20--1 Permit No. 1C) I o` �} H4M Master Permit No OKI. 19. 14 O Miami Dade Zip: NO Flood Zone: OWNER: Name (Fee Simple Titleho``ld'er) 5hNf .,5q uar`CaPrwl- i' Ip-I.-C Phone#: 305 —89,s—'"/"M5 Address: L R-P NE (� c51- City: 1N4 1 Q NZ a State: Zip: ..5_1110 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: Ue Co12/C r- . Phone#:18(( `Fg1J ' °t V3 Address: 20 (N7 &-j f 3 Cr- - City: (144 ( State: Zip: 3 3 Qualifier Name: 1_0( S A- State Certification or Registration #: 02 1 0d /'/3 6 Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone#: Phone#: Value of Work for this Permit: $ 1 COO Square/Linear Footage of Work: Type of Work: DAddress C1/Iteration C9New ❑Repair/Replace Description of Work: C `S-■ 6' A A r:+ /7 - a (& 6 _ate L eS C]Demolition —t-e' /Lt **************************************,F *+x***** *.e********** a**a•**********a•***** ***wax Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Notary $ TraininglEducation Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ 1 CI "1,0 4 y 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 co ncement must be posted at the job site for the first inspection which occurs ' en (7) days after the building permit is issue the absence of such posted notice, the inspection will not be appro , / ' °'a reinspection fee will be charged. Signature r or Agent The foregoing instrument was acknowledged before me this day oChM , 20 12, by NI UCI \ who rsonal isely known to�xe or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: .re,; rte. nr-ti � My Commission Expire *********O********* APPROVED BY **t Notary Public State of Hof too . Jacqueline O'iiz MyCommmssson EE Ia9637 t **11011d1+dti+t741#4** * ** * ** Signature Contractor The foregoing instrument was acknowledged before me this 2_ day of , 20 by L. c." Z S L , who is personally known to me or who has produced as identification and ' • - Y a NOTA Sign: o► Print: -. ounucotate of Fl{ dda ComtnisskOrh My Commission Expires: ********* t**** ***** *** * ** * ***** * * * *** ******** *'Kits ***** *** ����1' Plans Examiner Structural Review (Revised 3 /12/2012XRevised 07 /10/07XRevised 06/10/2009)(Revised 3 /15 /09) Zoning Clerk