BP-04-770BUILD
PERMIT APPLICATION
FBC 2001
Permit Type (circle):
Owner's Name (Fee Simple Ti
Owner's Address 11300 tS. E
City M ' SEIo+T.ros
$ Value of Work For this Permit
Miami Shores Village
State R, .
uilding . Department
50 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Tenant/Lessee Name Phone #
Job Address (where the work is being done) N .11J . i16 -'f
City Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES NO X
Contractor's Company Name 1504.uauseAt Coal sucxlo*) Co. Phone # 3.4'^ S7' - ofit
Contractor's Address 2* Gf oecA. Lowe •
City COryArt. I State Fl. Zip 33131
Qualifier . sse•.
Architect/Engineer's Name (if applicable) k-taa.fEnc 'oAt .S 41;,'11,4 Phone # o S - `17-(v -110
Type of Work: ❑Addition ❑Alteration Repairfl lace , ❑ Demolition
f : t , d
Describe Work: 1k ,
* *** * *1 * * * * * * * * * * * * * * * * * * *** F ees * * * ** * * * ***** * * * * ** * *** * **** *
Submittal Fee $ } ° Permit Fee $ /5
Notary $ fer Training/Education Fee $ ® c qV
Scanning $ Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $ L 0
(Continued on opposite side)
Permit No. i5 P O / 7 7 D
Master Permit No.
Electrical Plumbing Mechanical Roofing
Phone # 0 5 — Si/ ^ /1 6 6
Zip 3 31to
Square Footage Of Work: — A1rt —
CCF $ if 0 CO /CC
Technology Fee $ � � 7
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 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 �� Signature
ero- rtsgend S o c tI f
The foregoing instrument was acknowledged before me this 3 The fore oing instrument w acknowl ged be o
day of Su v1 e , 20 Of , by �t &14e -q -E.. Ul t O - , day of 2d1.', by ,1'K/te - • /
who is personally known to me or who has produced who i personally known o me or who has produced
As identification and who did take an oath. as identi pation and who did take an oath.
NOT .:LIC: I
Si j %C � � R ` t N�ry Pubttc - State of Florida
Sign: d o
s r. Sign: , t 1 RUSinque
+-z „ �� • ~ Commission # DD204613
Print: I'd Ir 4' A. gal vast o - Print _ �i �, s _ 7
'a7fAt • Bombay e
. n
My CommissionE its #,---- • - - - - -
y Xp �� � My Commission Expires:
Chc 12/15/03
APPLICATION APPROVED BY:
************************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Ae,(,74 q
* * * * * ** * * * * * * * * * ** I *� * * * * * * * * * * * * ** * * * * * * ** *****************,**,****** * * * * * * * * * * * * * * * * * * * * * * * * * * * * ***
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
********** z*ro�, * * * * * * * * * * * * * * * * * * * * * * * **
�UUY Plans Examiner
Engineer
Zoning
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 6/9/2004
Applicant: BARRY
Owner: UNIVERSITY
JOB ADDRESS: 140
Parcel # PARC2004 -8
N.W. 115
Legal Description:
Building Permit
Permit Number: BP2004 -770
UNIVERSITY
BARRY
ST.
Contractor BEAUCHAMP CONSTRUCTION CO INC Contractor's Address: 247 MINORCA AVE
Local Phone: 305 -445 -0819
Page 1 of 1
Fees: Description Amount
FEE2004 -5877 Building Fee $150.00
FEE2004 -5878 CCF $1.20
FEE2004 -5879 Training and Education Fee $0.40
FEE2004 -5880 Technology Fee $3.75
FEE2004 -5881 Scanning Fee $3.00
Total Fees: $158.35
Total Fees: $158.3L 0t r,
Total Receipts: 10.60
01),,S
Permit Status: APPROVED Permit Expiration: 11/30/2004 Construction Value: $1,200.00
Work: TEMP CONSTRUCTION TRAILER
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: