EL-09-1257Miami Shores Village XCIEE'VM3
Building Department •• %
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972 /6
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type: Electrical '' -�
Owner's Name (Fee Simple Titleholder) I4tl en, - -T--ex C
Permit No. O -1Q5)
Master Permit No.
Owner's Address 1 .2,10 Nor ects fi 95- t,e-c. -T
City /MA-11,06 Jh,(S(,2.$ State F[_ Zip 33 / 3 d (�
Tenant/Lessee Name ELL; pi (5 410. 10 Phone #
E -MAIL: 1�@.1..e.r\ r &c.1 6) ( d( .SO d 1- . Ae_r
Job Address (where the work is being done) 10 9 cl Nc -`( ecisT- 1 11'-- S
City
Phone # 3b5` =75 - 07 0 )
3a -7 -719 �.
Miami Shores Village County Miami -Dade Zip 33 139
FOLIO / PARCEL # 1 1 3 2,050 170010
Is Building Historically Designated YES NO ✓
Contractor's Company Name
Contractor's Address
City
Qualifier Name
i
Zip
Phone # C96-ey
State Certificate or Registration No. ` ri O/l v/ Certificate of Competency No.
E -MAIL:
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $1,9570 02)
Phone #
Square / Linear Footage Of Work:
Type of Work: ['Addition OA iteration di ew
❑ Repair /Replace Demolition
Describe Work:
L PAW-
Submittal x ***** ***** .xx ******* *** c*wwx**xxxxxx Fees* * * *wvcx**x*vcww* Y'4'tixxxxxxxx*** *�Y *ac�Yxxxxxx� ***
Fee $ r Permit Fee $ /00 ' G' CCF $ CO /CC
Notary $ Training /Education Fee $ Technology Fee $
Scanning $ Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $
See Reverse 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. 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. 1 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.
L. f -r620-.37a -6 -7429
Signature
Oignature
Owner or A nt
The for •.oing instrument was acknowledged before me this The fore;: sing instrume was .nowledged before me this`-c/
day of ''II. , 2005'
0 , by , day of 1� , 2C19/'
, by
who is !rsonally known to me or who has produced who is p9sonally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission, z es Alba Agu la
11 C ;irri s o,z '�1D66$2830'
**** .' ******4,f '�X �J ' -�°it lei% 'I.•�. 'y p1 GV.h�X �{'iC %�Y%
i eu�e °' Y B
APPLICATION APPROVED BY:
(Revised 02/08/06)
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
1tY kit h ti:.STATE " mA
_ � Alba /
r i"onnmission s j2830
My Commission Ei4 E Expires: JU1 2011
Y****x9x4YY*.**x % %%%%**w pxxxS44R4r14kxx9Avatie
******
Plans Examiner
Engineer
Zoning
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 132747 Permit Number: EL -7 -09 -1257
Scheduled Inspection Date: January 07, 2010
Inspector: Devaney, Michael
Owner: TRACY, HELEN
Job Address: 1099 NE 97 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: ADT SECURITY SERVICES, INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alarm
Phone Number
Parcel Number 1132050170070
Phone: (786)331 -3967
Building Department Comments
INSTALL BURGLAR ALARM
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
9
/e'
January 06, 2010
For Inspections please call: (305)762 -4949
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