ELC-11-358Miami 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
FBC 20
Permit Type: ELECTRICAL
Owner's Name (Fee Simple Titleholder) (j�, i , Phone #
Owner's Address (%j . E • ire
City I r ( e 4,1441 5;4011.t.6 State F'G,pe.14k.Ae
Tenant/Lessee Name st%//•
Email M l !Ar
Job Address (where the work is being done) %11 ' ' te4l C
City Miami Shores Village ounty Miami -Dade
FOLIO / PARCEL #
lE@MMYR
SL MA 0 2 2011 I
Permit No.
Master Permit No.
Zip S 31
Phone #
O treiv /Ai ef4wr (�� swag
Zip (feg, ,I Aft
Is Building Historically Designated YES NO ■'
Contractor's Company Name i• (&..-&c..
toe_
Contractor's Address 6 G 9 4) uJ 9 o � ss
.'
City /n O Q flh/
Qualifier Name
State Certificate or Registration No.
State
Contact Phone 7
Flood Zone
Phone # ezr
Zip AS/ ,179
Phone # ,,$dam 7.r6 • ?
Certificate of Competency No. EC d eo,/ 11
E -mail /1 ♦ GQtf (2_ii ►tie'C 6-tc • cak
Architect/Engineer's Name (if applicable) dtJ/ - Phone # • AVA-
Value of Work For this Permit $ zote
Square! Linear Footage Of Work:
Type of Work: ['Addition ❑Alteration ['New 0 Repair/Replace
[] Demolition
Describe Work: )� t) /..:',v riv i y (APO oaree,i-
�C% } x'0,•4 e.a., S -3
f * * *, * * * * ** * * * **** * * * * **** * * *** ******** Fees****** * * ** * * **** * ****** * * * ***** *** * *, * **
Submittal Fee $ Permit Fee $ R��04 c17 CCF $
CO /CC $
Notary $ Training/Education Fee $ Technology Fee $
Scanning $ Radon $ DPBR $ Bond $
Double Fee $ Violation date:
Structural Review. $ Total Fee Now Due $
See Reverse side —>
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 re- inspection fee will be charged.
Signature
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
• , ; ....' ... •, an oath.
NOTARY PUB)C�
Sign:
Print:
.41a11 un 3UQnd AP310N19111 Palma 4.411"
�-� SloB `Z Ant :S3kIIdx i
6269 as # NOISSIWVV0O AW
11:Od38V 31d0IN
The foregoing instrument was acknowledged before me this__
day of , 20 , by
who is personally known to me or who has produced
as i • entification an • who di take an oath.
It.OLE A. BERGERT
MMISSION # DD 892259
EXPIRES: Juiy 2, 2013
Bonded Thru Notary Public Underwriters
My Commission Expires:
Print:
My Commission Expires:
* * * * * * * * * * * * * * * * * * * * * * * *, - ***** ** * ** * ** ** ***** * * * ** * * * *** ** ***
,.6''1`1 )21L
Plans Examiner
APPROVED BY
Engineer
(Revised 07 /10 /07)(Revised 06/10/2009)
Zoning
Clerk checked
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO. TAX FOLIO NO. t (- 213C) - 00%
STATE OF FLORIDA: STATE OF FLORID
COUNTY OF MIAMI -DADS:
1 HEREBY CERTIFY th
THE UNDERSIGNED hereby gives notice that improvements will b
property, and in accordance with Chapter 713, Florida Statutes,
Is provided in this Notice of Commencement
r.J..,•,Atil :Cy
111111111111111111111111111 111111111111111111
CFN 201180156780
OR Bk 27612 Ps 49922 rips)
RECORDED 03/10/2011 12 :23:45
HARVEY RUVTI'ar CLERK OF COURT
MIAMI —DACE COUNTY r FLORIDA
LAST PAGE
A.D. o_
dal Seat.
C'
d Coun
CiiiiZinw
Space above reserved for use of recording office
3. Owner(s) name and address
Interest in property:
Name and address r.
of fee simple titleholder:
V1 kk) hi IAM4
5. Surety: (Payment bond required by owner
Name, address and phone number.
Amount of bond $
6. Lender's name and address
7, Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by
Section 713.13(1)(a)7., Florida Statutes,
Name, address and phone number_ A ONt
8. In addition to himself, Owners designates the following person(s) to receive a copy of the Uenor's Notice as provided In Section
713.13(1Xb), Florida Statutes.
Name, address and phone number, mom e 1
9. Expiration date of this Notice of Commencement 1 (44a r
(the aWratlon date is 1 year from the date of recording unless a different date is specifies
WARNING TO OWNER; ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF 'THE NOTICE OF COMM NCEMENTARE CONSIDERED
IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13. FLORIDA STATUTES. AND CAN RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK
OR RECORDING YOUR NOTICE OF COMMENCEMENT.
At/A-
A-
oG If any)
Signature(s) of Owner(s)
Prepared By
Print Name
Title/Office
STATE OF FLORIDA
COUNTY OF MIAMI -DADE
The forwol . inspument
BY gKH • '‹Q
Cl Individually,
Personally
s)' Authorized Ofcer/Director/Partner/Managerm
Prepared By
Print Name
Titie/Office
as,
or CI produced the following type of identificati
Signature of Notary Public:
Print Name:
acknowledged before me this its"
day of AA 044 . 201
for
1S
Under penalties of perjury, I declare that I have read the for
that the facts stated in it are true, to the best of my kno
Signatures) of • a • er(s)'s Authorized Officer/Director,
By
SY
Y
123.0142 PAOS3 3,10 .
JEFFRY 3. YAO
COAOSSEION #
EXPIRES: November 12,2014
f, Pr.NoueyAwoo.t9rs
/Manager