EL-10-1275BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type: Electrical
Owner's Name p Y) (Fee Simple Titleholder I 7 9 c t ! l 0
( P ) L�1�1i c° L.J �i�Yl 'honeF """"��! .� 11
Owner's Address 0 .2V4 7 Aviv 91
Cityli/V .o)c4 State Zip 33J5'4
Tenant/Lessee Name Phone #
E -MAIL: ` A
Job Address (where the work is being done) e25/9 A/14i / 4j-
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL #
Is Building Historically Designated YES NO
Contractor's Company Name
Contractor's ddress le
City
Qualifier Name
State Certificate or Registration Nct1A Ab 92/
E -MAIL:
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $
Type of Work: ['Addition / ❑Alterat
Describe Work:
Structural Review. $
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Permit P
Master Permit
Phone # 31 /C # 390°
Zip 33/
air
Phone # 5-D5 3 970
Certificate of Competency No.
Phone #
Square / Linear Footage Of Work:
❑New
r*** * * * * * *** * * It* * ** * * * * * * * * ** ** *x* Fees* * ************* * * ** * * * * * * * * *,* * * * * * * * * * * * **
Submittal Fee $ Permit Fee $ / ' ' G b CCF $
Notary $ Training /Education Fee $ Technology Fee $
Scanning $ Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
❑ Repair /Re6lace ❑ Demolition
Total Fee Now Due $
Sec Reverse side
o. EL 10_
o
CO /CC
°x:i5
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 . 'sted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued In the absence of h posted notice, the
inspection will not be approved and a reinspection fee will be charged
Signature) /V Y "V'" Signature
• . rAgent
The forego g instrument was acknow ged before a this
day of ` , 20 /D , by lilt
4/.2.106 .0/1
who is ersodall known to me or who has produced
p Y p
As identification and who did take an oath.
NOTARY PUBLIC:
Sr0
Print:
My Commission Expires:
two DERRICK MILLER
111 f ,4 " MY COMMISSION # DD 834636
EXPIRES: October 27, 2012
q{ t y Bonded Thw Notary Public Underwriters
I
Print:
ontractor
The foregoi� instrume was ackno edged . fore me is /
day of J , 20 / , by ot,. / -
who is persor4ally known to me or who ha produced
as identification apd yv_lto di5I take ap oath,
NOTARY PUBLIC:
Sign
My Commission Expires:
DERRICK MILLER
e: !! A MY COMMISSION # DD 834636
-�� rr EXPIRES: October 27, 2012
Bonded Thru Notary Public Underwrtere
****% 1' CAPOYeY' ir% oY? CiY9Y4te 7Y 7YvY1Y% SY**** AciY• oY' XlYeY9h*X 9Y1r1L'****' ie9liF9f *vY%'! roY' lY9t****dr****%x •IC** * *4CeY S**** ****
APPLICATION APPROVED BY: l / Plans Examiner
Engineer
Zoning
(Revised 02/08/06)
fin, • S w b It\
Scheduled Inspection Date: August 05, 2010
Inspector: Devaney, Michael
Owner: MENDER, VERA
Job Address: 249 NW 91 Street
Project: <NONE>
Contractor: BROADVIEW SECURITY
Building Department Comments
August 04, 2010
Miami Shores, FL 33150-
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 149478 Permit Number: EL -7 -10 -1275
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alarm
Phone Number
Parcel Number 1131010331330
Phone: (305)406 -3940
burglar alarm
Passed
[z
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
c Ae0),
For Inspections please call: (305)762 -4949
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