ELC-10-48Owner Information
January 14, 2010
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Fees Due
CCF
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Submittal Fee
Submittal Reversal Fee
Technology Fee
Total:
Amount
$1.20
$0.40
$100.00
$3.00
$50.00
($50.00)
$1.60
$106.20
Building Department Copy
Address
BANK OF AMERICA & DELOITTE & TOU( P.O. BOX 182588
COLUMBUS OH 43218-
Contractor(s)
ADT SECURITY SERVICES, INC (786)331 -3967
Phone Cell Phone
Authorized Signature: Owner / Applicant / Contractor / Agent
9475 2 Avenue
Miami Shores, FL 33138-
1132060133760
Block: Lot:
BANK OF AMERICA & DELOITTE
Phone
Expiration: 07/13/2010
Cell
Type of Work: ELECTRICAL
Additional Info: ALARM
Classification: Commercial
Invoice # Total Amt Paid Amt Due
ELC-1-10-36806 $ 106.20 $ 56.20
ELC -1 -10 -36806 $ 106.20 $ 106.20 $ 0.00
Check #: 3963
I O
For Inspections please call:
(305)762 -4949
Available Inspections:
Inspection Type:
Final
Meter Box
Alteration
Relocation
Fire Alarm
Service Change
Underground
W. W.
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 responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PLUMBING, MECHANICAL WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated
January 14, 2010
Date
1
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: ELECTRICAL
Owner's Name (Fee Simple Titleholder) .CM k_oP / f iC 'hone #
Owner's Address ( X I - 5 s
City L {!Y) b ' State 0 4"7'
Tenant/Lessee Name
Email
Job Address (where the work is being done) — t qqq k)- Z A u e'
City Miami Shores Village County Miami -Dade Zip . 3 c)) 5 F
FOLIO /PARCEL# I I J aC(/357(jb
Is Building Historically Designated YES NO Flood Zone
Contractor's Company Name ,4J)
ce,C12' �5�r
Contractor's Address /07 g /Liar& i
City 'lJ e( State 7
Qualifier Name l �` KOA /CC. / y \ Phone #
State Certificate or Registration No. 1 I2 a Certificate of Competency No.
Contact Phone P54 -5) as E -mail a. A
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $
Type of Work:
Describe Work:
Structural Review. $
['Addition
1 1 U
ubmittal Fee $ 00
Miami 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
I, aaa
❑Alteration ['New ❑ Repair/Replace
tLrrrl 1 f
***** * * * * * * * *: * * * * * * * * * * * * * * * * * * * * ** F * * * * * * * * * * * * * * * * * * * * * * * * **** * **
Training/Education Fee $
Notary $
Scanning $ Radon $ DPBR $
Double Fee $
Violation date:
ICiD-4g
Master Permit No. e, a-I a "+oa ° I q p
Phone #
Zip
Permit No.
Zip
Phone #
Total Fee Now Due $
530
Permit Fee $ ;! j /26>t �CCF $
1ug6 alb
IMOYEEV'Ma
L� JAN 11 2Q10
BY:
CO /CC $
Square / Linear Footage Of Work:
See Roverse side
❑ Dem9l
7 de0
Technology Fee $
Bond $
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 Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of , 20 , by , day of , 20 `0, by
who is personally known to me or who has produced 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:
* * * * * * * * * * * * **
APPROVED BY
(Revised 07 /10 /07)(Revised 06/10/2009)
®4
)1Plans Examiner
Engineer
Sign
Print:
NOTARY,PUBLIC:
_fize,- as identification and who did take an oath.
My Commission Fxpir �
MY COMMISSION # DD
EXPIRES: March 11, 2011
Zoning
Clerk checked