EL-07-1080BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type: Electrical
Owner's Name (Fee Simple Titleholder)
Owner's Address
City 41 , $ 4.
Tenant/Lessee Name
E -MAIL:
Job Address (where the work is being done) '
City Miami Shores Village County Miami -Dade
FOLIO / PARCEL # f f — 27.30 , fl ° o c9 o
Is Building Historically Designated YES NO Xi
Contractor's Company Name
Contractor's Address
City ' ,
Qualifier Name
Value of Work For this Permit $
Miami Shores Village J .
Building Department tan
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
MAY 252
BY:
TgP CAi-e-l/
/50/ ,r, /o3 SQL
State
A/4
o A d a 03, 4 etAle,
State FL
State Certificate or Registration No. 66 (3o XS -62 Certificate of Competency No.
E -MAIL: JA.ks fq9 B .!,50 ,I
Architect/Engineer's Name (if applicable) Phone #
Permit No. 6101- OW
7 Li
Master Permit No. - 0 7 9
Zip
33 /31
Phone #
Phone # 30 C � .- S
zip (33/
Phone # 7 '9.4 09.92
Square / Linear Footage Of Work:
Phone # ?X 2 g 07o 7
i
Type of Work: ❑Addition Alteration piNew
1 /a
�. /
Describe Work: 1 l i ' S 5' � 6 04 , 0�
/CCi' S 03--c(4/
Zip
❑ Repair /Replace ❑ Demolition
x xxx x x** * * * ** * ** * * * * * *** * * * * * * * ** * *** F ees* * *** * *** * ** * * * ** *** * * **** * * * * ** * * * ****
Submittal Fee $ Permit Fee $ /J Bi0
Notary $ Training /Education Fee $ (
Scanning $ 5 Radon $
DPBR $
Bond $ Code Enforcement $
Double Fee $
CCF $ I '90 CO /CC
Technology Fee $ 3 ��
Zoning $
Structural Review. $ Total Fee Now Due $ ) 58
See Reverse side -a
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. 1 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. l 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 r inspection fee will be charged
/"
Signature
NOTARY PUBLIC:
APPLICATION APPROVED BY:
(Revised 02/08/06)
Owner or Agent
The foregoing instrument was acknowledged before me this
day of ,20,by
who is personally known to me or who has produced
The fore
day of
who is p - rsonally
As identification and who did take an 040.'06 00"
Sign:
Print:
My Commission Expires:
x *x &xxxxxx* 4exxxxxxx *xx xxx aF xxu *4cxa4exxdc***wuxx*xxxxxxa **Irwxx
Co tractor /,
rug ent was nowledged before me this `
, 20 ,
� n�nt�to�e or who has produced 12(i
s�itntification and ' did take an oath.
My Commission Expires:
w* * **ve***wit*wwwww*w*acw****
Plans Examiner
Engineer
Zoning
ELECTRICAL FOR INTERIOR ALTERATION CLOSE A
DEN WITH 2 PARTITIONS
\ 60
Passed
Inspector Comments
ML D
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid
until
Vie@ :r;, bee \
�, rtes
\ � FX• - �` - � .
Inspection Date: 12/07/2007
Inspector: Devaney, Michael
Owner: POWELL, JEFFREY
Job Address: 1501 105 Street NE 1 -11
Miami Shores, FL
Project: <NONE>
Contractor: JAKE'S ELECTRIC, INC
Building Department Comments
Thursday, December 6, 2007
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
................
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Block:
�cc�1 -�6a
eL , Phone Number (786)286 -0107
Parcel Number 1122300530590
Lot:
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