RC-07-2535Bill To
JOSEPH POTTIER
1284 92 Street FE
MIAMI SHOPES FL 33138-2937
Return to
'
Miami Shore
10050 N. •Jenue
Miami Shoi, 3Z.1o000
Date Fee Name
11/14/200c. L Permit Renewal Fee
Payments
Friday, Novem5 14, 2008
VPlaye
N.E. 2nd Aver
FL 331
Pho!le: GVi3O27S5-22C4 Far: 755-3972
-----•--
•
krir Thor:
t Ty pl.'
C -lculatei
Date li:),1:ty Type Che;k Nunt!)e° Amount Paid Change
11/14/2008 ":',. (7:.....1 $150.00 $0.00
'IntlEftlIWIEWEIBMITEMEMMEMIRATIGEMLUDili !DA.
47.v Nuribor: RC-11-08-33266
(atl.: November 14, 2008
TItal Fees Due:
1:,
Total Paid: $150.00
Fee Amount
$150.00
$150.00
Total Due: $0.00
REO C:07 11i408 154n MM1 054562 BLDG. PERM $150.00
IBill To
JOSEPH POI/FR
1284 92 Stree,t
MIAMI SHe.)REI'z FL 3i38-2937
Return to
Miami Shores V fizge
10050 NI_ •:..nri
Miami Shorcs. 3„7IA-0000
. . . VI
3errn kl • ,..-
Date Fe€ Name
11/141. Permit Renewal Fee
Payments
Friday. Klovein'oc': 1 el 2108
“qian
N.F., 2nd 14
FL 3 -6010
Phone: cA5756-.,W4"2
rJ r1
ce NIA" PL-11-08-33267
oic ta: November 14, 2008
pccroji Number: PL-12-07-2537
F Tyj
Date P71. b)':..1r Amount Paid Change
11/14/2003 !:. $190.00 $0.00
. 111iLEMIffilEIIEEILXEREENEEEMPERIPlifilfri ThI I i1ILLII lW maw'
Total Fees Due:
rot ai Paid: $190.00
Fee Amount
$190.00
$190.00
Total Due: $0.00 II
".„
3 1540 MC01 054562 BLDG. PERM $190.00.
BATHROOM REMODEL
REVISION ON FEBRUARY 208 TO ADD KITCHEN WORK
ON THE SAME PERMIT
'•
Passed
Inspector Comments
0/,t jcce5s
P!eot5t:, neTddde
Failed
,,,,vicia
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Inspection Date: 11/19/2008
Inspector: Bruhn, Norman
Owner: POITIER, JOSEPH
Job Address: 1284 92 Street NE
Miami Shores, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
Tuesday, November 18, 2008
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Block:
Permit Type: Residential Construction
Inspection Type: Final
Work Classification: Alteration
Phone Number
Parcel Number 1132050270520
Lot:
Page 1 of 2
Inspection Date: 08/28/2008
Inspector: Devaney, Michael
Owner: POITIER, JOSEPH
Job Address: 1284 92 Street NE
Miami Shores, FL 33138-
Project: <NONE>
Contractor: AJL ELECTRIC INC
Building Department Comments
BATHROOM AND KITCHEN REMODELING
Passed
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspectc
MAKE I
/ 3 Y 70a)--
Wednesday, October 22, 2008
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Parcel Number 1132050270520
Block: Lot:
Phone: 305 - 895 -4971
Phone Number
(cevinieline HC1 3m,
Page 1 of 2
BATHROOM AND KITCHEN REMODELING
O ksk
Passed
Inspector Comments
0 /"'
s %�2_ ,1
/7
'
,
L
°
1°1 ' G J 0 ,ee
_ 4--
®/ i
e o
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid .
until
Inspection Date: 05/01/2008
Inspector: Devaney, Michael
Owner: POITIER, JOSEPH
Job Address: 1284 92 Street NE
Miami Shores, FL 33138-
Project: <NONE>
Contractor: AJL ELECTRIC INC
Building Department Comments
Wednesday, April 30, 2008
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit Type: Electrical - Residential
Inspection Type: Underground Rough
Work Classification: Addition /Alteration
Block:
Phone Number
Parcel Number 1132050270520
Lot:
Phone: 305 - 895 -4971
Page 2 of 2
Bill To I
JOSEPH POTTIER
1284 92 Street NE
MIAMI SHORES, FL 33138 -2937
Return to:
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Date
Fee Name
04/30/2008 Revision Fee
Wednesday, April 30, 2008
Invoice
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Invoice Number: EL-4 -08 -31710
Invoice Date: April 30, 2008
Permit Number: EL -12 -07 -2536
Ty
Electrical - Residen l 1t r Classification:
Fee Type
Calculated
APR 0 PAID
014
Fee Amount
$75.00
Total Fees Due: $75.00
P
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type: Electrical
Job Address (where the work is being done)
City Miami Shores Village
FOLIO / PARCEL #
Architect/Engineer's Name (if applicable)
Value of Work For this Per
Su bmitta
Structural Review. $
x * xxxxxxxxxxxxx
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
y3 td k3 ® ®QaoleMPS
Owner's Name (Fee Simple Titleholder)
Owner's Address 1
�,�,y�,, 2 > i
City ���'�" _ 1 State Zip
Tenant/Lessee Name
E -MAIL:
( -C
66v ,
Permit Fee $ 7S i ®® --
Notary $ Training /Education Fee $
Scanning $ Radon $ DPBR $
Bond $ Code Enforcement $
Phone #
6244 LV-cs. 1
Is Building Historically Designated YES NO
Permit No. -1.
aster Permit No. 120Cri V c3C�
County Miami -Dade Zip 3 ' (3
Contractor's Company Name
Contractor's Address
City State Zip
Qualifier Name Phone #
State Certificate or Registration No. Certificate of Competency No.
E -MAIL:
Phone #
Phone #
Square / Linear Footage Of Work:
Phone # ( ?N 070 -/4/
„f 6/
Type of Work: DAlteration ❑New ❑ Repair /Replace ❑ Demolition
Describe Work:
1P1e-c P7 v K r fj9 6 (�
xxx *Fees xxxxxx>.xa : xxxx ** x x xxxxxx xx xx* xx x***xxx x xxxxxx
CCF$
Double Fee $
CO /CC
Technology Fee $
Zoning $
Total Fee Now Due $
See Reverse side -a
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. 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 rs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not -.e approved and ection fL ill be charged.
Signature
Owner or Agent
The foregoing instrument was acknowledged be ore me this
day of ' i , 2 0 (> by .../ le ®s POW—
who is
As identification and who did take an oath.
NOTARY PUBLIC:
xrxxxxxxxxraY
APPLICATION APPROVED BY
(Revised 02/08/06)
to me or who has produced who is rsonally know to : e or who has produced
-4111616/ e
aP
C tractor
The foregoing instrument was acknowledged before me this
day of
Signature
i
A / �:tt
ina -
. '''�``' •a`= Expires: OCT. 19, 2008
My Commission Expires: • ,�l , My Commission Expires:
xxxxxxxxx xxxx Y'x' .x'xx www.AARONNoTARY. RRm
s identification and who did take an oath.
NOTARY PUBLIC:
Sign
Print: j bm, S
IC
It
,20,by
4,4f
uddin
Commission #DD363993
' • /Expires: OCT. 19, 2008
. WWW.AARONNOTARY.com
✓� 2 % / 1 "A Plans Examiner
Engineer
Zoning
rxx
PERMIT #: (�
Miami Shores Village
APPROVED BY DATE
e
SUBJECT TO COMPLIANCE WITH ALL FEDERAL
STATE AND COUNTY RULES •AND'REGULATIONS
,Naats-3ty3t.Liod
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type: Electrical
Owner's Name (Fee Simple Titleholder
Owner's Address
City
City Miami Shores Village
FOLIO / PARCEL #
Is Building Historically Designated YES
Contractor's Company Name
Contractor's Address
City Wit
Qualifier Name
State
hiviKetry
State Certificate or Registration No.ee �l
E -MAIL:
Describe Work:
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
P®
State d Zip 1p i3
Tenant/Lessee Name Phone #
E -MAIL: 7 PO tiie# At)
Job Address (where the work is being done)
9401-, 660
A l& a&*()
f�r�S hj(,f7,s1ti / ?09
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $
Type of Work: ❑Addition
f ro.0
Iteration
netwme tha �om9m
*x**** *****x********xxux9exxx9rx ***** ****F **** ******** ** *x**xxxx, ***** **** **** **x*xxxx
Submittal Fee $ Permit Fee $ CCF $ 1 • CO /CC
Notary $ Training /Education Fee $ n.40
Scanning $ '00 Radon $ DPBR $
Bond $ Code Enforcement $
Structural Review. $ Total Fee Now Due $ i b8
OAN 1 5P D
c
County Miami -Dade
NO
Permit No.E / aa_CO
Master Permit No. TZCj Qj 953 5
Phone #
Phone #
Zip
Phone #
Certificate of Competency No.
Square / Linear Footage Of Work:
❑New ❑ Repair /Replace
Double Fee $
dos) )17-fi-1
See Reverse side —*
imeminhit
El DEC 2 ? 2(lfll ,
BY:
Zip
eito
po5) 4 11, 7
❑ Demolition
Technology Fee $ '75
Zoning $
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. 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
whosgnroperty 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 reinspection fee will be charged.
Owner or Agent
The foregoing instrument was acknowledged before me this
day of 7 , 20 0-7, by
who •
to me or who has produced
27
As identification and who did take an oath.
NOTARY PUBLIC:
The foregoing instrument was acknowledged before me this
day of A) 0-0 , 2007, by nl i t.�e r� Y
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: 14I -1'74
My COmmission#D
Commission y si n Expires: %�� � � ; ElPire5; p 1 - - 200
i26 *k�c'i'* *Viti'a'Ciiic xcxacxxrxeYxxxxxve **wxxxxxxxxxxaewse* 4cxxx
Sign:
Print:
My Commission
APPLICATION APPROVED BY/�/ /', "��%'� % j`
(Revised 02/08/06)
Plans Examiner
Engineer
Zoning
Project Address
1284 NE 92 Street
Miami Shores, FL 33138-
1132050270520
Block: Lot
JOSEPH POITIER
Owner Information
JOSEPH POITIER
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Address
Contractor(s)
AJL ELECTRIC INC
Phone
305 - 895 -4971
Cell Phone
Parcel Number
1284 NE 92 Street
MIAMI SHORES FL 33138 -2937
Phone
Valuation:
Total Sq Feet:
Type of Work: ELECTRICAL
Additional Info: BATHROOM REMODEL
Classification: Residential
Fees Due
CCF
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
$1.20
$0.40
$150.00
$3.00
$3.75
$158.35
IA 1 5 PAID
CK045
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.
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Total
$ 0.00
Payment Type:
Amt Paid I Amt Due
$ 0.0
$ 0.00
Expiration: 07/01/2008
Applicant
Available Inspections :
Inspection Type:
Underground Rough
Service Change
Final
Relocation
Fire Alarm
Alteration
Meter Box
W. W.
January 03, 2008
Date
Cell
$ 2,000.00
0
Thursday, January 3, 2008 1
Inspection Date: December 23, 2008
Inspector: Levrock, James
Owner: POTTIER, JOSEPH
Job Address: 1284 92 Street
Project:
Miami Shores, FL 33138-
<NONE>
Contractor: MG PLUMBING & SPRINKLER SERVICE
Building Department Comments
Monday, December 22, 2008
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Block:
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132050270520
Lot:
Phone: (305)525 -9236
Page 1 of 1
• "EA
1 u
PLEASE
• r Comments
S AS REINSPECTION FOR INSP- 70836. cc
NE •= , , _ 12/03/08 JL
CALL JONNY 404.444.5254
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspection Date: December 23, 2008
Inspector: Levrock, James
Owner: POTTIER, JOSEPH
Job Address: 1284 92 Street
Project:
Miami Shores, FL 33138-
<NONE>
Contractor: MG PLUMBING & SPRINKLER SERVICE
Building Department Comments
Monday, December 22, 2008
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Block:
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132050270520
Lot:
Phone: (305)525 -9236
Page 1 of 1
PLUMBING FOR BATHROOM
REMODEL ®A.,
1V- '
0 'h� 0 v
OA
li di/ I1/
Passed
Inspector Comments
cc
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Inspection Date: 12/03/2008
Inspector: Levrock, James
Owner: POITIER, JOSEPH
Job Address: 1284 92 Street NE
Project: <NONE>
Miami Shores, FL 33138-
Contractor: MG PLUMBING & SPRINKLER SERVICE
Building Department Comments
Tuesday, December 2, 2008
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, F
Phone: (305)795 -2204 Fax: (305)756 -897
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Block:
Phone Number
Parcel Number 1132050270520
Lot:
Phone: (305)525 -9236
Page 1 of 2
Inspection Date. 94 OY
Inspector: Bruhn, Norman
Owner: POITIER, JOSEPH
Job Address: 1284 92 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
Tuesday, December 23, 2008
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Block:
Permit Type: Residential Construction
Inspection Type: Final
eiL s„...
Work Classification: Alteration
Phone Number
Parcel Number 1132050270520
Lot:
Page 1 of 1
Passed
Inspector Comments
CREATED AS REINSPECTION FOR INSP- 100272. No access
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Inspection Date. 94 OY
Inspector: Bruhn, Norman
Owner: POITIER, JOSEPH
Job Address: 1284 92 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
Tuesday, December 23, 2008
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Block:
Permit Type: Residential Construction
Inspection Type: Final
eiL s„...
Work Classification: Alteration
Phone Number
Parcel Number 1132050270520
Lot:
Page 1 of 1
(PERMIT #:gC( ] - 2„5
Miami Shores Village
APPROVED
BY
D'TE
ZONING DEPT
4,®«
/
BLDG DEPT
SUBJECT TO COMPLIANCE WI FH ALL FEDERAL
STATE AND COUNTY RULES AND REGULATIONS
11) - 7 1 'C' .' 7 9 7 7, :71_,L l'
FEB 1 1 2063 1 219
BY: - m - -- --
WALL-C-134"-Boa onn Overro-30'°
Coak p-309" Wan a se cablaels
JP DESLGNS,Inc
305 -759 -4217 F -305- 756 -6359
e-R naii ,1F4 Design @aoi.coal
•• • .9' • • • • ••
• • • • • • • • •
• • i
• •
•
•• ••• •• • • • • •
ITIOZR RIESIDENCI
1284 ` . t3 92"
ilia nnbthe,(i.3if : •
• • • • • •
• • • • •• ••
• • • •
1GTCH }. °,. 1t ': • : :
New caPaleet4G4N4
A U Applit w . :• •: •:• ••• :• •:
WALL -A -1W' Sins Base Cabinet, 36"
2- M"base es meta w/drawers
No Uppers-Window Wd
• •
••• •
• • •
• • •
• • • •
• • • •
• •
CITV
WALL- :- 80"- Dishwasher -30"
Base and Waif Cabinets
33/3 8?
Bill To I
JOSEPH POITIER
1284 92 Street NE
MIAMI SHORES, FL 33138 -2937
Return to:
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Date
02/19/2008
02/19/2008
Fee Name
Revision Fee
Scanning Fee
Tuesday, February 19, 2008
Invoice
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Invoice Number: RC -2 -08 -31029
Invoice Date: February 19, 2008
Permit Number: RC -12 -07 -2535
Fee Type
Calculated
Calculated
Total Fees Due:
Fee Amount
$150.00
$3.00
$153.00
APR 1 5 PAfl
NAME:
ADDRESS:
VILLAGE OF MIAMI SHORES
OWNER BUILDER DISCLOSURE STATEMENT
�Q S�
t-f-vet' �v� qi
DATE:
Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws
of the State of Florida, F.S 489.103(7). And I have read and understood the following disclosure
statement, which entitles me to work as my own contractor; I further understand that I as the
owner must appear in person to complete all applications.
State Law requires construction to be done by a licensed contractor. You have applied for a
permit under an exception to the law. The exemption allows you, as the owner of your property,
to act as your own contractor even though you do not have a license. You must supervise the
construction yourself. You may build or improve a one - family or two- family residence. You may
also build or improve a commercial building at a cost of $25,000:00 or less. The building must be
for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a
building you have built yourself within one year after the construction is complete, the law will
presume that you built for sale or Lease, which is a violation of this exemption. You may not hire
an unlicensed person as a contractor. It is your responsibility to make sure the people employed
by you have licenses required by state law and by county or municipal licensing ordinances. Any
person working on your building who is not licensed must work under your supervision and must
be employed by you, which means that you must deduct F.I.C.A and with - holdings tax and
provide workers' compensation for that employee, all as prescribed by law. Your construction
must comply with all applicable laws, ordinances, buildings codes and zoning regulations.
Please read and initial each paragraph.
1. I hold title to the above property and I am planning on doing this cons t n
Initial
2. I understand that as an owner- builder I must abide by all zoning ordinances and
building regulations in effect at the time of permit application
Initia 1
3. :I have an understanding of the 2004 F:. & FRC and understand that this
department and its inspectors are there to help enforce and interpret the code.
There is a copy of the code in this office for review.
Initial
4. I understand that the building official and inspectors are not there to design,
alter or give advice on how to meet code —. only if the structure meets the
minimum code.
Initial
By
5. I understand that as an owner - builder, that any contractor disputes with sub-
contractors and myself must be handled in a civil court with the advice of an
attorney. The department will not mitigate contract disputes.
Initial Cf1-
6. I understand that if I compensate any person or company for work performed
they are required to have a business license in the county. If for any reason they
do not posses a business license I will be responsible and liable for any wrong
doing from this unlicensed company or person.
Initial
7. I understand that if any person gets injured on my construction project —they are
entitled to workmen's compensation. And if they do not posses a workmen's
policy I could be held liable for all doctor and related cost which could include
loss of wages during recovery from injury.
Was acknowledged before me this
Initial
8. I understand that under state and local laws I can not do any Electrical,
Plumbing, Heating, Air & Roof work on my•property with out first obtaining
the proper permits by licensed contractors.
Initial .
day of 7) t 20 67
who was personally known to me or who has
Produced there License or as identification.
` oa r t i , Luonna Salahuddin
ECommission#DD363993
•':.±.: o; Expires; OCT. 19, 2008
p 4'N" AARONNOT RY.com
Project Address
1284 NE 92 Street
Miami Shores, FL 33138-
1132050270520
Block: Lot:
JOSEPH POITIER
Owner Information
Valuation:
Total Sq Feet:
$ 5,000.00
0
JOSEPH POITIER
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Address
Parcel Number
1284 NE 92 Street
MIAMI SHORES FL 33138 -2937
Approved: In Review
Comments:
Date Approved: : In Review
Date Denied:
Type of Construction: BATHROOM
Stories: REMODEL
Front Setback:
Left Setback:
Bedrooms:
Plans Submitted:
Certificate Date:
Bond Retum :
Occupancy:
Exterior:
Rear Setback:
Right Setback:
Bathrooms:
Certificate Status:
Additional Info:
Classification: Residential
Fees Due
CCF
Education Surcharge
Notary Fee
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
$3.00
$1.00
$5.00
$150.00
$3.00
$3.75
$165.75
JiAk 1 5 PAIL
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.
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Thursday, January 3, 2008
Phone
Applicant
Available Inspections :
January 03, 2008
Date
Cell
Addition
I PROVE >
Expiration: 07/01/2008
Inspection Type:
Trusses Plan Submittal
Spot Survey
Drywall Screw
Stem Wall Footer
Final Building
Roof Trusses
Wall Sheathing
Framing
Wire Lathe
Floor Trusses
Rake Beam
Shutter Attachment
Window and Door Buck
Final PE Certification
Insulation
Roof Sheathing
Second Floor Tie Bond Beam
Density
Window Door Attachment
Slab
Fill Cells Columns
Termite Letter
1
Ofor
t oot Ireitoloir/
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type (circle):
Owner's Name (Fee Simple Titleholder)
OS
t it* .G .
Owner's Address
r -
Value of Work For this Permit $ 3'7 0751 LO
Type of Work: DAddition
Describe Work:
Miami Shores Village NMOMEWM-iii
Building Department DEC 2 7' 2001
10050 N.E.2nd Avenue, Miami Shores,. Florida 33138 B Y: c
mAufr. not
1--,, sortgthe
l� coN*A.
Tel: (305) 795.2204 Fax: (305) 756.8972
Roofing
City State Zip
Tenant/Lessee Name Phone #
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 floveco W `1 I Phone #
Contractor's Address
City State Zip
Qualifier Name Phone #
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
Alteration
Square / Linear Footage Of Work:
['New
mept
.lokv\1
Permit No.1
Master Permit No.
Phone #
�0� 7S�I-lyl/
Repair/Replace 0 Demolition
** * * **** ** * *** ********** * * * **** x *** **** F ees * * * ** * * * * ************ ** * *** x * *** *** *** ** **
Permit Fee $ d6 CCF $ 3'IJ.J CO /CC
Technology Fee '$ .13
DPBR $ Zoning $
Submittal Fee $
Notary $ 500 Training/Education Fee $ )' (X)
Scanning $ 0 0 Radon $
Bond $ Code Enforcement $ Double Fee $ C
Structural Review. $ Total Fee Now Due $ 1 t p Q S • 13
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. 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 Fr.ECTRICAL 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 # :: ' • and a reinspection fee will be charged.
Signature A c / Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this d 7 � The foregoing instrument was acknowledged before me this
L
day of 'L , 20 6 by T ® � ` 2 / 1 , day of , 20 _ , by
who personally known to me or who has producedfT V ' who is personally known to me or who has produced
S f ( (-e As identification and who did take an oath. � as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
\ f tt. o o' s
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires: = '� a e
*************** * * * * **•x******* ** *** * *** ** y * **x * x* * * ********* **** +x ** * ** *** ** * x* **.x** * •x *** *a
APPLICATION APPROVED BY:
(Revised 07/10/07)
My Commission Expires:
0 -- vR Plans Examiner
Engineer
Zoning
This lns mentPr - tares y:
Name f ..`. 41 le
Address
Permit No.
STATE OF
COUNTY OF
specified)
5. Surety
a. Name and address:
b. Amount of bond $
c. Phone number.
6. Lender
a. Name and address:
b. Phone number.
Signatory's e/Office
The foregoing Instrument was acknowledged before me this k ay of _
(name of person) as �nt7
authority, ...e.g. officer, trustee, attomey In fact) for
behalf of whom Instrument was executed).
NOTARY punie -syATR OF FLORIIk ;
Claudia V. Cubillo4.
Commission #DD717923'
Expo: SEP. 23, 2011
BONDE TmW atone BONDING CO.,ING
D
:F�i 2111aSF�ntt3 Q29 OR PM I 111111 , 1 1 1111111 p 11111 11111 111
11111 1111111111
RECORDED 01/15/2003 10:07: 45
HARVEY R:UVIHp CLERK OF COURT? I1IAMI -DADE COUHTYv FLORIDA
ST .FAG
.q2f.°
NOTICE OF COMMENCEMENT W
THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property, and in accordance with
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
1. Description of property: (legal description of property, and street address if available)
y &Y -O 27 s40
2. General description of improvement:
e (O R. - 6 7 00 M rn • /Cr d al/
p
Owner Information e
. Name and address;_
b. Interest in property: `.' I4` /1' , E q
)(Contractor. Name and address of fee simple titleholder (if other than owner,,: (�I/ �p� I / /��� (i p t Y f 1 /" ` � /' , b. Name and address: J C f y /i1,, ,
b. Phone number. G- e / �
2144,6thi f fr
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as
provided by Section 713.13(1)(a)7., Florida Statutes:
a. Name and address:
b. Phone number.
•
8. In addition to himself, Owner designates the following person(s) to receive a copy of the LIenor's Notice as provided In
Section
713.13(1)(b), Florida Statutes:
a. Name and address:
b. Phone number.
9. Expiration date of notice ment (the expiration date is 1 year from the date of recording unless a different date is
iJy
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13,
FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A
NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
Signature of Owner Owner's Authorized Officer /Director
Partner/Manager
Tax Folio No.tk 2� '0f Os jQ
1
Signature of Natural Person Signing Above
year b1U) •i1 /11 ' jr
(type of
(name of party on
Sign re of Notary Public — State of Florida
Print, Type, or Stamp Commissioned Name of Notary Public
Commission Number
v, flL
Personalty Known or Produced Identification
m 112 2002
Verification Pursuant to Section 92.525. Florida Statutes
Under penalties of perjury, I dedare that I have read the foregoing and that the facts stated in it are true to the best of my
knowledge and belief.
1
BATHROOM REMODELING
Passed
Inspector Comments
mld X671 m�
* ~ ®9
, „CA--
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid .
until
•
Inspection Date: 01/24/2008
Inspector: Devaney, Michael
Job Address: 1284 92 Street NE
Project: <NONE>
Wednesday, January 23, 2008
Owner: POITIER, JOSEPH
Miami Shores, FL 33138-
Contractor: AJL ELECTRIC INC
Building Department Comments
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Block:
Phone Number
Permit Type: Electrical - Residential
Inspection Type: 544
Work Classification: Addition /Alteration
f ame '- 91
Parcel Number 1132050270520
Lot:
Phone: 305 - 895 -4971
Page 1 of 2
S' O A d. ' RESIDENCE
CE
1284 NE 9
MIAMI SHO ,FL.3313
.... • .. ... •.
• • • • • • • •
• •• • •• •
•
•••••1• • •
• •
.• •
JP
30545
e .
'F-30545
slam
RATIIROOIVI UPDATE
Original e °o remain
Nom► Tile- Shower -Doors-Sink. g and
lilt* 4
ZONI DEPT
BLDG DEPT
SUBJECT TO COMPLIAN
Miami Shores Vi1 .7ge
A
2007 AL
BY:
APPROVED
BY DALE
4.7,2111
WI IN ALL F DERAL
STATE AND COUNTY RULES AND REGULATIONS
zlictlos
volcovoL
BUILDING
PERMIT APPLICATION
FBC 2004
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Permit Type (circle): adding Roofing
Owner's Name (Fee Simple older) JSQ L. l "W
Owner's Address l `if ,A p E qi c1V 3
Ci State I
eta S$
Job Address (where the work is being done)
City Miami Shores Village County Miami -Dade
Zip
zip ` 3 �� 3 cT
FEB L . 2003 I
B Y:
Permit No. -C/71 J D 3
Master Permit No.
Phone # r 7 r 1 t L
Tenant/Lessee Name -_� x 1 Ay t z e k' Phone # 7 2 (n - Q- - S / £ �^
FOLIO / PARCEL #
Is Building Historically Designated YES NO
Type of Work:
Describe Work:
Sub
0
Contractor's Company Name
Contractor's Address
City State
Value of Work For this Permit $ c )
❑Addit n Alterarion
• ►Y)•
['New ❑ Repair/Replace
Nota
Scanning Radon $ DPBR $
Bond $ Code Enforcement $
Structural Review. $
•
3- 1
Phone #
Zip
Qualifier Name Phone #
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
Square / Linear Footage Of Work:
❑ Demolition
* * * * * * **
************F
eIV
Permit Fee $ l5 • CCF $ CO /CC
Training/Education Fee $ Technology Fee $
Zoning $
Double Fee $
Total Fee Now Due $
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. 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 reinspection fee will be charged.
Signature
(Revised 07/10/07)
0,Aimuk. Cl\- Co \-c
Owner or Agent Contractor
The fore g instrument was ackno ledged b this 1 foregoing instrument was acknowledged before me this
day of , 20( o' , by � Q ' `' 01 , ay of , 20 _ , by
is personally known to me or who has produced ITV who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
OTARY UBLIC: � "a NOTARY PUBLIC:
Sign:
.,A,,,-,.;\s,.....,.,.
Ittv6 � 5 `S�' '� ' � 'D Sign:
y w 4'
ote°
`a' S o� Print:
. ... My Commission Expires:
Signature
APPLICATION APPROVED BY: Plans Examiner
Engineer
Zoning
BATHROOM REMODEL
i � z 6 20
Passed
Inspector Comments
Pr t
'
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid .
until
Inspection Date: 02/25/2008
Inspector: Grande, Claudio
Owner: POITIER, JOSEPH
Job Address: 1284 92 Street NE
Miami Shores, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
Friday, February 22, 2008
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Block:
Permit Type: Residential Construction
Inspection Type: Slab
Work Classification: Addition
Phone Number
Parcel Number 1132050270520
Lot:
Page 1 of 2
BATHROOM REMODEL
7
ve
Passed
Inspector Comments
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid .
until
Inspection Date: 02/25/2008
Inspector: Grande, Claudio
Owner: POITIER, JOSEPH
Job Address: 1284 92 Street NE
Miami Shores, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
Friday, February 22, 2008
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Block:
Permit Type: Residential Construction
Inspection Type: Drywall Screw
Work Classification: Addition
Phone Number
Parcel Number 1132050270520
Lot:
Page 1 of 2
1284 NE 92 Street
Miami Shores, FL 33138-
1132050270520
Block: Lot:
JOSEPH POITIER
Owner Information
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Address
JOSEPH POITIER
1284 NE 92 Street
MIAMI SHORES FL 33138 -2937
Valuation:
Total Sq Feet
$ 2,000.00
0
Contractor(s) Phone CeII Phone
MG PLUMBING & SPRINKLER SERVIC (305)525 -9236
Type of Work: PLUMBING
Type of Piping: BATHROOM REMODEL
Additional Info:
Bond Retum :
Classification: Residential
Fees Due
CCF
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
$1.20
$0.40
$190.00
$3.00
$4.75
$199.35
Building Department Copy
Thursday, January 3, 2008
Sta
Expiration: 07/01/2008
Total Amt Paid 1 Amt Due
$ 0.00
Payment Type:
,C140
Authorized Signature: Owner / Applicant / Contractor / Agent
$ 0.00
Phone
N1SPAM
Available Inspections :
January 03, 2008
Date
CeII
Inspection Type:
Main Drain
Final
Lavatory
Underground Rough
Water Main
Water Service
Heater
Top Out
Re Pipe
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.
1
40B TIN
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type: Plumbing l ,
Owner's Name (Fee Sim le Titleholder) _• • T ?Q
Owner's Address ic NJ ' oz, IA
City 1/I s1/4-Tics State Zip 5138
Phone #
Tenant/Lessee Name
E -MAIL:
Job Address (where the work is being done) l , ofas
City Miami Shores Village
FOLIO / PARCEL #
Is Building Historically Designated YES NO
Contractor's Company Name Me.-.1/ `` * ' ((J n�.t2Y
4 �W Cr
Contractor's Address 19 (2 Q ' 9 5T
City tA GCVIM 'r State
Qualifier Name �aVYie� W jt(
State Certificate or Registration No J .) �CPO
E -MAIL:
10050 N.E.2nd Avenue, Miami Shores, Florida 33 l38
Tel: (305) 795.2204 Fax: (305) 756.8972
Miami Shores Village
County
Value of Work For this Permit $
Building Department
Type of Work: ❑Addition ❑Alteration New
Describe Work:
Notary $
Scanning $ d b- GO
13rt voeyn karmid Jnmal
Bond $ Code Enforcement $
Miami -Dade Zip
5� q�
I1n V�phone # 30 S,. S2
Architect/Engineer's Name (if applicable) Phone #
Master Permit No. 1 0 9 5 '(��'
Phone# E'7sI' )o l,l
Zip 3D1(09
Phone #
Certificate of Competency No.
Square / Linear Footage Of Work:
Double Fee $
Permit No. pt-0 0x3
0 Repair /R
place
******** ** * * * * * * * * * * * * * * * ** * * * ** * * * * * **F ************ * * * * * * * * * * * * * * * * ** * * * ** * * * * ****
* �
Submittal Fee $ Permit Fee $ �(� ` CCF $ I 'ID CO /CC
Training /Education Fee $ O .40 Technology Fee $ 415
Radon $ DPBR $
❑ Demolition
Zoning $
Structural Review. $ Total Fee Now Due $ / C ( •30
See Reverse side -
DEC NIEC MEV
La 2 7 2007.
BY: Utz
Signature
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
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: [ 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 reinspection fee will be charged.
The foregoing instrument was acknowledged before me this 62? The foregoing instrument was acknowledged before me this
day o 20 j by day of 01 L , 20 07, by
ho is so . _. to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC• "
Si
1r is
Owner or Agent
(Revised 02108/06)
APPLICATION APPROVED BY:
udd
Print/ ...:/' - I ujii€, ; on 1 1' . ° • •
P
rint/ �
rid ,1 !e x�:d 1 N 1 1
. it ` %. WWW,AARONNOTARY..com
My Commission Expires.
Zip
Signature — +-S.e� Gam`
Contractor
who is a ersonally known • me or who has produced
as id and who did take an oath.
NOTARY PUBL
Sim .4) ** . . -
E ' hu1 3
Print: '• ' "
�l/•°� RON
see i i�
My Commission I xpues •
.
.J..•..4d+•L d.,.4 1 • I '4s- 4`,5tiititski[ Q �'J�YYSf1f F Y 14-30 9CX* ****** ******* ***3.•]Y*%****
■
IA 2008
OTARY.com
CI7 Plans Examiner
Engineer
Zoning