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RC-09-1353Owner Information TYRONE HARRIS September 01, 2009 Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 102 93 Street Miami Shores, FL 33150- 1131010330900 Block: Lot: TYRONE HARRIS Fees Due CCF DBPR Surcharge Education Surcharge Notary Fee Permit Fee - Additions/Alterations Radon Surcharge Scanning Fee Submittal Fee Submittal Reversal Fee Technology Fee Total: Amount $7.20 $1.00 $2.40 $5.00 $360.00 $1.00 $6.00 $50.00 ($50.00) $9.00 $391.60 Building Department Copy Address Expiration: 02/23/2010 102 NW 93 ST MIAMI FL 33150 -2235 Contractor(s) HOME OWNER Phone Cell Phone Approved: In Review Comments: Date Approved: : In Review Date Denied: Type of Construction: KITCHEN REMODEL Stories: Front Setback: Left Setback: Bedrooms: Plans Submitted: Certificate Date: Bond Retum : Occupancy: Single Family Exterior: Rear Setback: Right Setback: Bathrooms: Certificate Status: Additional Info: Classification: Residential Authorized Signature: Owner / Applicant / Contractor / Agent Phone Invoice # RC -8-09 -35629 RC -8-09 -35629 Check #: 494 Total Amt Paid Amt Due $ 391.60 $ 50.00 " 34 $ 391.60 $ 391.60 $ 0.00 September 01, 2009 Date Cell For Inspections please call: (305)762 -4949 Available Inspections: Inspection Type: Final PE Certification Shutter Final Window Door Attachment Tie Beam Slab Termite Letter Framing Insulation Drywall Screw Shutter Attachment Window and Door Buck Ceiling Grid Fill Cells Columns 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 1 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, 1 authorize the above -named contractor to do the work stated. 1 BUILDING PERMIT APPLICATION FBC 2004 Permit Type (circle): Building) Roofing // � Owner's Name (Fee Simple Titleholder) G) (�9 Z T 6 I 4t'I /'hone # Owner's Address �, O ) . ° l 3 5 +/t p City iNkt hA J 5 6 1 5 State ry . Zip 3 Tenant/Lessee Name Phone # ® G ^fo ; o a AitJ. d Job Address (where the work is being done) City Miami Shores Village • County Miami -Dade Zip FOLIO / PARCEL # I — 3/0j-033- t9dit O Is Building Historically Designated YES NO ' Contractor's Company Name A /iQ4/1/4 -- Pt) (t d,e, 5 / 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) Value of Work For this Permit $ Type of Work: ['Addition ❑Alterati Describe Work: ***************************************F ************ ***** *********** ** *•x******* 41 6a Submittal Fee $ O % Permit Fee $ Notary $ Fee $ Miami Shores Village Building Department /14 Phone # 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 �' G Permit No. /Qom- -- Master Permit No. Square / Linear Footage Of Work: 6 ew r / VI Repair/Replace El Demolition G CCF $ ✓ _ CO /CC Technology Fee $ Scanning $ (0'00 Radon $ Q • OO DPBR $ '00 Zoning $ Bond $ Code Enforcement $ Double Fee $ I Structural Review. $ Total Fee Now Due $ „a # ` ' b , See Reverse side --> '2 A 1 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 CONDmONERS, 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 %proved and ' einspec ion fee will be charged. Signature The for going day of who is 551 My Commission Expires: (Revised 07/10/07) Owner or gent trument was ac for a this 5 The foregoing instrument was acknowledged before me this OW a day of , 20 , by — -- ,20L4,by rs. nally known to me or who has produced 11- t who is personally known to me or who has produced 1 . 31 . Ot(Jl�s�identification and who did take an oath. as identification and who did take an oath. NOT PUBLIC• 4 �� NOTARY PUBLIC: o Sign: �, yip fi t , . I, dr Sign: Print: Fc , S. C , ' Print. •- , "�' a6® r My Commission Expires: APPLICATION APPROVED BY-- „// /fr- �. Signature Contractor Plans Examiner Engineer Zoning NMI MUM MONNIM woes w• ammo MIN ew r Cf. ammo 11111111111 woe O0. mow° .Tw 1 wow r - •.t Cc: 111111111•1 '1. MINN c.C.) o a: Cr- s:. so N _J • CO I-1 en e: en, Lt � W Cr- t3 47 w 4Z e.73 :e- O.. ca Ct 1- la w w 0 O LL z 0 o o F , 4 a...0 0 O > • CO - EC o This Instr mP ar d Bi/ , ,. ^ _ aj ccia Name �//" a Q(�(,(O� Address 4 � N f 141 Permit No. STATE OF COUNTY OF 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: (IegaI description of property, and street address if available) 04i414A 2. General scri( Lion of improvemen 3. Owner information a. Name and address: b. Interest In property: c. Name and address of fee s 4. Contractor. a. Name and address: b. Phone number: 5. Surety a. Name and address: b. Amount of bond $ c. Phone number. 6. Lender a. Name and address: b. Phone number. 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as a. Name and address: b. Phone number: c/ 16- 376611 ( 1 VC- 4 sv f� O ('/ /#04,1-A f pie TIU older (fI other than owner): / CA 014/A- eiGet-q.-.,..) J NOTICE OF COMMENCEMENT 8. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided In Section 7.13.13(1)(b), Florida Statutes: a. Name and address: b. Phone number. 9. Expiration date of notice of commencement (the expiration date Is 1 year from the date of recording unless a different date Is specified) 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 COMM 2 MENT. Sig Partne of Owner or anager Tax Folio No, j '"/ltf'I 0,06 wner's Authorized Officer /Director Signatory's tie /Offlc li , s fo ment was acknowledged before me this 5 d f J (name of person) as ,, authority, ...e.g. officer, trustee, attorney In fact) for behalf of whom Instrument was executed). NOTF1tY PUBLIC -STATE OF FLORIDA °. ",.� Claudia V. (; los ° t ' ''Ics #PD71.7923 •it <rs• ''. x3, 2011 ° N^• 0 ° C BONDING CO.,INC. BONllID �II ��� Verification Pursuant to Section 92.626. Florida Statutes Under penalties of perjury, I declare that 1 have read the foregoin knowledge and belief. ,Ol / year) byjO • (type of (name of party on Sig ature of Notary Public - State of Florida Print, Type, or Stamp Commissioned Name of Notary Public Commission Number Personally Known or Produced Identification ` ` d that the is s - .d In It are true to the best of my ure of Natur Person Signing Above OWNER BUILDER DISCLOSURE STATEMENT NAME: Tdcil �' �2Q� ADDRESS: to VILLAGE OF MIAMI SHORES 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 co ... s ' ion I wb Myself. 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. Inactive permits for a period of over 180 days will become null and void (expired) and a new permit will be required to be issued for reinstate e �� f the p ermit. Initial Initial 3. I have an understanding of the 2004 FBC & 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. 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 m eets the minimum code. 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 any contract disputes. 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. 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 day of Initial Initial 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. ,209 Zo ni I < p Y ho was J . `lees personally known to me or who has Produced there License or OU 531^ 0 01 31 • aot as identification. 6 WA NOT AI C.s TA�� �llOS °, t.arpol 52. 3, , tea, havarr BOrabD A 11,11- I 3: 07P srae / PAT- 1 4 1, 4e/z- 2 4 14" - --71 # •-■ 4.) 1 t• c o z • 't•S P X n U) u CL o cz D U 0 1 Alt dimensions _size designations given are subject to verification on job site and adjustment to fitjob conditions. 8050fc97.kit This is an original design and must not be released or copied unless applicable fee has been paid orjob order placed. Designed: 8/812009 Printed: 8/8/2009 mvxg Alt Drawing IA: I All dimensions .size designations given are subject to verification on job site and adjustment to fit job conditions. 18050fc97.kit This is an 'original design and must not be released or copied unless applicable fee has been paid or job order placed. E1 1 Designed: 8/8/2009 Printed_ 8/8/2009 1 Drawing #: I II W1530L TEP2484F 36REF -2D �s1 DB3OSS 1 " 27" ,i 27" All dimensions _size designations given are subject to verification on job site and adjustment to fit job conditions. This is an original design and must not be released or copied unless applicable fee has been paid or job order placed. Designed: 81812009 Printed: 818/2009 8050fc97.kit 1E1 2 J Drawing #: ( If 27" 754 " 1" 2 1 1 36" 190 3" B 1 15"1-30" "15" 2 49$" 27"1--24" Olo 3 1772" 24" ,'12' ' 36" ,12':r 30" Al 2 1t 1 DW Mar SLS36R 16 Ion =I W30In 11111111111 CD3015 111111111 " 18" W1230R 4DB18BTC12LR 1 73" 1 is 2 All dimensions _size designations given are subject to verification an job site and adjustment to fit job conditions. This is an original design and must not be released or copied unless applicable fee has been paid or job order placed. Designed: 8/8/2009 Printed: 8/8/2009 8050107.1cit 1813 [Drawing #: 1 Inspection Type: Top Out Re Pipe Main Drain Underground Rough Heater Water Service Final Water Main Lavatory Project Address 102 93 Street Miami Shores, FL 33150- Owner Information TYRONE HARRIS Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Contractor(s) ALEXS PLUMBING SERVICE INC (954)755 -3900 Phone Cell Phone Type of Work: NEW SINK Type of Piping: Additional Info: Bond Return : Classification: Residential Fees Due CCF Education Surcharge Notary Fee Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $0.60 $0.20 $5.00 $180.00 $3.00 $4.50 $193.30 Address 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 September 01, 2009 tits, AonIAI1 'eri t' S tatus. APR 102 NW 93 ST MIAMI FL 33150 -2235 Parcel Number 1131010330900 Block: Lot: Phone Invoice # PL -8-09 -35748 Check #: 496 Total Amt Paid Amt Due $ 193.30 $ 193.30 $ 0.00 09',. _. Expiration: 02/23/2010 Applicant TYRONE HARRIS CeII Valuation: Total Sq Feet: $ 500.00 200 For Inspections please call: (305)762 -4949 Available Inspections: September 01, 2009 Date 1 BUILDING PERMIT APPLICATION FBC 20 Miami Shores Village Building Department 10050 N.E 2nd Avenue, Miami Shores, Florida 33138 Tel: IJ (305) 795.2204 Fax: (305) 756.8972 Permit Type: PLUMBING Owner's Name (Fee Simple Titleholder) ■ 2'3 + RQ� 'YM '4 /y Phone # Owner's Address (62 itE41 9 ' S d , Cit IF4 I S‘u§i4J5 State. Tenant/Lessee Name Ii Email Job Address (where the work is being done t. ow q 3 5 ° City Miami Shores Village County Miami -Dade Zip j /5V FOLIO / PARCEL # 11 3101 •" 613-0960 Is Building Historically Designated YES NO Flood Zone it." 6 C Contractor's Company Name ,Z (.. f evr # 9 `— 2S 3 lex Contractor's Address o? /3) /lit/ /07 7 CityJZ f / r) "IS State c11.\ Zip 0 30 \— Qualifier Name ,4/!y $7o/ , Phone # `J' r /`- 30.3 -3 a s '- State Certificate or Registration No. G �G Aog 63 &'V Certificate of Competency No. Contact Phone -- 305 — 3c'' Architect/Engineer's Name (if applicable) "5 Value of Work For this Permit $ E -mail 57 4-4N, 4,7 Permit No. Master Permit No. C 09 l ` Zip — 4 3/ CO Phone # �(f� Phone # Square / Linear Footage Of Work: P.00 Type of Work: ['Addition Alt ratio DNew Repair/Re lace p ❑Demolition Describe Work: C, Submittal Fee t $ Permit Fee $ CCF $ V (OD CO /CC Notary $ 0 0 Training/Education Fee I$ 0 - o Technology Fee $ 4O Scanning $ 3- 00 Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ I (7 r3 • 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 Stagy. Zi 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 proved and a reinspectio fee will be charged. The fore day of oing instrument was ac { l - ,20a,by ho is personally known to me or who has produced As identification and who did take an oath�9 �3��' J • tO' I'' i ld�itification and who did take an oath. . `;?:;;ti Q' NOTARY P UBLIC: p r #� C O Sign: � 4,�,,��,�Pp�'�'��,e NOTAR PUBLIC: Print: Qg`,u.. APPLICATION APPROV (Revised 07/10/07) Owner or A ent owledged My Commission Expires: s�aF; Engineer Contrac oing in ument was acknovyl , 2001 by who is personally known to me or who has produce The fore day of Sign: Print: My Commission Expires: clzo * ** * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * ** aminer Zoning Clerk checked t 4. Inspection Number: INSP- 122032 Scheduled Inspection Date: December 18, 2009 Inspector: Levrock, James Owner: HARRIS, TYRONE Job Address: 102 NW 93 Street Miami Shores, FL 33150- Project: <NONE> Contractor: ALEXS PLUMBING SERVICE INC Building Department Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. In 1. • r Comments December 17, 2009 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 For Inspections please call: (305)762 -4949 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Permit Number: PL -8 -09 -1354 Phone Number cat i3s3 Parcel Number 1131010330900 Phone: (954)755 -3900 Page 5 of 11 Inspection Number: INSP - 122039 Scheduled Inspection Date: December 16, 2009 Inspector: Devaney, Michael Owner: HARRIS, TYRONE Job Address: 102 NW 93 Street Project: <NONE> Miami Shores, FL 33150- Contractor: MIAMI ELECTRICAL SERVICES INC Building Department Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments KITCHEN REMODEL December 15, 2009 800 /900Ii Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 For Inspections please call: (305)762 -4949 SaDIA2ias Q'ITIA NVOS VZVU CSC., tsocii -1363 Permit Number: EL -8 -09 -1355 Permit Type: Electrical - Residential Inspection Type: Rough Work Classification: Addition /Alteration Phone Number Parcel Number 1131010330900 Phone: (786)399 -8762 Page 5 of 23 net 289 009 T IVA t.17 :CT 6003/9T/ET Project Address Owner Information Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Address Parcel Number 102 93 Street Miami Shores, FL 33150- TYRONE HARRIS 102NW93ST MIAMI FL 33150 -2235 Valuation: Total Sq Feet: $ 1,800.00 Contractor(s) Phone Cell Phone MIAMI ELECTRICAL SERVICES INC (786)399 -8762 Expiration: 02/23/2010 Phone Type of Work: KITCHEN RENOVATION Additional Info: ELECTRICAL Classification: Residential Fees Due CCF Education Surcharge Notary Fee Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $1.20 $0.40 $5.00 $186.67 $3.00 $4.67 $200.94 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy September 01, 2009 Invoice # EL -8-09 -35747 Check #: 496 Total Amt Paid Amt Due $ 200.94 $ 200.94 $ 0.00 Applicant Date Cell For Inspections please call: (305)762 -4949 Available Inspections: Inspection Type: Underground Rough Final Meter Box Alteration Relocation Fire Alarm Service Change W. W. 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. September 01, 2009 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING Permit No. EL - 07- fi PERMIT APPLICATION FBC 20 Permit Type; ELECTRICAL Owner's Name (Fee Simple Titleholder) Owner's Address L 0 g. 5.161.1 €17 S / City c � J t State F(� 1 O rvcv 3 5 Master Permit No. Phone # zip 3 '1 D Tenant/Lessee Name / / Phone # Email Job Address (where the work is being done) City Miami Shores Village County Miami -Dade Zip / SV FOLIO / PARCEL # Is Building Historically Designated YES NO y Flood Zone Contractor's Company Name fro k A i E1eC.-41r4 1 U oCQ„C Phone # (7 ) 3n a7 f Contractor's Address 6p AJW 1t4 T- j City 1414412k. State F Zip 3 I Qualifier Name Qv/7sta0 Ak�.QQ . Phone # (7 60 3qq - 762- State Certificate or Registration .• No. k /307264 Certificate of Competency No. 63 E b-cei Contact Phone(776)8q'? E-mail 762___ Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ / 7 () Square / Linear Footage Work: Type of Work: ['Addition ['Alteration ❑New Repair/Replace ❑ Demolition Describe Work: Rep /acP eK'I 5 -414' r:OtJtl -41e r" f P.c@_ 4 ***************************************F ********** ***** * * *** *a * * ** * * * * **** ** * * * ** x ** Submittal Fee $ Permit Fee $ /! ©t CCF $ 1-�O CO /CC $ Notary $ ' '` J Training/Education Fee $ 0 AO Technology Fee $ 4.00 Scanning $ 3'00 Radon $ DPBR $ Bond $ Double Fee $ Violation date: nn,,nn Structural Review. $ Total Fee Now Due $ O0Q - &t9" 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 FT.FCTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S A1414 )AVIT: 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspect' in fee will be charged. Signature X The for day of who i Owner or °gent oing i '.trument as ac owledg ,21ol by I Sign: Print: My Commission Expires: APPROVED BY (Revised 07 /10 /07XRevised 06 /10/2009) personally known to me or who has produced 00 12 identification and who did take an oath. NOTARY UBLIC: f me this •POP 11 Signature Contractor The foregoing instrument was acknowledged before me this f3 day of , 20 en, by QSh to t y /Q 1 ta 614. who is personally known to me or who has produced as identification and who did take an oath. '/frem pi. A C yyd -7? Sign: Print: 6 2 42u /-1A( *= k************* *** ******** *** ** *** ************ Rik$% k**** **%k+k ** ** * k*** * * #* 2 Examiner Zoning Engineer Clerk checked