EL-05-358Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 10/21/2005
Applicant: SUSAN
Owner: KOMORNIK
JOB ADDRESS: 145
Contractor ELW ELECTRIC, INC.
Local Phone: 305/345 -7398
Parcel # 1131010240310
NW 95
Signed: (INSPECTOR)
Signed: (Contractor or Builder)
Electrical Permit
Permit Number: EL2005 -358
KOMORNIK
SUSAN
ST
Contractor's Address: 21757 SW 129 AVE
Legal Description: BONMAR PARK
Page 1 of 1
PB 17 -11 LOT 13 & W1/2 LOT 14 BLK 5 LOT SIZE 75.000 X
Fees:
FEE2005 -13805
FEE2005 -13806
FEE2005 -13807
FEE2005 -13808
FEE2005 -13809
Description
Building Fee
CCF
Training and Education Fee
Technology Fee
Scanning Fee
Total Fees:
Amount
$150.00
$1.20
$0.40
$3.75
$3.00
$158.35
Total Fees: $158.35
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration: 4/16/2006 Construction Value: $1,500.00
Work: SERVICE REAPAIR
IOV02PAID
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 responisibility for all work
done by either myself, my agent, servants or employes.
BY:
BUILDING
PERMIT APPLICATIO
FBC 2001
Permit Type (circle): Building
Owner's Name (Fee Simple Titleholder)
Owner's Address / 'Y5 4 q.6
City / /l�__ � State fy`
Tenant/Lessee Name
Job Address (where the work is being done) / t 4.40 9'- 5 } :
City Miami Shores Villa e
Miami Shores Village
Building Department
County Miami -Dade
Is Building Historically Designated YES NO
Contractor's Company Nai
Contractor's Address
City Q�
Qualifier
State Certificate or Registration No. E /30 ' 130 /®
$ Value of Work For this Permit
Type of Work: DAddition [Alteration DNew
Describe Work ..y_ _ �` d 1 Ct e / } ite
* * **
Submittal Fee $
Notary $ Training/Education Fee $ Q • 40
Scanning $ 3 . 0 0 . Radon $ Zoning
Code Enforcement $
Total Fee Now Due $ Ise. as
(Continued on opposite side)
10050 N.E.2nd Avenue ShoTes, Florida 33138
T = 1:40' ) 756.8972
Permit No.
x /75 5c..& !a c _ -
Structural Plan Review. $
Master Permit No.
lumb* g Mechanical Roofing
Phone # 0 o ) 4702 ° 3 '( ‘o
Zip
Phone #
Zip
i (3 a • L (� L° 9 ( Gg ° Phone # v6' 7356
Zip
Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
/0. °t)
Square Footage Of Work:
* * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Permit Fee $ C.S . 1 ‘ CCF $ l 2-0 CO /CC.
Technology Fee $ 3. 7-5
Bond $
❑ Demolition
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 o commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, ' 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 absnce of such posted notice, the
inspection will not be approved and a reinspe ion fee will be charged
Signature
Owner or Agent / 9 0 Contractor
The foregoing instrument was acknowledged before me this /D The foregoing insttrument was acknowledged before me this (0
day of /5 , 20Q by , day of b9
, 20 ( by
who is personally known to me or who has produced
who is personally known to me or who has produced
NOTARY PUBLIC
Sign:
Print:
My Commission Expires:
* * * * * * * * * * * * * * * * * * * * **
* * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
chc
05/13/03
As identification and who did take an oath.
Signature
Zoning
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: , - � C, c_,. �a
ss
a JOR
My Commissio . �. a° Notary s
GE
..r
* * * * * * * * * * * * * * * * ** i *Snig
" ih` " ,C,�o�n� issiog Na - r'68Oct4,'
Bonded
36015
G�l'lans Examiner
Engineer
ADDENDUM TO BUILDING PERMIT APPLICATION
(AN A£PLICATION FOR BUILDING PERMIT MUST ACCOMPANY v THIS ADDENDUM.
ON SUBSEQUENT APPLICATIONS. j BE OBTAINED, YHE OWNER'S NOTARIZED SIGNATURE De=
PLUMBING
ELECTRICAL
MECHANICAL
ITEM
BATH TU3
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS
CENTRAL HEATING
DISHWASHER
RECEPTACLES
A/C (WIND)
DISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN AMPS
DUCT WORK
FLOOR DRAIN
SERVICE REPAIR/METER CHANGE
1 '
2Q9
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TOP
UNDERGROUND TANKS
LAVATORY
OVEN
ABOVE (ROUND TANKS
LAUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
MOTORS 0- 1 HP
STEAM BOILERS
SHOWER
MOTCRS OVER 1- 3 1-P
HOT WATER BOILERS
SINK, POT /3 COMP.
MOTCRS OVER 3- 5 HP
MECHANICAL VENTILATION
SINK, RESIDENCE
MOTCRS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTORS OVER 8- 10 HP
ELEVATORS/ESCALATORS
TEMPORARY WATER CLOSET
MOTCRS OVER 10- 25 HP
FIRE SPRINKLER SYSTEMS
URINAL
MOTORS OVER 25-100 FP
COOLING TOWERS
WATER CLOSET
MOTORS OVER 100 HP
VIOLATION
INDIRECT WASTES
A/C WINDOW
REI.NSPECT1ON
WATER SUPPLY TO:
AIR CONDITIONERS
A/C UNIT
STRIP HEATER
FIRE SPRINKLER
GENERATORS TRANSFORMERS
i
'HEATER -NEW INST.
GENERATORS
HEATER - REPLACE
GENERATORS TRANSFORMERS
LAWN SPRINKLER -WELL
SPECIAL PURPOSE
SWIMMING POOL
OUTLETS COMMERCIAL
WATER SERVICE
SIGN TUBES
SEWER CONNECTIONS
••SIGN
TRANSFORMERS
UTILITY -SEWER
SIGN TIME CLOCK
UTILITY -WATER
FIXTURES
SEPTIC TANK
ANTENNA
RELAY
'TELEVISION OUTLETS
DRAINFIELO, 4' TILE/RES.
VIOLATION
PUMP & ABANDON SEPTIC TANK
. REINSPECTION
SOAKAGE PIT CU. FT.
CATCH BASIN
-
_
DISCHARGE WELL
"
DOMESTIC WELL
AREA DRAIN
ROOF INLET
SOLAR WATER HEATER
FIRE STANDPIPE
POOL PIPING
I
LAWN SPRINKLER SYSTEM
I
I
GAS RANGE
(
i
METER SET (GAS)
I
GAS PIPING
ADDENDUM TO BUILDING PERMIT APPLICATION
(AN A£PLICATION FOR BUILDING PERMIT MUST ACCOMPANY v THIS ADDENDUM.
ON SUBSEQUENT APPLICATIONS. j BE OBTAINED, YHE OWNER'S NOTARIZED SIGNATURE De=
PLUMBING
ELECTRICAL
MECHANICAL