EL-10-858Miami Shores Village
Building Department irmAC7111 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 v Tel: (305) 795.2204 Fax: (305) 756.8972 �` 1�'
INSPECTION'S PHONE NUMBER: (305) 762.4949 A/27.7. .
BUILDING Permit No. el-10 ' Z . S V
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type: ELECTRICAL
Owner's Name (Fee Simple Titleholder) 14 e tr'i b-e r 4 C 1- 1'2 Phone # g 6 38' E 4 45)- Z_
Owner's Address 100 0 P . ' ° 6 .S - r
City 1 10 S N'D(�“State
Job Address (where the work is being done)
Tenant/Lessee Name Phone #
Email L' . r 7. ® ®1 It) Le . .
City Miami Shores Village County Miami -Dade Zip 33138
FOLIO / PARCEL #
1000 G. 9 6 '
Zip 331 38'
Is Building Historically Designated YES NO Y Flood Zone
Contractor's Company Name t•'% CL EL
c c�Z`C� d°,n
Contractor's Address l(- C-, 0
Architect/Engineer's Name (if applicable)
Spa e
. CCU - t 3OI 9-t )
Phone #
o
City ( k.0 ZL11�\ State L Zip ? t 3
Qualifier Name r cR I Cur cz1/4..c 0 Phone #_(220 4— (?
State Certificate or Registra (` r
Contact Phone E -mail (t-- Ej.e h � f cLa
Certificate of Competency No. CC-g (') 9 EC c) ( )
Phone #
Value of Work For this Permit $ 2000 00 Square / Linear Footage Of Work: 144
Type of Work: DAddition ❑Alteration :New I ❑ Repair/Replace ❑ Demolition
Describe Work: 1∎.) t� (
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4.
4T ) oltr
C' a
.......... ,,,,,,,,,,,,,,..,,..,,,,, ,, Fees * * * * ** * * * * * **** ..* * **** , *. *,, * * * * * ** *x
Submittal Fee $5 . co Permit Fee $ ,Z,..4 - -1.;t CCF $ 1 • /0 CO /CC $
Notary $ g C)-• Training/Education Fee $ 0 °L 0
Scanning $ _2_ 0°. Radon $ On DPBR $ on 2—
Double Fee $ Violation date:
Structural Review. $ Total Fee Now Due $ t 1 .
See Reverse side —>
Technology Fee $ 1- (4 e
Bond $
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered e person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be pos at th - job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such piosted Mice, the
inspection will not be approved and a re- inspection fee will be charged.
Sign:
Print:
Owner or Agent
The foregoing instrument was acknowledged before me this 1
day of 11/1A'1 , 2010, by N 12. 10-62- Cieduz
who is personally known to me or who has produced \ ( )
As identification and who did take an oath.
NOTARY PUBLIC:
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My Commission Expires:
* * * * * * * * * * * * * * * * *
APPROVED BY
(Revised 07 /10 /07)(Revised 06/10/2009)
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•
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Engineer
Signature
ontractor
The foregoing instrument was acknowledged before me this ( L
day of 'nom , 20 tv , by <S ( CS 1KJt 1 O
who is personally known. 8 me or who has produced A- ID
C. O 4.1 el `' as identification and who did take an oath.
NOTARY PUBLIC:
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t1�t1?$P� ��� ✓
Sign: e ''.
��
Print: _ 4. 4� W C '.
My Commission Expires:_ %
****************** *** ********************************:Wr
4 1 . 4444A4itle
/ /'Plans Examiner Zoning
Clerk checked
Inspection Number: INSP- 149448 Permit Number: EL -5 -10 458
Scheduled Inspection Date: July 29, 2010
Inspector: Devaney, Michael
Owner: PRICE, ELIZABETH
Job Address: 1000 NE 96 Street
Miami Shores, FL
Project: <NONE>
Contractor: JCL ELECTRICAL CORP
Building Department Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
\7
July 28, 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
P
\o' c) 7
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number
Parcel Number 1132060143560
Phone: (305)498 -7268
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