EL-05-176 (5)RECEIVED
MAY 2 6 MI5
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138.
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING Permit No. 1033 6'f-7(c,
PERMIT APPLICATION Master Permit No.
FBC 2001
Permit Type (circle): Building (Electrical / Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) / // iJ& i2/ a2 y Phone # (go---) 7a- %, 9UC)
Owner's Address 4"- —I 'U' E, /UO2x"1
City J'iik' / i "Sh0E6'5 State `-Z. Zip 3,5/-5P
Tenant/Lessee Name
Phone #
Job Address (where the work is being done) 'V, 5. )t h1
City Miami Shores Village County Miami -Dade Zip 3
Is Building Historically Designated YES NO 4-
Contractor's Company Name A/LA,UT/s ak- RiCCJ/e
Contractor' Address ABU 3 5� /) ci�' -e - 1
City G G�(,�; State AZ Zip '
Qualifier
hone #
Architect/Engineer's Name (if applicable) ga,e k, A. t'»9 6// Phone #
6)amv,1.111111.
$ Value of Work For this Permit
Square Footage Of Work: ?g0
Type of Work: Addition ['Alteration /❑New / ❑ Repair/Replace ID Demolition
Describe Work: / A�% T/O/# Gf J/1 SS/2 t�e'c/, ,Y e /d 5!7 C/34-1/,v5 L(Je'//cps
,veto Office, f Le, 4 rc). Re.. / JO Pkj_
****************************Fees******************************
Submittal Fee $ Permit Fee $ .2,? 7 CCF $ CO/CC
Notary $ Training/Education Fee $ Technology Fee $
Scanning $ Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $
(Continued on opposite side)
Bonding Company's Name (if applicable) ;1) mot .
Bonding Company's Address NI .
City State Zip
Mortgage Lender's Name (if applicable) /°'/A
Mortgage Lender's Address /01A .
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 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
Signature
Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of , 20 _, by , day of
who is personally known to me or who has produced who is per
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
NOTARY PURL
identif
, 20 by
to me or who has produced
ation and who did take an oath.
'gip'' . Nancy Iglesias
Sign: �I ' �'LCommission # DD117024
Print: 2006
: r'''`;lc. Banires deedd 11uu
•;„ f 1-: Atlantic BoodingCQ,,7nc.
My Commission Expires:
************************************************************************************************************
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
*********************************************. '*********************************************************
APPLICATION APPROVED B
•Chc 12/15/03
os Plans Examiner
Engineer
Zoning
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305-795-2204
Printed: 8/18/2005
Electrical Permit
Permit Number: EL2005-176
Applicant: CORY GITTNER
Owner: GITTNER CORY
JOB ADDRESS: 551 NE 102 ST
Contractor ATLANTIS ELECTRICAL CORP Contractor's Address: 12803 SW 20 TERR
Local Phone: (305) 551-4043
Parcel # 1132060170980
Legal Description: MIAMI SHORES SEC 4 AMD PLAT
Page 1 of 1
PB 15-14 LOT 19 & W1/2 LOT 20
Fees: Description Amount
FEE2005-11373 Building Fee $225.00
FEE2005-11374 Training and Education Fee $1.20
FEE2005-11384 Technology Fee $5.62
FEE2005-11385 Scanning Fee $3.00
FEE2005-11386 CCF $3.60
Total Fees:
$238.42
Total Fees: $238.42
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration: 1/23/2006 Construction Value: $6,000.00
Work: ELECTRICAL WORK NEW OFFICE AND GARAGE
AUG 18 PAID
C (11s3
Signed: (INSPECTOR)
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict
conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY: