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BP-05-114Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 2/9 /2005 Applicant: SCOTT Owner: CLARK JOB ADDRESS: 62 Contractor Local Phone: Parcel # 1121360110030 Signed: NE 108 (INSPECTOR) Building Permit Permit Number: BP2005 -114 CLARK SCOTT ST Contractor's Address: Permit Status: APPROVED Permit Expiration: 7/25/2005 Construction Value: $15,000.00 Work: REPLACE KITCHEN CABINETS Page 1 of 1 Legal Description: 36 52 41 PB 52 -33 DUNNINGS MIAMI SHORES EXT NO 7 LOT 3 Fees: Description Amount FEE2005 -1746 Building Fee $450.00 FEE2005 -1747 CCF $9.00 FEE2005 -1748 CO /CC $50.00 FEE2005 -1749 Notary Fee $5.00 FEE2005 -1750 Training and Education Fee $3.00 FEE2005 -1751 Technology Fee $11.25 FEE2005 -1753 Scanning Fee $9.00 FEE2005 -1754 Submittal Fee ($50.00) Total Fees: $487.25 Total Fees: $487.25 Total Receipts: $0.00 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: Bill To SCOTT CLARK 62 NE 108 ST MIAMI SHORES, FL 33161 -7036 Return to: I Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Date Fee Name 09/12/2006 RENEWAL Tuesday, September 12, 2006 Invoice Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Invoice Number: imp -9 -06 -26130 Invoice Date: September 12, 2006 Permit Number: BP2005 -114 Fee Type Calculated Total Fees Due: Fee Amount $75.00 $75.00 Payments Date Pay Type Check Number Amount Paid Change 09/12/2006 Check 7603 $75.00 $0.00 Total Paid: $75.00 Total Due: $0.00 I 8/22/2006 To: Current Owner 62 NE 108 Street Miami Shores Village, FL 33138- Dear Sir or Madam Sincerely, MabeWargas Administrative Assistant Miami Shores Village Building Department 10050 NE 2 Ave, Miami Shores, Fl 33138 Tel: (305)795 -2204 • Fax; (305)756 -8972 Permit: BP2005 -114 Address:62 NE 108 Street Miami Shores Village FL33138- Date Expired: 7/25/2005 In order for us to serve you better, we need to keep our files up to date. Our records indicate that the above reference Permit has expired. The Building Department has determined that the work applied for has been completed with out the required inspections and it has been more than 180 days since your last approved inspection and thus your permit has expired as per Sec. 104.5.of the Florida Building Code. You are required to renew your permit and schedule all required inspections. In the event you do not comply with the requirements herein, the Building Department will file a complaint with Miami -Dade County Building Code Compliance Office for possible disciplinary action against your licensed contractor And/or if permit was obtained by the home owner the requirements of the Unsafe Structure Code of Miami Dade County Sec. 8 -5. (3) will apply. "The building shall be presumed and deemed unsafe and a permit shall be obtained to demolish the structure or bring the building in to compliance with applicable codes as provided herein." Please contact the Building Department, immediately upon receipt of this letter. s E ; 7 t S7Or BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Owner's Name (Fee Simple Title . i 7T Z 7 �_ � Phone # Owner's ddress City ,n State l Zip ,3, /4" / Tenant/Lessee Name Phone # Job Address (where the work is being done) /OE— /01 City Miami Shores Village County Miami -Dade Zip 3,0 lea/ Is Building Historically Designated YES NO Contractor's Company Name. °c lJ ne Y' Phone # Contractor's Address City State Qualifier State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # $ Value of Work For this Permit Type of Work: ❑Ad.. on ❑Alteration Describe Work: Jz diet Notary $ Training/Education Fee $ Scanning $ Radon $ '`'—› Electrical Plumbing Mechanical Roofing Code Enforcement $ —, Structural Plan Review. $ Total Fee Now Due $ n inued on opposite side) Permit No. Master Permit No. Square Footage Of Work: opon-liq / 7, 7.-- `. Zip tocr ['New Repair/Replace emolition Submittal Fee $ no .00 Permit Fee $ CCF $ Technology Fee $ ! a s C /C C 5?) Zoning ' 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 FI.FCTRICAL 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. NOTARY Sign: Print: r Si gnature Contractor The forego s g instrument was acknowl B before me this �G�O _ The foregoing instrument was acknowledged before me this day of 20 05 by 5a a (0 rL- y e day of , 20 by who is pers onall known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath NOTARY PUBLIC• Mabel \- ,.trga .`�P�e . 1,23198 Sign: *.= Expires: Ju 1:3, 200 Print: va . l Rl My Commission Expires: APPLICATION APPROVED BY: Cho 05/13/03 Own =r or Agent Signature ' "' antic Bondine Co it My Commission Expires: ** ************************ * * * * * * * * * * * * * * * * * * ** * ** * * * * * * ** ************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** FEB 0 9 NM Plans Examiner Engineer Zoning t, VILLAGE OF MIAMI SHORES BUILDING DEPARTMENT OWNER BUILDER DISCLOSURE .STATEMENT Owner 47M-- being the legal property owner, for the property Legally described as . Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S. 489.103(7),,•gnd I have read and understand the following disclosure Statement, which entitles me td *ork as my own contractor, I further understand that I as the owner must appear in person to complete all applications. DISCLOSURE STATEMENT State law requires construction to be done by licensed contractors. You have applied for a permit under an exemption to that law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two-family residence or a farm out - building. r You may also build or improve a commercial building at a cost of $25,000.00 or less. The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is completed, the law will presume that you built it for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as your contractor. It is your responsibility to make sure that people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A. and with- holding tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, building codes and zoning regulations. Proof of ownership provided ( ) initial of reviewing clerk. Tlie foregoing instrument Was acknowledged before me this day of . , 20 03 •. PI By $CCYJ+ Q (O IC y who is personally known to me or who has Produced as identification and who did take an oath. O ' bej M /,argaC E xpires:: hi 1,3, 2007 1-antic Bonding Co.. Inc 41ts "flyAG- VA; - co PAhyr it.9 • gVA — BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building $ Value of Work For this Permit Total Fee Now Due $ (Continued on opposite side) Miain Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Electrical A— � Phone # Owner's Name (Fee Simple Titleholder) Owner's Address c71. ®l.) 1 , / ,-- City y errn, / State . 2,---- Zip OR/69 / Tenant/Lessee Name Phone # oA)L /4)3. Type of Work: ['Addition ['Alteration / New Describe Work: g- S Permit No I 0 s Master Permit No. 8PQS I I L Mechanical Job Address (where the work is being done) City Miami Shores Village County Miami -Dam Zip eg, /. 6/ Is Building Historically Designated YES NO Square Footage Of Work: Repair/Replace ECE E© �c 2 4,N �l �3 195 e'S.6 tom; Roofing Vi a , "�� �- G c 1 Contractor's Company Name OW 1 1 -( Phone # Contractor's Address City State Zip Qualifier State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # ❑ Demolition 'Ai i J2 J * * * * * * *,* * * * * * ** *,* * * * *,* * * * ** *Fees* * * *** * * * * * * ** * ** * * * * * * ** Submittal Fee $ 50 .00 Permit Fee $ /30 CCF $ 4.0 0 CO /CC,- Notary $ Training/Education Fee $ - Technology Fee $ o Scanning $ Radon $ Zoning Bond $ Code Enforcement $ Structural Plan Review. $ Bonding Company's Name (if applicable) Bonding Company's Address City Si The for day of who is NOTARY PUBL Sign: Print: er or Agent going instrument was acknowledge 203by My Commission Expires: * * * * * * * * * * * * * * * * * * * * * * * * * * ** ** ** ** *** * * * * * * * * * ** ** * ** * ** APPLICATION APPROVED BY: Chc 05/13/03 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 FT ,RCTRICAL 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 IlVIPROVEMENTS 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. efore me this C to v 11abC;A ���Y ^`as sonally .a ' to me or who has produced As identification and who did take an oath. Signature Contractor The foregoing instrument was acknowledged before me this day of ,20by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: orimmsion DD231 Expire J: 13, 2007 ** * ** * *' igii 1!******************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** anlic howling CO . Inc My Commission Expires: *** ****** ** ** * * * * * * * * * * * * * * * * * * * * ** * * * * * ** ** *fie * * * * * * * * ** i 5 Plans Examiner Engineer Zoning ITEM BATH TUB UNIT • FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES A/C (WIND) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/METER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY OVEN ABOVE GROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 FP STEAM BOILERS SHOWER MOTORS OVER 1- 3 If HOT WATER BOILERS SINK, POT/3 COMP. MOTORS OVER 3- 5 HP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES SINK, SLOP MOTORS OVER 8- 10 H' ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL ` hOTCRS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 HP VIOLATION INDIRECT WARES.' A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS { HEATER -NEW INST. GENERATORS TRANSFORMERS I HEATER- REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL _ SPECIAL PURPOSE SWIMMING POOL _ OUTLETS COWERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY -SEWER _ SIGN TIME CLOCK UTILITY -WATER FIXTURES SEPTIC TANK _ ANTENNA RELAY TELEVISION OUTLETS DRAINFIELD, 4' TILE/RES. VIOLATION PUhP & ABANON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) , GAS PIPING ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 2/9 /2005 Applicant: SCOTT CLARK Owner: CLARK SCOTT JOB ADDRESS: 62 NE 108 ST Contractor Local Phone: Parcel # 1121360110030 Plumbing Permit Permit Number: PL2005 -36 Contractor's Address: Permit Status: APPLIED Permit Expiration: 7/25/2005 Construction Value: $500.00 Work: KIT REMODELING CABINETS - MASTER BP2005 -114 Page 1 of 1 Legal Description: 36 52 41 PB 52 -33 DUNNINGS MIAMI SHORES EXT NO 7 LOT 3 Fees: Description Amount FEE2005 -1755 Building Fee $130.00 FEE2005 -1756 CCF $0.60 FEE2005 -1757 Training and Education Fee $0.20 FEE2005 -1758 Technology Fee $3.25 FEE2005 -1759 Submittal Fee ($50.00) Total Fees: $84.05 Total Fees: $84.05 Total Receipts: $0.00 Signed: (INSPECTOR) 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: \ RECEIVED PERMIT APPLICATION U E3 C 7 " . FBC 2001 BUILDING Permit Type (circle): Building Owner's Name (Fee � le itleholder) Owner's Address O v City i4'Y^°` �ril;;°r State Tenant/Lessee Name Job Address (where the work is being done) 62e /t, /c' - St City Nfiami Shores Village County Miami -D,ie Zip - - C/ is Building Historically Designated YES NO Contractor's Company Name :S (4Je C Z ` C(4 chPhone # ?S / Contractor's Address /9z...5 3 4 ' / City 12.6 o/'�:Q �/Y.PJS State ' Zip ,j O 2 Qualifier .44 4 State Certificate or Registration No. Certificate of Competency No. ` : :Pe 7- Architect/Engineer's Name (if applicable) $ Value of Work For this Permit Type of Work: DAddition Describe Work: lee Total Fee Now Due $ (Continued on opposite side) Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305 756.8972 ['Alteration ['New Permit No. ,V OS Master Permit No 5 11 Plumbing Mechanical Roofing Phone # Phone # Square Footage Of Work: * * * * *** * ** * ** ** ** **** * * ** ** Fees *** * * * * * * *** * *** * * * * ** * ** * **** Code Enforcement $ Structural Plan Review. $ 1 " 35 $j2 23 Zip f� Repair/Replace ❑ Demolition Submittal Fee $ Permit Fee $ /C :P/ �! CCF $ / ' CO /CC ,-r Notary $ Training/Education Fee $ 01 40 Technology Fee $ 9� Scanning $ Radon $ Zoning Bond $ Bonding Company's Name (if applicable) 4 oOt 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 W1TH 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 (7j 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. or Agent The foreg. mg instrument was acknowledged before me this 1 da of-F'da.W M7 20®S bySeO TT 6. C:L.d e tc, who is personally known to me or who has produced PUBLIC: Si Print: My Commission Expires: PLICATION APPROVED BY: Chc 05/13/03 As identification and who did take an oath. Contractor The foregoing instrument was acknydged be fore this day of 20 Q by 4 t fQ T6 rid. d who is personally kno' ' ► me or who has produced .. tification and who did take an oath. My Commission Expire. i, '� gyres: Jul 1, 2007 oFFl• ,r Ronded Thru ROSANNE PANTALEO Notary Public, State of Florida QOyRtIPti' 'dubs' ill' f *1001 No. DD 0955844 Bonded thru Arthur J. Gallagher & Co. ******************** * * * * * * * * **** * * * * ** * ** * * * * * * * * ** * * * ** * * * ** * *• ****** * * * * ** * * * * *,x * * * *** * * * * * * * * * *** Plans Examiner Engineer Zoning ITEM BATH TUB UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES f / A/C (WIND) DISPOSAL A SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR MAIN SERVICE REPAIR /METER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS 2 PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY OVEN / ABOVE GROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 HP STEAM BOILERS SHOWER MOTORS OVER 1- 3 EP HOT WATER BOILERS SINK, POT/3 COMP. MOTORS OVER 3- 5 HP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES ` SINK, SLOP MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 HP VIOLATION INDIRECT WASTES' A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER- REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIMMING POOL OUTLETS COMMERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS .SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTURES SEPTIC TANK ANTENNA ' RELAY TELEVISION OUTLETS DRAINFIELD, 4' TILE/RES. VIOLATION PUMP 8 ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RAKE METER SET (GAS) GAS PIPING ADDENDUM TO BUILDING PERMIT APPLICATION , . *� (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 2/9 /2005 Applicant: SCOTT Owner: CLARK JOB ADDRESS: 62 Parcel # 1121360110030 NE 108 Signed: (INSPECTOR) Electrical Permit Permit Number: EL2005 -55 CLARK SCOTT ST Contractor FSH ELECTRICAL SERVICES Contractor's Address: 14253 NW 19 ST Local Phone: 954- 829 -7192 Permit Status: APPROVED Permit Expiration: 8/7/2005 Construction Value: $1,800.00 Work: ELECTRICAL FOR KITCHEN - MASTER BP2005 -114 Page 1 of 1 Legal Description: 36 52 41 PB 52 -33 DUNNINGS MIAMI SHORES EXT NO 7 LOT 3 Fees: Description Amount FEE2005 -1765 Building Fee $150.00 FEE2005 -1766 CCF $1.20 FEE2005 -1767 Notary Fee $5.00 FEE2005 -1768 Technology Fee $3.75 FEE2005 -1769 Training and Education Fee $0.40 Total Fees: $160.35 Total Fees: $160.35 Total Receipts: $0.00 ' /D 4 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: