EL-09-294Project Address
74 103 Street
Miami Shores, FL 33138-
1132060131580
Block: Lot:
EMC MORTGAGE CORP.
Owner Information
•
Fees Due
CCF
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Submittal Fee
Submittal Fee
Submittal Reversal Fee
Technology Fee
Total:
Amount
$0.60
$0.20
$160.00
$3.00
$50.00
$0.00
($50.00)
$1.25
$165.05
March 06. 2009
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Address
Contractor(s)
MESA BROTHERS INC
Phone
(305)345 -1974
Cell Phone
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Parcel Number
Phone
Expiration: 08/29/2009
Applicant
Cell
EMC MORTGAGE CORP.
801 UNIVERSITY Drive
PLANTATION FL 33324-
Valuation:
Total Sq Feet:
$ 1,000.00
0
Type of Work: REPAIR OF METER CAN
Additional Info:
Classification: Residential
Invoice #
EL -2 -09 -34085
EL -2 -09 -34085
Check #: 1287
Total Amt Paid Amt Due
$ 165.05 $ 50.00
$ 165.05 $ 165.05 $ 0.00
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.
March 06, 2009
Date
1
Vkk, ke-ytft5\1
BUILDING
PERMIT APPLICATION
FBC 2004
Value of Work For this Permit $
Describe Work:
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Permit Type: Electrical
Owner's Name (Fee Simple Titleholder) cwt✓.,
Owner's Address e/Q
City � � U� State CA— Zip ? 3c-(, S
Phone #
Tenant/Lessee Name
E -MAIL:
Job Address (where the work is being done)
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL # i 1 Z 0 GC> ( ■ 6 2 O
Is Building Historically Designated YES NO
Contractor's Company Name /tie , t___ . , ‘5, - C4.--er , 4 4 •phone # ?O = 4 fie" ?`/
Contractor's Address .572--/ -t> s /0 3 '`�',pe�
City /�e State !-- - 7 Zip a_3/4 L
�
Qualifier Name � - '(7' i- /�
� Phony # � •. � � 7v
State Certificate or Registration No. 4 e- /.3- "V/F?0' Certificate Competency o. Z / ®4:
E -MAIL:
Architect/Engineer's Name (if applicable)
Sub it tal Fee $ Permit Fee $ /60o m
4 4 iL\ t ®3 s
Permit No. (
Master Permit No.
Phone #
Square / Linear Footage Of Work:
Type of Work: LiAddition ElAlteration , [New
'PP R. �'fiz- CAI' ,/U1 D .SCoivoc7.
Structural Review. $ Total Fee Now Due $
Pifone # 3 oS B a-13 7 - 6
5
3
Repair /Replace ID Demolition
....
.,......
� � o q co
X 6 CCF $ O. (' CO /CC
Notary $ .. Training /Education Fee $ O. dp Technology Fee $ 1.25
Scanning $ oa) Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
115.05
See Reverse side —>
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
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 : ase such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Mortgage Lender's Name (if applicable) ,-, l/8"
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. 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."
Sign:
Print:
The foregoing instrument was acknowledged before me this V
day of , 200,, by i f ? 4'�a(�c ( ,
who is pers known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
/
i I
Ad ifo_ I ► t� tr LP 4_ N
Annie Montgomery
4 of moo/ My � 0 Commission D
1'difx'i!Ycxxxxxxd I.xxxxxxxxxxxm
My Commission Expires: I
xr. ** x xx x do** eY *
APPLICATION APPROVED BY:
(Revised 02 /08/06)
Signature
Contractor
The foregoi g ' strument was acknowledged before me this
a G�f
day of r ,20 /27by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY P !Z LIC:
Sign:
Print:
Commission Et ES Novembm 7, 20
°'q Qc gonded E ! Budget NOSY Se
deg: xxxxxxxx�x- xx EXPIR xxxxx n: x x x� Y a: xx xxxx**.
My Com
Plans Examiner
Engineer
Zoning
Scheduled Inspection Date: March 09, 2009
Inspector: Devaney, Michael
Owner: STERN, CIO DAVID
Job Address: 74 NE 103 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: MESA BROTHERS INC
Building Department Comments
March 06, 2009
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
Phone Number
Parcel Number 1132060131580
t
Phone: (305)345 -1974
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
t°'P4' ›" e
/mac /fie ' % -'
RA-
Page 8 of 21