EL-04-230MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305 - 795 -2204
B iding Inspection Req
Date Z S
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Permit No. asoUq r) 6 ' # -
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ex Name - 11 (J . \ -
Address WC) I LOr 1 tki
Company pOL W pro
Type Insp'n
Phone #
Inspection Date 2 I Z'
Approved ,❑,/
Correction
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Re -Insp' n Fee
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BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building
Owner's Name (Fee Simple Titleholder)
Owner's Address 1 t 3 c ("
city v _ ( State �l >
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41(4, ) ti)
Tenant/Lessee Name
Job Address (where the work is being done) i (3 n I V , 1► ` (GiVV\/(, /v e
City. Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES NO
Contractor's Company Name �® GU ei\
Contractor's Address 5
State
Q ualifier "'Q �'L h P Ph
$ Value of Work For this Permit
Type of Work: ❑Addition
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Describe Work:
Total Fee Now Due $`--S1 _CD
(Continued on opposite side)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
PK
Plumbing Mechanical Roofing
hone 100 l �'1��� 1 Kr l
Zip
Permit No.
Master Permit No.
Phone # -�
Phone #DC ) 4 2_1 6
Zip 7 2 6
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1 6 RN
cv Go, as Gm aft
6
34-1
State Certificate or Registration No. C — C90 0/ { 0_2 Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
Square Footage Of Work:
❑Alteration kNew 0 Repair/Replace 0 Demolition
Y1f M € D / Th en c v) / /atl /.ter P G7?) fai
*** * * *** * * * * * ** *** * * * * * * * ** Fees*** * * * * * ***** * * * * * * * **********
Submittal Fee ' C Permit Fee $ l ®e' 4 ''d CCF $ ,6 0 CO /CC
Notary $5 ,. a D Training/Education Fee $ ' . v Technology Fee $ . 0
Scanning $ Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
Bonding Company's Name (if applicable)
Bonding Company's A x)flress
a
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
cpmmenced 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 Si
Owner or Agent
The foregoing instrument was acknowledged before me this
day of , 20 _, by
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
******************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY
Chc 05/13/03
Contractor
The foregoing instrument was acknowledged before me this ISO
day of
who is personally kno ' ' me or who has produced
NOTARY PUBLIC:
Sign:
Print:
My Commission E
20- , by ifQ., hole. eoY I > t..-n e.
ntification and who did take an oath.
************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Engineer
Zoning
T
ng a., ' s��,
* * * * * * * * * **
Examiner
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 8/16/2004
Applicant: UNIVERSITY
Owner: STUDENT UNION BARRY UNIVERSITY
JOB ADDRESS: 11300 N MIAMI AVE
Contractor POWER PRO
Local Phone: 305 - 687 -7080
Parcel # 1121360000040
Legal Description:
Electrical Permit
Permit Number: EL2004 -230
Page 1 of 1
Contractor's Address: 18800 NW 2 AVE 214
Fees: Description Amount
FEE2004 -8282 Building Fee $100.00
FEE2004 -8283 CCF $0.60
FEE2004 -8284 Notary Fee $5.00
FEE2004 -8285 Training and Education Fee $0.20
FEE2004 -8286 Technology Fee $2.50
Total Fees: $108.30
Total Fees: $1_08.30
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration: 2/12/2005 Construction Value: $500.00
Work: PROVIDE 110 VOLT SERVICE TO GATE GUARD MACHINE. 20' TRENCH PULL WIRE TO PANEL IN TO NEW STU
cl e UNION
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: