PL-04-332•
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
BUILDING
PERMIT APPLICATIO
FBC 2001
r0
NOV 1 7 2004
5) 756.8972
Permit No.
Master Permit No.
1,94-33Z
Permit Type (circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) b /1/ i64f Phone #
Owner's Address /7-2 2-- / K"' () ,('
Ci ty MAXIM 1 S -S State FLA Zip
Tenant/Lessee Name Phone #
Job Address (where the work is being done) 1 2-1)- 6 tie %U0
City Miami Shores Village County Miami -Dade
Is Building Historically Designated YES NO
Contractor's Company Name 7-e. e0
(¢S ccAg
Contractor's Address % 57 ? IVp
Zip
Phone # `9ar 6170 17 83
City A, 44 (• 1&24e1-1 State Zip 1 6 2—
Qualifier ` 4-1 S u S V e &A
State Certificate or Registration No. Certificate of Competency No. & --/G 6'1?
Arcbitect/Engineer's Name (if applicable) Phone # '
�y
$ Value of Work For this Permit t• Square Footage Of Work:
Type of Work:
Describe Work:
CA ()Fee l i
['Addition
['Alteration ❑New/ ❑ Repair/Replace j 1 Demolitio
e - '° - ` � ice .i lYY�°Is' �a (� ce (Ace. ( G is „4-
b rp <AA11A/ J-Oe j 7 S ® A✓ /oil Ns )
3
s *,
Submittal Fee $ ��� Permit Fee $ / 070
Notary $ Training/Education Fee $ 0 •
* * * *** *** ** * * * *** * * *********
CCF $ 0 CO /CC -�
Technology Fee $ .
Scanning $ 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 rst inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the
inspection w'l be approved and a reinspection fee will be charged.
Signature
Owner or Agent
The foregoin. instrumen�t `'as acknowledged before me thi
day of 1. • `1 2OC by
AMvirlAtt
who is orally known to me who has produced
NOTARY P C:
Sign:
Print:
My Commission Expires:
As identification and who did take an oath.
Signature.
Contractor
The foregoing instrument was acknowledged before me this f" 7/er
day of fib/ ,Mtn ,by v VC; Cry,
personally known to me.1)r who has produced
as identification and who did take an oath.
NOTARY PUBI.rI�:l�(ti
? Notary Public - State of Florida
;` Commission # DD084905
B, BI�9Ft °a
Bonded By National Notary Assn.
Sign:
Print: /t.S Aflidt AL.
roil 11 s1,n Ares:
AAA *AAA* *AAA * * * * ** *AAA*
****** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
Cho 05/13/03
Notary Puti .; - Star FI iid
E My. Cura ;t n ExTis. Jan Z7, 2008
Commission # DD084
°°`"'N+ LUIS MONTERO
r is
Notary Public - State of Fk
My Corm Eigires Jan Z7,
Commission # 000349
Acilh ilaaai N
A
* * * * * * * * * * **
Plans Examiner
Engineer
Zoning
N1
NE 12TH AVENUE
E.O.P
N.R /W
NE 100 STREET
E.O.P
RE TIE CUT SERVICE.
E.O.P / 2' SP GAS MAIN
CONSRUCTION NOTES:
N.P /L
131
r
3
co
E.O.P
SET EXCESS FLOW VALVE
1. ALL GAS PIPELINE CONSTRUCTION TO FOLLOW TECO PEOPLES CAS STANDARDS.
2. TRAFFIC CONTROL SHOULD BE MAINTAINED AND COORDINATED WITH THE
APPRORIATE COVERNMENTAL AGENCY.
3. ALL DISTRUBED ASPHALT /CONCRETE /SOD AREAS TO BE RESTORED TO PRIOR
CONDITION, UNLESS OTHERWISE SPECIFIED.
(1226)
A.C. UNIT.
NEEDS RISER.
AOLD RISER IS GONE
48 HOURS BEFORE DIGGING
CALL SUNSHINE 1 -800- 432 -4770
ATLAS:
M 22
SCALE:
NTS
DRAWN BY:
LM
RE TIE EXISTING CUT SERVICE.
1226 NE 100 STREET. MIAMI SHORES, FLA
DATE:
11/16/04
SHEET:
1/1
JO:
1226
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 11/30/2004
Plumbing Permit
Permit Number: PL2004 -332
Applicant: DEAN MADIGAN
Owner: MADIGAN DEAN
JOB ADDRESS: 1226 NE 100 ST
Contractor TECO PEOPLES GAS SYSTEM Contractor's Address: 1218 NE 101 ST
Local Phone: 957 -3857 X7383
Parcel # 1132050090060
Page 1 of 1
Legal Description: 5 53 42 EARLETON SHORES PB 43 -80 LOT 6 BLK 1 LOT SIZE 75.000
Fees: Description Amount
FEE2004 -11851 Building Fee $120.00
FEE2004 -11852 CCF $0.60
FEE2004 -11853 Training and Education Fee $0.20
FEE2004 -11854 Technology Fee $3.00
FEE2004 -11855 Scanning Fee $6.00
FEE2004 -11856 Submittal Fee ($50.00)
Total Fees: $79.80
Total Fees: $79.80
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration: 5/16/2005 Construction Value: $600.00
Work: RE -TIE EXISTING GAS SERVICE
Signed:
(INSPECTOR)
a,9j0
7,ss f
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: