EL-10-883a
BUILDING
PERMIT APPLICATION
FBC 2001
Total Fee Now Due $
(Continued on opposite side)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Architect/Engineer's Name (if applicable)
s� ®
$ Value of Work For this Permit C, (D• Square Footage Of Work:
(- c. rl G(rr - ■
1
NAY A 8 2010 Ai
BY:..
Permit No. -7.... I U ` o 3
Master Permit No.
Permit Type (circle): Building •• 1 Plumbing Mechanical Roofing
ic 7 Owner's Name (Fee Simple Titleholder) Phone # ✓ ! S c09
Owner's Addres Liao Y `� E 9 C
City. C, � � `ei State L Zip 3 3 / 3 8
Tenant/Lessee Name Phone #
Job Address (where the work is being done) 4 (v I\) 2
City Miami Shores Village County Miami -Dade Zip f ( J
Is Building Historically Designated YES NO
Contractor's Company Name �) 4 C (J 1 et-3 Lf ° l Phone # J ¥O L ` V
Contractor' Ad (
dress 4 9) w(A) I ? S '� / 4 °
/ L_ Zip 3
Cit (� �C ( r State J /
Qualifier k..0 (A [ c c /3 d
Phone #
Type of Work: ❑Addition teration ❑New ❑ Repair/Replace ❑ Demolition
Describe Work:
** * *** ** * * ****** ***** **a *, *F * *, *, * *, *,r*** * *** * * * * * * *** ** **
Submittal Fee go • 00 Permit Fee $ /o . 0e) CCF $
Notary $ ..- tC training/Education Fee $ Technology Fee $
Scanning $ Radon $ Bond $
Code Enforcement $ Structural Plan Review. $
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 #livered to the person
whose property is subject to attachment. Also, a certi copy of the recorded notice of commencement must ' e posted at the job site
for the first inspection which occurs seven (7) days after t building permit is issued In the absence such posted notice, the
inspection will not be and a reinspection fee will be hanged
Signature
Owner or Agent
The foregoing instrument was ackno edged before e this if
day of 20 _, by G 4
who is s�known to me or who has produced
P Y Pr
My Commission Expires: '
APPLICATION APPROVED BY:
Chc 10/14/03
Signature
(Certificate of Competency Holder)
Air
'Contractor
efore me this /1
(4q
The
foregoin instrument was acknow dged
day of 20 /�, by p.
who is personally known to me or who has produced
NOTARY PUBL
Sign:
Print:
My Commission Expires:
State Certificate or Registration No. Certificate of Competency No.
* * * * * * * * * * * * * * * * * * * * * * * * * * * ** ********************************** * * * * *** * * * * * ** * ***** * * * * * * * ****
Plans Examiner
Engineer
Zoning
er,sselg
Inspection Number: INSP - 151983
Scheduled Inspection Date: October 06, 2010
Inspector: Devaney, Michael
Owner: HAILE, GREGORY & CHAE
Job Address: 410 NE 94 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: BROADVIEW SECURITY
Building Department Comments
October 05, 2010
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
eL.
10 -13K?
Permit Number: EL -5 -10 -883
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alarm
Phone Number
Parcel Number 1132060140360
Phone: (305)406 -3940
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
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