PW-09-736 s+'s Miami Shores Village`s f�
10050 N.E. 2nd Avenue
Miami Shores, FL 33138- 0000rr
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o Phone: (305)795 -2204
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Expiration: 08 1031200 9
3.
Project Address Parcel Number Applicant
44S 94 Street 1132060140520
MICHAEL JOHNSON
Miami Shores, FL Block: Lot:
Owner Information Add ns Phone Cell
MICHAEL JOHNSON 445 NE 94 ST
MIAMI SHORES FL 33138 -2845
Contractor(s) Phone Cell Phone
Valuation: $ 1,000.00
TE PE OPLES GAS SYSTEM
(305)957 -3857 (305)970 -1783
Total Sq Feet: 0
Available Inspections:
Inspection Type:
Final
Excavation
Fees Due Amount Invoice # Total Amt Paid Amt Due
CCF $0.60 PW_5-09 -34700 $ 106.30 $ 106.30
Education Surcharge $0,20 $ �'��
Permit Fee $100.00
Check #: 1938
Scanning Fee $3.00
Technology Fee $2.50
Total: $106.30
In consideration of the issuance to me of this permit, 1 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 taws regulating
construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated
May 11, 2009
Authorized Signature: Owner / Applicant / Contractor / Agent Date
Building Department Copy
Mav 11, 2009 1
0
rZ4AM
' MAY 01 2009
e
Miami shores Vi-Ilage
Public Works Department
10050 N.E. 2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 7952204 Fax (305) 756.8972
Public Works tom.
Permit Application
FBC 2004
PermRType. Mile Waikat WATER
(j�'� Phone #. t
Owners Name (Fee Simple lVetwlder) l' (
i �0► l�
Owrtm's Address
S
cit 0-1 m] Suft ZIP
Tenn MAssee Nary Phones:
Job Address WwWo to wo I Wsbeing
S 6 T 4S� odleu wau 1 t� S
City Miami Srwres vie Dad. ZIP
Is Building NistotioW ly Designated: YES NO '
Contractor's Phone is
Contrador"s
�� - 1 '3 M OM W(4
7 +
C." t Smte mp 3
anus
ArdritedtEngineaes Name Of Phone S:
$ Value or Work For oft penn � i� A J + W ' Lineai.Footrage Ot Work
Type of Work ❑ Addition ❑Al6erallon ❑ New ❑ RepeirMeplace ❑ DertmBbOn
Describe work
»� Fees � o r ^
Submittal Fee $ ✓� + Permit Fee Y t>O CCF $ ►1L -�—
Notary $ ..-+" Trand�on Fee $ Technology Fee S
Scanning $
,� + Radon $ Zoning Bond Y
Code Entorc enwat ueUual Man Review $
1? 10(Q - 3 0
t `'
Total Fee Now Du
(Continued on opposite side)
Bonding Company's Name (if applicable)
Bonding.Comparr/s Address NIA
City State Zp
Mortgage Lenders Name ('d applicable) NIA
Mortgage Landers Address
City State z
Application In hereby nude to obtain a permit to do the work and installations as Indicated. I certify 00 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 coructton 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 cowmONERS, ETC....
OWNER'S AFFIDAVIT: i certify that all the foregoing Informatiion 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 IIIIIPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANICM CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMIEs'NICE IEN 7 -r
fdoNce to Applkarrl: As a condfHon to this Issuance of a Pubic Works permit with an saffmmted vefue exceeding $2500, the applicent must
promise In good faftr that a copy of ire noe= of cxm menconmrrt and car Ron tow broduve wN be e # to the person whose
properlyfs subject to oftafterrt, Alt, a ceri fred copy of Me r�misof rxdw of commet.gunerdmust be at the ir aye forgo End
Inspection which oc om so mn (7) days aft ft building permit is issued. in the absence of such posted nice, ire Inter wtl not be
appmved and a refngxxbon fee wN be charged
Signature Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me taus The foregoing instrument was ackriowledged before me this
day of 20� by day of 20_, by
who is personally known to me or who has produced Who Is personally know to me or has produced .
as identification and who did take an oath. as idenific:ation and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: Print:
My Commission Expires: My Commission Expires:
APPLICATION APPROVED BY: " Public Works Director or
his designee.
11/17/2005
I
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 331;38
Tel: (305) 795.2204 Fag: (305) 756.8972
BUILDING Permit No.
PERMIT APPLICATION Master Permit No.
FBC 2004
Permit Type (circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) &e_/ nS6r7 Phone # C
Owner's Address ' j�'a5 /✓ c "s2T
City State zip
Tenant/Lessee Name Phone #
Job Address (where the work is being done) _?`''S G VCV2.E i v i��v ..d LCt ! t4 A -SrAez Cr1
City Miami Shores Village County Miami -Dade zip,
FOLIO / PARCEL # Z.O fo - 052 Q :Lai 2es f.2,1 R195
Is Building Historically Designated YES NO
Contractor's Company Name 7Z�26 P&:1pler JAU ' Phone # 170 /373 Sr6vY�
Contractor's Address / G 77 241t3T ,0 ;146 A&V m . n9 c
City A 4W M ,,4 pry. 4 State r / zip '..3a /40e7
Qualifier Name J,QSUS Yq
m , I ( Phone #
State Certificate or Registration No. Certificate of Competency No.
Architect/Engiaieer's Name (if applicable) �� r°� Phone # ,?4,5' 9 76 '/ 3 7!3
y �
Value of Work For this Permit $ fit' co o&
Square! Linear Footage Of Work:
Type of Work: ❑ ❑Alteration INew- ❑ Repair/Replace ❑ Demolition
Describe Work:
ear 4wr ro ` toco , 4
��✓ ./�-L Lam' liicc y IAI 4 44JW
Submittal Fee $ Permit Fee $ r � CCF $ C AIE"�
Notary $ Training/Education Fee $ Technology Fee $
Scanning $ Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ 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 i 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 CU O
the
P noti d C omm
g .f commencement and construction lien law brochure will be delivered to the person
Py o r d e
.f f
P
whose property is subject to attachment Also, a certified ed 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 Signature . �„/
Owner or Agent Contractor
The foregoing instrument was acknowledged me this The foregoing instrument was acknowledged before me this
day of , 20 _ by day of . 20 by ,
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take ath
NOTARY PUBLIC: NOTARY P `^^^�
' STEVEN L. MITCHELL c
MY COMMISSION # DD83
EXPIRES: Novanba 29, 2012
1 - NOTARY FL
Sign Sign: >. Co. AA
Print: Print:
My Commission Expires: My Commission Expires:
APPLICATION APPROVED BY - F9 Plans Examiner
Engineer
Zoning
(Revised 02t08/06)
PgS 237 Rev 1099
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Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 113130 Permit Number: PW -5 -09 -736
Scheduled Inspection Date: July 09, 2009 Permit Type: Public Works
Inspector: Levrock, James Inspection Type: Final
Owner: JOHNSON, MICHAEL Work Classification: Public Works
Job Address: 445 NE 94 Street
Miami Shores, FL Phone Number
Parcel Number 113206014052
Project: <NONE>
Contractor: TECO PEOPLES GAS SYSTEM Phone: (305)957 -3857
Building Department Comments
PROPOSED: 70' OF 314 PLASTIC GAS SERVICE FROM
EXISTING 2" BSE NAT. GAS MAIN BORE TO GET TO
RISER LOCATION AT 445 NE 94 ST ON ALLEY WAY.
Spec r mff a is w
Passed
Failed `
Correction
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
July 08, 2009 For Inspections please call: (305)762 -4949 Page 12 of 28