EL-05-406MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305 - 795 -2204 NOV 2 1 2005
Building Ins Request
Date 1 t l D
Type Insp'n C e_c.^n • L...0J/
S
Permit No. EL O O 5
Name `
Address 1 "1 S ? 1 N / � '� �l`2 rzA
Company 3Q) �+ L [+ E'
Phone #
Inspection Date 1 1 e
Approved 17V
Correction
Re- Insp'n Fee
4300
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) C p r e-ae, ' .v i • V. Co ®N S , P h o n e # 20 a 7 4 - 7 - '71
1,3
Owner's Address 9 sS 1 1...) & 41 ' Ave_ e--A.
Cit M. e a ...... 31, a c . R - g , S t a t e F _ I Zip 3` 13
Tenant/Lessee Name Phone #
Job Address (where the work is being done) j , '4
City Miami Shores Village County Miami -Dade Zip 3 3 ! 3
Is Building Historically Designated YES NO N
Contractor's Company Name -p, ckiLv , •Rr
Contractor's Address (o c l 0 f 4 f- o0 , .A-I-
City, . &:.:v v, State F Zip ' 3 )3
Qualifier
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Floricja 33138
Tel: (305) 795.2204 Fax: (305) 756.872
Permit No. EL 100
Master Permit No.
Phone #70-5" ‘ l ) 4_
Zr L P
oa
State Certificate or Registration NoEC - a (� Z Certificate of Competency No.
Architect/Engineer's Name (if applicable) /J / A ° Phone #
$ Value of Work For this Permit 13 113 0 0 74 Square Footage Of Work:
Type of Work: DAddition Alteration ['New Repair/Replace ❑ Demolition
Describe Work: C Imo, c.-rw , La !�Q ra a ®�-
* * * ** * * * * * * * * * * *** * * * ** * * * ** Fees ** ** ** * * ** * * * * * * * * * * ** *** * * * **
ECEfVED
NOV 1 6 2M5
Submittal Fee $ Permit Fee $ /--5`®' ' .,� CCF $ ) . PSQ CO /CC
Notary $ Training/Education Fee $ 0. ( Technology Fee $ 3. 15
Scanning $ 3 - 00 Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
r --
Total Fee Now Due $
(Continued on opposite 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 . ' 1 not be ap roved and a reinfection fee will be charged
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this / k, �t
day of /JP 4 20 / by 0/U 0 4
who is personally known to me or who has produced
Sign:
Print:
NOTARY P �
My Commission
* * * * * * * * * * **
c
As identification and who did take an oath.
4, JUAN CARLOS RODRIGUEZ
; *, MY COMMISSION # DD 355174
3; * *EXf RE06#19beia,a08* **
'ay r ge Bonded Thru Notary Public Undervwlters
APPLICATION APPROVED BY•
Chc 05/13/03
The foregoing instrument was acknowledged before me this /.5
day °toe; vim, , 200 , by � k P 14, as ,
who is personally known to me or who has produced
identification and who did take an oath.
NOTARY P
Si
Print:
My C
41
LOS RODRIGUEZ
1 ct,,,7,f t MY COMMISSION # DD 355174
7/ 04 ' ' Bonded Thru a Ooe 23 2oo8
Notary Public Underwd[ers
IC:
sion Expires:
****************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Plans Examiner
Engineer
Zoning
ADDENDUM TO BUILDING PERMIT APPLICATION
'AN A£PLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PRMITHAS B.
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ELECTRICAL
MECHANICAL
TEM
IATH T B
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
I
FEE
ITEM
SPACE HEATERS
UNIT
FEE
IIDET
LIGHT OUTLETS
CENTRAL HEATING
I ISH 1ASHER
RECEPTACLES
A/C (WIND)
)ISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL)
)RINKING FOUNTAIN
SERVICE SIZE IN AMPS
DUCT WORK
L0OR DRAIN
SERVICE REPAIR/METER CHANGE
REFRIGERATION
3REASE TRAP
APPLIANCE OUTLETS
1
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TOP
UNDERGROUND TANKS
LAVATORY
OVEN
.
1
ABOVE GROUND TANKS
LAUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
MOTORS 0- 1 HP
STEAM BOILERS
SHOWER
MOTORS OVER 1- 3 If
HOT WATER BOILERS
SINK, POT /3 COMP.
MOTORS OVER 3- 5 HP
MECHANICAL VENTILATION
SINK, RESIDENCE
MOTORS OVER 5- 8 HP
_
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTORS OVER 8- 10 HP.
ELEVATORS/ESCALATORS
TEMPORARY WATER CLOSET
MOTORS OVER 10- 25 HP
FIRE SPRINKLER SYSTEMS
URINAL
MOTORS OVER 25-100 FP
COOLING TOWERS
WATER CLOSET
MOTCRS OVER 100 FP
VIOLATION
INDIRECT WASTES
I
A/C WINDOW
1
REI;NSeECTjON
WATER SUPPLY TO:
AIR CONDITIONERS
A/C UNIT
STRIP HEATER
FIRE SPRINKLER
GENERATORS TRANSFORMERS
I
'HEATER -NEW INST.
GENERATORS TRANSFORMERS
1
I
HEATER - REPLACE
1 GENERATORS TRANSFORMERS
LAWN SPRINKLER -WELL
SPECIAL PURPOSE
1
SWIMMING POOL
OUTLETS COMMERCIAL
WATER SERVICE
SIGN TUBES
SEWER CONNECTIONS
.:SIGN TRANSFORMERS
UTILITY -SEWER
SIGN TIME CLOCK
UTILITY -WATER
F I XTIRES
(0
SEPTIC TANK
ANTENNA
RELAY
TELEVISION OUTLETS
DRAINFIELO, 4' TILE/RES.
VIOLATION
PUMP 8 ABANDON SEPTIC TANK
REINSPECTION
SOAKAGE PIT CU. FT.
., ,
CATCH BASIN
DISCHARGE WELL
DOMESTIC WELL
AREA DRAIN
ROOF INLET
SOLAR WATER HEATER
FIRE STANDPIPE
POOL PIPING
I
LAWN SPRINKLER SYSTEW
1
GAS RANEE.
k
METER SET (GAS)
I
GAS P P
GA_ i IN"
N l I
ADDENDUM TO BUILDING PERMIT APPLICATION
'AN A£PLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PRMITHAS B.
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ELECTRICAL
MECHANICAL
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 11 /17/2005
Applicant: GEORGE EVANS
Owner: EVANS GEORGE
JOB ADDRESS: 9957 NE 4 AVENUE RD
Parcel # 1132060171240
Signed:
Electrical Permit
Permit Number: EL2005 -406
Contractor BENNETT ELECTRIC SERVICES CO Contractor's Address: 6900 NE 4TH COURT
Local Phone: 305/759 -1665
Page 1 of 1
Legal Description: MIAMI SHORES SEC 4 AMD PB 15 -14 LOTS 3 4 BLK 96 LOT SIZE 103.100 X 130 OR
Fees: Description Amount
FEE2005 -14672 Building Fee $150.00
FEE2005 -14673 CCF $1.80
FEE2005 -14674 Training and Education Fee $0.60
FEE2005 -14675 Technology Fee $3.75
FEE2005 -14676 Scanning Fee $3.00
Total Fees: $159.15
Total Fees: $159.15
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration: 5/15/2006 Construction Value: $2,300.00
Work: ELECTRICAL REMODELING FOR KITCHEN
(INSPECTOR)
GC- 52 C
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: