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EL-08-1678Project Address Parcel Number 10480 NE 5 Avenue 1122310150010 Miami Shores Village, FL 33138- Block: Lot: SAILESH MEHTA Owner Information SAILESH MEHTA Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Address 10480 NE 5 AVE MIAMI SHORES FL 33138 -2040 Contractor(s) HOME OWNER Phone CeII Phone Fees Due CCF Education Surcharge Notary Fee Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $0.60 $0.20 $5.00 $100.00 $3.00 $2.50 $111.30 Lid =: Authorized Signature : Owner / Applicant / Contractor / Agent Building Department Copy Wednesday, September 17, 2008 Expiration: 03/16/2000 Phone (305)491 -5729 Valuation: Total Sq Feet: Type of Work: Additional Info: Classification: Residential Total $ 0.00 $ 0.00 Payment Type : Amt Paid I Amt Due $ 0.00 pe o° X ( 1( Applicant Available Inspections: September 17, 2008 Date CeII $ 1,000.00 0 Inspection Type : Final Underground Rough 1 In considerrtion 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 strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I asst[Nne responsibility for all work done by either myself, my agent, servants, or employes . I understand that separate permits are required for ELECTRICAL, PLUMBINCrJMECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work . OWNERSWFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constructioend zoning . Futhermore , I authorize the above -named contractor to do the work stated . 1 Miami Shores Village Building D epartment 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING Permit No. !�c, PERMIT APPLICATION Master Permit NO. e f - / (r> e 7� FBC 2004 Permit Type: Electrical (LO'. v ®L-ri- 4 4q /- Si Z 9 (c' ) Owner's Name (Fee Simple Titleholder) S '41 11 4 k eel Phone # 30 5 ?ID °) 0© 9 Owner's Address 1 0 4 5 0 rq& I/ L %, Cit 1 16'5 -'fl 1 State PL Zip l3 Tenant/Lessee Name Phone # E-MAIL: S� G �c� S Le C' q .C4 , c r v- Job Address (where the work is being done) City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name �� Q p Y C Phone Contractor's Address City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. E -MAIL: Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ 2 • cs° Square / Linear Footage Of Work: Type of Work: Describe Work: 7 i1, Structural Review. $ ddition ❑Alteration [New ❑ Repair /Replace ❑ Demolition >C %Xis** ****X KKXXXXXX'J:KKKKKKY.X'XY.XXKXKKK Fees XXXKKKKK* XXKXXXX XXXXX / X � K X X ' KKXKXXXXKXXXKXX Permit Fee $ / ' e' CCF $ 1✓�VV CO /CC Technology Fee $ C Submittal Fee $ Notary$ Scanning $ 41,0 - ) DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Training /Education Fee $ Radon $ Total Fee Now Due $ ( . 30 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. 1 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. 1 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 t at a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose properly is subje to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection w s ccurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved an a ' .s ection, fee will be charged. Signature Owner o gent The foregoing instrume - s led _e' .efore me this 15 The foregoing instrument was acknowledged before me this day of St , 20 6 8, by 1 S K tM/ 1- (0 ( day of , 20 , by who is personally known to me or who has produced • . Vv`4. who is personally known to me or who has produced Ss Z.9v NOTARY PUBLIC: Sign: Print: My Commission Expires: xxxxx sex x**** *xxxxx APPLICATION APPROVED BY: (Revised 02/08/06) As identification and who did tak Signature Sign: Print: My Commission Expires: Contractor as identification and who did take an oath. NOTARY PUBLIC: .xx xxxxxxx*x** x x xxxx x xx xx xx x x * wax:** >c* xxxx x 'car xxx Xx xx xxXXxxxxxxxxY .XY.XXX xY.xx Y.XY.xW W W W W ,�' i " ,I' Plans Examiner Engineer Zoning