EL-10-1482BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: Electrical
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
Permit No.El
10
Master Permit No.
OWNER: Name (Fee Simple Titleholder): nZ a1 f n q G rL t h Phone #: V6 B 4. 8 .S 8'3 O
Address: 1 13 lie 101 S+ . C +- ()Ink 13
City: M t 4 fil t S h b NZ S State: TS-- Zip: X3 13 $
Tenant/Lessee Name: Z at V) H . (l ✓ e. [ Yl Phone #:
Email:
h 1 0 1 S+Yz -1-- Un +' 2,
City: Miami Shores County: Miami Dade Zip: 3 3 rag
g
Folio/Parcel #:
Is the Building Historically Designated: Yes NO L Flood Zone:
CONTRACTOR: Company Name: S L L U v t -1- S S+ e� f Phone 5 16g 9 00
_ _
Address: 2. 1 1 nu, b9 S 4 --- 1 � .X 8
City: rvItearvi 1 State: � .. ] Zip: 3 1 b
Qualifier Name: �';.'� ��: tin 4 Y 4— 1 h G 4� D Phone #: - 3 0 3 a0C) 3 i. an
State Certification or Registration 50d E F Z 00 0 V 1-S 9 Certificate of Competency #:
Contact Phone #: .5' �!"" 37 � Email Address: t 11/14 V t i 11 P Sr LU r i 4) S y .S, tL rl).i s • con.
DESIGNER: Architect/Engineer: Phone #:
JOB ADDRESS: 1 1 3
,
Value of Work for this Permit: $ OO + Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration // 4N ❑Repair/Replace ❑Demolition
Description of Work: , 3V P,1 " r `li r'^"''
******* * * *** * ***** ** * * ***** * *** * ** * * ** F ** * ** *** * * *** * * ** ** *** ** * * * ****
CZEVED
AUG 1 7 '=p
BY: ..�f
Submittal Fee $ Permit Fee $ ,,/et,) ,e, n CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
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 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.
Signatur
er or Agent
The for oing i strument was a owledged befor
day of
who i
NOT
Sign:
Print:
PUBLIC:
My Commission Expires:
•
by
known to me or who has produced
As identification and who did take an oath.
Structural Review
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3 /15/09)
`di The for
day of
1 /1 who is
Signature t/
Contractor
PUBLIC•
Sign:
Print:
My Commission Expires:
oing in trument was acknowl• be'� re me t i irr
, 20 10, by -_ L 1r i k +/Y i/
known me or who has produced imr.k
tification and who did take an oath.
t6} oks .0.0 i`•
, ;1 "a c S:X.� + 0idL
******** * * * * * * * * * * * * * * * **** * * * * * *m *** ** �** *** Is m * * * * * * **
/ N
/? Plans Examiner
Zoning
Clerk
lv
Inspection Number: INSP - 150351 Permit Number: EL -8 -10 -1482
Scheduled Inspection Date: August 24, 2010 Permit Type: Electrical - Residential
Inspection Type: Final
Owner: GREEN, GIL & DEANNA Work Classification: Alarm
Job Address: 113 NE 101 Street
Miami Shores, FL 33138-
Inspector: Devaney, Michael
Project: <NONE>
Contractor: SECURITY SYSTEMS SOLUTIONS CORP
Building Department Comments
August 23, 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
Phone Number
Parcel Number 1132060131910
Phone: (305)468 -8900
ALARM SYSTEM INSTALLATION FOR DETTACHED
GUEST HOUSE ON THE BACK OF THE PROPERTY
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
97z._
Page 32 of 35
08/17/2010 03:20
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