EL-09-1645Project Address
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000
Phone: (305)795 -2204
1294 96 Street
Miami Shores, FL
1132060143840
Block: Lot:
BRIAN BLACK
Owner Information
Address
Parcel Number
Expiration: 0410612010
BRIAN BLACK
1294 NE 96 ST
Miami Shores FL 33138
(678)986 -2032 (305)803 -3176
Valuation:
Total Sq Feet:
$ 1,000.00
Contractor(s)
METPLANET ELECTRICAL
Phone Cell Phone
(754)214-1695
Phone
Type of Work: ELECTRICAL
Additional Info: NC UNIT HOOK UP
Classification: Residential
Fees Due
CCF
Education Surcharge
Notary Fee
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Amount
$0.60
$0.20
$5.00
$160.00
$3.00
$4.00
Total: $172.80
Invoice #
Total Amt Paid Amt Due
EL -10-09 -36098 $ 172.80 $ 172.80 $ 0.00
Applicant
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.
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
October 09, 2009
October 09, 2009
Date
Cell
1
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: ELECTRICAL
Owner's Name (Fee Simple Titlehold_., Vern
Owner's Address
City,
Tenant/Lessee Name
Email
State
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
.333
Permit No. Lt..1 CR ROC
Master Permit No. ,/C //-
�l Phone # (JI 7) 9 7,4 9/ 2_
Phone # ,e 7g
Job Address where the work is being done) _____ /' t I9 £7C 6-
City ; - 74 iami Shores Village County Miami-Dade Zip ,j a4.3 / J
FOLIO / PARCEL #
Is Building Historically Designated YES
Contractor's Company Name
Contractor's Ad
City
Qualifier Name
Describe Work:
ess
State Certificate or Registration No.
Contact Phone 7
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $
Type of Work: ['Addition
4/7' Celze.4i
con
❑Alteration
,vS
Notary $ - (�� Training/Education Fee $ d 20
Scanning $ Q Radon $ DPBR $
Double Fee $ Violation date:
NO Flood Zone
Phone #
) ea/ / �f�z
Zip
Phone #
Phone #
/ ® ,4 7rCertificate of Competency No ®7 7eO 63,
�f 4 /C gir E- mail (/ �` 9, � 40/ L
Square / Linear Footage Of Work:
ENew (epair/Replace
Technology Fee $
Bond $
Structural Review. $ Total Fee Now Due $ 1 71 7. 8
See Reverse side -*
❑ Demolition
3
******** * * * * * ***** * * * * * * * * * * * * * * * * * * * ** F * * *** * * * * * ** * * * * * * * * * * * * * * * * **
Submittal Fee $ " Permit Fee $ /104d.0 CCF $ ' (Qv CO /CC $
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 MR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work wine 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
4 ■3 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 abs - - of such posted notice, the
inspection will not be approved and a re- inspection fee will be charged. `
The fo
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+ who is pers
NOTAR PUBLIC:
Sign:
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My Commission Expires:
APPROVED BY
(Revised 07 /10 /07)(Revised 06/10/2009)
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My Commission Expires:
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