EL-05-199Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795q ,:J 6E u;• e ( 2
ii 1 F ?Pfd Permit No.e.105 —1 (=lc!
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building
Rastt r Permit No.
Plumbing
Mechanical
Roofing
Owner's Name (Fee Simple Titleholder) Q Phone J
Owner's Address "fie c —1
City k\ to C�
Tenant/Lessee Name
Zip —T (2 a)
Phone #
Job Address (where the work is being done)
City Miami Shores Villa e
Is Building Historically Designated YES
County Miami -Dade
NO 'JC
Zip
Contractor's Company Name 602-e.71. wc®1 Phone #
Contractor's Address 4c3
y
City /4 State Zip 4f" 6 0
Qualifier E`°° - f a/ v /,‘-'&4„/...c r /
State Certificate or Registration No. & , 2 . — /176-5" Certificate of Competency No. 9 ®
Architect/Engineer's Name (if applicable)
$ Value of Work For this Permit
Sq0
Phone # T °° h4/ 2- C)064--•
Square Footage Of Work:
Type of Work: "'Addition ❑Alteration New
❑ Repair/Replace ❑Demolition
Describe Work: PC.- C,
r
Submittal Fee $
* * ** * ** * * * * * * * * * *** *** * *** ** Fees ** * ** * * * * * * * * * * * * * * * * * * * ** * * **
Permit Fee $ Are 4# AP ODG `CCF $ CO /CC
Notary $ Training/Education Fee $
Scanning $
Technology Fee $
Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $
(Continued on opposite side)
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
Owner or Agent
The foregoing instrument was acknowledged before me this The fore oing instrument was apknowledged before me this /6
day of ,20by , day of ,20 by
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. 4js entiaion and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign: k,
Print: Print:
My Commission Expires: My Commission Expires:
07-, e-4/
e4c
3 �P
P$oPS
LUIS FERNANDEZ
MY COMMISSION # DD 348468
EXPIRES. November 7, 2008
Bonded Thru Budget Notary Services
******************** ************ ********* * * **************** * * * * * ** * * * * * * * * * * * * * * * * * * * * * * **
®Kam/'°
APPLICATION APPROVED BY - ti. Plans Examiner
Engineer
Zoning
Chc 05/13/03
441 AMP
ADDENDUM TO BUILDING PERMIT APPLICATION
(AN APPLICATION 1"OR 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
ITEM
BATH TUB
UNIT
•
FEE
ITEM
SWITCH OUTLETS
UNIT
1
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS
CENTRAL HEATING
DISHWASHER
RECEPTACLES
44
A/C (WIND)
DISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN AMPS
DUCT WORK
FLOOR DRAIN
SERVICE REPAIR/METER CHARGE
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 HP
STEAM BOILERS
SHOYIER
MOTORS QVER 1- 3 HP
HOT WATER BOILERS
SI%1K, 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 COM,IERCIAL
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
PUM' & 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 RANGE
METER SET (GAS)
GAS PIPING
c't
Z 2
o
II %6'2__.
I 2-6
w�
ly
<at
t (44 2-
IF .7 2-
.2: 0 0_0
'2/'9 5E)A-(se
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7
1
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: EL2005 -199
Printed: 6/23/2005
Applicant: M BRONWYN
Owner: ARENAS JORGE
JOB ADDRESS: 623 NE 97 ST
Electrical Permit
Contractor CARIBE ELECTRICAL CONTRACTOR INC Contractor's Address: 261 W. 27TH ST.
Local Phone: 786 -412 -0067
Parcel # 1132060171870
Page 1 of 1
Legal Description: MIAMI SHORES SEC 4 AMD PB 15 -14 LOT 15 & W1/2 LOT 16 BLK 101 LOT SIZE
Fees: Description Amount
FEE2005 -8527 CCF $0.60
FEE2005 -8528 Notary Fee $5.00
FEE2005 -8529 Training and Education Fee $0.20
FEE2005 -8531 Scanning Fee $3.00
FEE2005 -8635 Building Fee $100.00
FEE2005 -8636 Technology Fee $2.50
Total Fees: $111.30
Total Fees: $111.30
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration: 12/13/2005 Construction Value: $750.00
Work: ELECTRICAL
JUN 3 0 PAID
e b
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:
zq
MIAMI SHORES LAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date? /13 /05
Type Insp'n g(D(.29 r ,
Permit No. ELO5 — 1 qq
Name J o r ae. 4 r -cr-10 3
Address 3 NE 97 ST
Company CP 1 1 (
Phone # (305) 3C0- -3103
Inspection Date 7 /1 4 /05 •
Approved
Correction
Re- Insp'n Fee
o