ELECTRICALMIAMI SHORES VILLAGE
BUILDING DEPARTM NT
305- 795 -2204
Building Inspection Request
Phone# c.S iaSq
- 17
Inspection Date j i l0
Approved 73
Correction
Re -Insp' n Fee ❑
Date 1, I1 ICC{
Type Insp'n Tna I f10 (tom
Permit No. J,.�- 9003- 6X3 _
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PERMIT APPLICATION FOR MIAMI SHORES VILLAO
Date 1 0/ 16 / 0 3 Job Address 1216 NE 93rd S t.
WORK DESCRIPTION ALARM ADDITIONS
Nota,^y q
My Commits` ,t,
' "- Y R VIUA
a eOlidaftaiiitin0178221 a Date
Expires 1/20/2007
,?; , �; ;�••` Bonded through
(800. 432 -42s4) Florida Notary Asps, inn.
( 6w0s 00
FEES: PERMIT / 42 ` .424: " RADON
APPROVED:
Zoning
Mechanical
- A
No
My Co
Tax Folio
Legal Description Historically Designated: Yes
Chimer/Lessee / Tenant KURT GUSTINGER Master Permit # 1 31
Owner's Address SAME Phone 305 7 51 - 5 5 5 4
Contracting Co. SECURITY MASTERS Address 1150 NE 125th St.
Qualifier RON ADAMS SS#
Phone 305 8 9 3 - 7 7 6 6
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRIC ' PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
— 12 drops
Square Ft. Estimated Cost (value) 4 ,'2'o
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO 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.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work
will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL
PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in co ✓ iance with all applicable laws regulating
cons '.ruction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
Sign a of Contractor or Owner - Builder` Date
p�f3;�3
es: 1/ 000178239
Exp(rea 1/20/2007
Bonded through
II OHIO � ; d Assn., Inc.
No X
C.C.F.. 6 0 NOTARY BOND
. S 0 J TOTAL DUE ( 7, 30
Date
Building Electric? 4 > 7 /e ,--2."
Plumbing Structural Engineer
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 -795 -2204
Printed: 10 /22/2003
Electrical Permit
Contractor SECURITY MASTERS INC
Local Phone: 305 893 - 7766
Parcel # 1132050270160
Permit Number: EL2003 -313
Applicant: DONNA GUSTINGER
Owner: GUSTINGER DONNA
JOB ADDRESS: 1216 NE 93 ST
Contractor's Address: 1150 NE 125 ST
Permit Status: APPROVED Permit Expiration: 4/18/2004 Construction Value: $1,000.00
Work: ALARM ADDITIONS - 12 DROPS
Page 1 of 1
Fees: Description Amount
FEE2003 -6342 Building Fee $100.00
FEE2003 -6343 CCF $0.60
FEE2003.6344 Training and Education Fee $0.20
FEE2003 -6345 Technology Fee $2.50
Total Fees: $103.30
Total Fees: $13.30 � �
Total Receipts: .a�
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.
Signed: (Contractor or Builder) BY:
Legal Description: BAY LURE PB 44 -63 LOT 3 & W25FT LOT 4 BLK 2 LOT SIZE IRREGULAR
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