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EL-04-38BUILDING PERMIT APPLICATION FBC 2001 $ Value of Work For this Permit O d ?° c . 05 13 ***************a************ Fees* * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ a_)-00 Permit Fee $ /ate'to' e. CCF $ Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ Bond $ Code Enforcement $ Structural Plan Review. $ Total Fee Now Due $ (Continued on opposite side) Miami Shores Village Building Department M -i31 FEB R 7 2004 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. E 1 3E( Master Permit No. eiZ(6A ' 1 3 Permit Type (circle): Building Electrical Plumbing Mechanical Roofing Owner's Name (Fee Simple Titleholder) 1 4 1111 SSf `a Js9 +C I (qyl Phone # t)S S L " (3Z 6 Owner's Address 6 0 C2 - L! 5i-reek- Ciord' � � � 3 L ,�� City M 1 arY11 CIA 6 185 State Ft-Obri do zip Tenant/Lessee Name AI* Wlfe,J e s &Y'Uift, Phone # 4 1-67-- 6 61-- S C 9,1 Job Address (where the work is being done) 6 0 2 - N E 9 C ,S free City Miami Shores Village County Miami Dade Zip S � J «O Is Building Historically Designated YES NO X Contractor's Company Name 11 LL i Phone #(3) (2(3z-1,046 Cont Pany Contractor's tt.ddress 411 r Q J 'Dr ®� City _ 1' ; / ' y ' . [Ia �� State Zip Qualifier 1� �+ G I la rn i1 ja Architect/Engineer's N a m e ( i f a p p l i c a b l e ) M PrC T C P h o n e # 3 0 5 2 5 g g Square Footage Of Work: Type of Work: XAdclition ❑Alteration ❑New ❑ Repair/Replace ❑ Demolition Describe Work: AY\ keAY\ d�l,l n fro € legs G© m M n fcfl1 -1-j 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 Zi p 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 to the person 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 absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged • Signature 0 i� ' �,r- P ,`� .e , =s:. � o 4; . Expires: Sep 03, 2007 ,, ,,,, Bonded - 11m Atlantic Banding Co., Inc. Sign: Print: R L My Commission Expires. J3�� APPLICATION APPROVED BY: le 10/14/03 . 1 •II NOTARY P Sign: Print My Co � \o I_.rie. on Expires: ********************************************* * * * * * * * ** * * * * ** * * * * * * * * * * * * * *** �'�1 (Certificate of Competency Holder) C_J State Certificate or Registration No. �_ — 0 1)06 'S Y Certificate of Competen - - . ctor The forego' g instrument ' ., • ck �T' Ey nowl - _ed efore me this 14 The foregoing instrument was acknowledg before me this day of , 20c!-, by MINTY IN , day of Q10� {�,� by, 20 2 � by a � / �a� ', I �I rJ wfio s personally known me or w o has produced .�pFIY As ide who is perso Alt known to me or who has produced as identification did take an oath. JOLENE GUFFEY Notary Public State of Florida vty comm expires'March 13, 2006 Comm No DD99734 ******************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** .*-** ********************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** 7/ e� Plans Examiner Engineer Zoning Correction Re- Insp'n Fee MIAMI SHORES VILLA BUILDING DEPARTME 305- 795 -2204 Building Inspection Request Date Type Insp'n Permit o. ` L 1 3 , Address 0 j .2 7(1 : 44 Comp Phone # Inspection Date t y Approved ITK Applicant: Owner: JOB ADDRESS: 602 NE 96 Contractor WINGATE ELECTRICAL Local Phone: Parcel # 1132060141410 Electrical Permit Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Permit Number: EL2004 -38 Printed: 3/1/2004 ST Contractor's Address: 4715 MONTEREY DR Page 1 of 1 Legal Description: MIAMI SHORES SEC 2 PB 10 -37 LOTS 1 TO 10 INC BLK 61 LOT SIZE Fees: FEE2004 -2191 FEE2004 -2192 FEE2004 -2193 FEE2004 -2194 Description Building Fee CCF Training and Education Fee Technology Fee Total Fees: Amount $100.00 $0.60 $0.20 $2.50 $103.30 Total Fees: $103.30 Total Receipts: $% 53.30 cK 4051 Permit Status: APPROVED Permit Expiration: 8/15/2004 Construction Value: $500.00 Work: ANTENNA ADDITION TO EXISTING WIRLESS COMMUNITY Signed: (INSPECTOR) alga Z 0 wol 3 4oS sp--g 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. Signed: (Contractor or Builder) BY: