EL-04-81Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
1
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building
Qualifier 121114&uv.r, VIP-vie-0o jC
Architect/Engineer's Name (if applicable)
to
$ Value of Work For this Permit * l tea
Type of Work: ['Addition ❑Alteration ,rNew
�e��>> V r
Dom;' . -.a-�� k.;,. ��O fi 0,te.
• t i :'i Si ,r 'F 1P;e$90 ,ibatl krO.A.J
(Continued on opposite side)
State FL •
i iifii`1 �i 9:d�'�IN 1t f� \.li�S.' N 44att y'wi 1
Total Fee Now Due $ _ 4,1) 3 c 3 D
Miami Shores Village
Zip 33((0
Zip
Contractor's Company Name ` f-Aackeir-.04... COLIM to s, Phone # . /#.3218
Contractor's Address 2 AAA . q°' -
City iIvMroll State R.
33 1q. 2 -
Phone # 305-- `lam' 1102-
Permit No. E L 0 ` 4 1
Master Permit No. SP-' ZOUZ 1$
Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) $ssg.e y UA1Weer,•i Phone # 3Q - g5t i°I-? 3052.
Owner's Address 11300 14. M itewL i 51nl t1Q` Mr
City OA i AoM t
Tenant/Lessee Name Phone #
Job Address (where the work is being done) 11''5 00 eel, till ti i i 4,►ox n1 ue -- S'[urmor O u ta. a S1cit .
City Miami Shores Village County Miami -Dade Zip 331f \ tl
Is Building Historically Designated YES NO X
Square Footage Of Work: 1 S v0O
❑ Repair/Repla ❑ Demolition
Cow kite- CmMv t�ouJ1 t iru31
****************************F
Submittal Fee $ , � Permit Fee $ d'' r CCF $ a CO /CC
Notary $ Training/Education Fee $ • D Technology Fee $ D a (V
Scanning $ Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
Bonding Company's Name (if applicable)
( 5
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 CONDmONERS, 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 YOIIR
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.
-Roo- %BAi 0 1 _ UNtve,zstri
NOT
Sign:
Print:
My Commission Expires:
Mc 12/15/03
Signature
Owner or Agent DO`S U U.oA
A ss* v �c.
The foregoing instrument was acknowledged before me this / r p
day of 00I , 20 CI, by -�rec U l i c ,
who is rsonally known to me or who has produced
As identifi • tion and who did take an oath.
APPLICATION APPROVED BY)
**************** ** * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Contractor
The foregoing instrument was acknowledged before rz this /
day of /Ph 20 eV, by/yda1®® 4te4a,
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY P
• Sign:
Print:
My Commissio
****** * * * * *, * * * * * *** * ** * * ** * * * * * * * * * * ** ***** **** ** *
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
***** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
Plans Examiner
Engineer
Zoning
Page 1 of 2
BUILDING AND ZONING DEPARTMENT
10050 N.E. SECOND AVENUE
MIAMI SHORES. FLORIDA 33138 -2382
TELEPHONE (305) 795 -2204
FAX (305) 756 -8972
AFFIDAVIT FOR 30 DAY TEMPORARY ELECTRIC SERVICE
(To be executed by Owner and/or Tenant, Bml ng & Electical Contractor)
NOTE: ELECTRIC SERVICE WILL BE DISCONNECTED "WITHOUT NOTICE"
UPON 30 DAY TERMINATION UNLESS APPLICATION IS RENEWED
It is understood that the temporary - electrical approval by the Miami Shores Village, Building & Zoning Department
given in connection with the building being constructed under.
Building Permit No. ?:5? ZOoz — ► °' 1 Electrical Permit No. E L- 2004 " 417-
at address: 1130 0 i A4 P--r lu E ALA L ,
for owners: 13 V N ■%.1 017* t
is being given only for construction purposes or for testing the following installations being made in sai d structure:
ilt
lr - COMve;aoc 1 ttt4 1 /f-tiI.#J8 144 id FOix. 11/20 Sysky s
L l SippEr'1 s ysi s
Sub- paragraph 4501.3 (d) (3) of the South Florida Building Code provides for a 30 day maximum approval only in an
URGENT NECESSITY for electric current exists. Necessity shall include the use of current for irrigation, security,
humidity control, emergency power and lighting, such as for testing or construction purposes, provided the Electrical
Contractor and owner do hereby agree to assume the responsibility of Maintaining the installation in such a manner that
there is no hazard to life and property.
Such approval is in no event to be considered a release of said structure for purposes of use and occupancy, and no
occupancy shall be granted or permitted until final inspections have been called for and approved by the inspection
divisions concerned, and an occupancy permit obtained.
The undersigned also understand that the temporary- electric approval is subjectto rescission and cancellation, and
electric power can be cut off at the discretion of the Building and Zoning Department and will be disconnected if the
building concerned is occupied before final inspections are approved and occupancy permit obtained.
L ire t j U l 0 , being first duly sworn,
depose and say that Pam the owner of the above described property, and that I agree that the structure covered in this
agreement shall not be occupied until the building contractor 1. • btained ap • royal of final inspections.
Sworn and subscribed before me this r Q
day of rtL1 , ®200 4 +
Notary Public, State of Florida at Large
My Commission Ext►ires• _ _ _
o
n y CAROLR(IA S. SALVADOR
t gi°� ;` ;toy Fh�c - State of Florida
• •C.ammissionB +esApr21.2007
Commission # DD20461 3
1 x SofudedBy Notional Notary Assn.
SIGNATURE OF O VNER U P Cc
/ /
SIGNATURE OF NOTARY PUBLIC
30 DAY TEMPORARY- ELECTRIC SERVICE (continue)
1, REYNALDO MADIEDO II , being first duly sworn,
depose and say that I am the Electrical Contractor for the above described property and that the electrical installations as
now e:dsting will not create a safety hazard if temporary - service is connected.
Sworn and subscribed before me this 4TH
day of MARCH , 2004
Notary Public, State of Florida. at Large
My commission expires:
I, D cs N P L O L CZ- t S S , being first duly sworn,
depose and said that I am the Building Contractor of the above described property and that I will not permit occupancy
of this building until final division obtained and that I have the authority insofar as the owner of said property is
concerned to prohibit occupancy until such final inspections are obtained.
Sworn and subscribed before me this j
day of 4 C , _L(
Notary Public, State of Florida at Large
My Commission Expires:
Dade: 7er-
Page 2 of 2
CTZICAL CONTRACTOR
SUPERIOR ELECTRIAL CONTRACTORS, INC.
ATURE OF NOTARY C
by: ( name)
Date:
SIGNATURE OF BUILDTIG CO,
cuLA A A a,
SIGNATURE OF NOTARY PUBLIC
Release to FLORIDA POWER & LIGHT CO.
To: (name)
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 3/19/2004
Applicant: BARRY UNIVERSITY
Owner: STUDENT UNION
JOB ADDRESS: 11300 N MIAMI AVE
Electrical Permit
Permit Number: EL2004 -81
STUDENT UNION
BARRY UNIVERSITY
Contractor SUPERIOR ELECTRICAL CONTRACTORS INContractor's Address: 1407 EL RADO
Local Phone:
Parcel # 1121360000040
Fees: Description Amount
FEE2004 -2912 Building Fee $500.00
FEE2004 -2913 CCF $0.60
FEE2004 -2914 Training and Education Fee $0.20
FEE2004 -2915 Technology Fee $12.50
Total Fees: $513.30
Total Fees: $51,00
Total Receipts: -
eceipts 10:00
3
Permit Status: APPROVED Permit Expiration: 9/13/2004 Construction Value: $1,000.00
Work: 30 DAY TEMP FOR TEST FOR A/C
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.
M
Legal Description:
Page 1 of 1
MAR 3 0 E 'D
Signed: (Contractor or Builder) BY: