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DEMO-11-223Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 pnspection Number: INSP - 161142 Permit Number: DEMO -2 -11 -223 Inspection Date: July 18, 2011 Inspector: Bruhn, Norman Owner: YVEL, ARMAND Job Address: 138 NW 106 Street Miami Shores, FL 33150- Project: <NONE> Contractor: JDF CONSTRUCTION AND ROOFING INC Permit Type: Demolition Inspection Type: Final Work Classification: Building Phone Number (407)427 -1657 Parcel Number 1121360080040 Phone: (407)456 -2259 Building Department Comments DEMOLITION PERMIT PARTITION WALL NON STRUCTURAL Passe • � / .77 /t- Inspector Comments CREATED AS REINSPECTION FOR INSP- 155893. Cancelled by owner. C� Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until For Inspections please call: (305)762-4949 July 19, 2011 Page 1 of 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Permit No. pririll 0 1 \ Master Permit No. BUILDING PERMIT APPLICATION FBC 20 Tom' S7i FEB 102011� Permit Type: BUILDING OWNER: Name (Fee Simple Titleholder): Arwitivtett F. YVp,I Phone #: 407 - 6qt -1 S 04 Address: z t 4 IJ• ,rtcf1e 124 City: G eut t? vrt4 J State: 1L Zip: 17.7 31 Tenant/Lessee Name: Mot r+u,% Cm Sf ro L o Phone #: LSO G — 51i — Z &I Email: Acwtd aat.'(veL F re vAa,iI• cn wt JOB ADDRESS: t3 8 IJ .(A) to 6 11. S4a eet City: Miami Shores Folio/Parcel#: 1 t2 l 3 6 0 o (ripe, 4 D County: Miami Dade Zip: 1y3 l S O Is the Building Historically Designated: Yes NO Flood Zone: WA CONTRACTOR: Company Name: 1 Dr Crs►nstract IOvt tt ra ukr.6 (vu.. Phone#: 407 -45 A - � 5 c( Address: _%43 a gE RRI ooyQ 2D : City: OrLat.wd 0 State: F L Zip: 3 2 13 L 5 Qualifier Name: Inc Ferrer Phone#: 407- + 5 6 - 2.25 7 State Certification or Registration #: C b C 12.5 t 446 Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ t t>d . — Square/Linear Footage of Work: Type of Work: ❑Address UAlteration ❑New ❑Repair/Replace ®Demolition Description of Work: Deuu.0L t o to ¢I-Ht E Far 441 oIA (Audi [v► art - Structy trti .) ret..o v d-L COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by: * * * ** ** * * * * * ****** * * * * * * * * * * * * * * * * * * ** Fees************* ** * * * * * * ***** * * * * * * * * * * *,* * **** a. Submittal Fee Permit Fee $ /60 Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ 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 o s seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be ap i 'ed and a reinspection fee will be charged Signature er or Agent The foregoing instrument was actin ledged bei ore rpe thi day of T ib , 20 ! / , by ,1f q7,i �/ Y�' j who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commis et Pit Notary Public State of Florida f, Mary Ellen T Cechowski is My Commission DD981329 'lFesr ** lac Rl nIx4 * * * * *** ** APPROVED BY sir Signature Contractor The foregoing- i I ent was acknowledged before m�ihis day of 20/! , by e / e /f ; who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Co 10 r * * * * * * * * * * * * * * * * * * * * * * * * ** (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)(rev6/4/10) Plans Examiner Structural Review s $ .1 . :ear Pit Notary Public State of Florida Mary Ellen T Cechowski ' G if My Commission DD981329 94' o•• Expires 06/07/2014 Zoning Clerk Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 156065 Permit Number: DEMO -2 -11 -259 Scheduled Inspection Date: May 10, 2011 Inspector: Devaney, Michael Owner: YVEL, ARMAND Job Address: 138 NW 106 Street Miami Shores, FL 33150- Project: <NONE> Contractor: AJL ELECTRIC INC Permit Type: Demolition Inspection Type: Final Work Classification: Electric Phone Number (407)427 -1657 Parcel Number 1121360080040 Phone: 305 - 895 -4971 Building Department Comments demolition permit for restoring electrical connection of new structural partition wall removal Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments 94_ -&97/ May 09, 2011 For Inspections please call: (305)762 -4949 Page 6 of 23 1 1 Protect Address Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 138 NW 106 Street Miami Shores, FL 33150- 1121360080040 Block: Lot: ARMAND YVEL Owner information Address Phone CeII ARMAND YVEL 214 N JUNGLE Road GENEVA FL 32732 (407)427 -1657 Contractor(s) AJL ELECTRIC INC Phone 305 - 895 -4971 Cell Phone Valuation: Total Sq Feet: $ 65.00 0 Type of Demo: Electric Additional Info: demo elec of partion wall Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $0.60 $2.00 $2.00 $0.20 $100.00 $3.00 $0.80 $108.60 Pay Date Pay Type Amt Paid Amt Due Invoice # DEMO -2 -11 -40090 03/15/2011 Credit Card $ 58.60 $ 50.00 02/16/2011 Credit Card $ 50.00 $ 0.00 Available Inspections: 1 Inspection Type: Final 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 15, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date March 15, 2011 1 t DElecfl r< <uQ � oI Demol.tt o � Icu LTLO N %.'ct ll Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 , Permit No. `Z' L 1 QI Master Permit No. BUILDING PERMIT APPLICATION FBC 20 Permit Type: Electrical Phone #: 407• G94-15 04- OWNER: Name (Fee Simple Titleholder): AA. INA,at v c( • F. yveL Address: '2.14 N • 3vr..c.i lei 1Y� City: Ger�vo�. 0 State: _ Tenant/Lessee Name: }tM c Ora n Email: /sr ct Yug. et G a . L Gew► JOB ADDRESS: 13 S tato le 64L Zip: 317 3 2 Phone#: 365-519-Z603 greet City: Miami Shores County: Folio/Parcel #: It/43600g 00 40 Is the Building Historically Designated: Yes NO X Miami Dade Zip: 3315 Flood Zone: AT`A CONTRACTOR: Company Name: /13-1.- E L°c. -/X4 C. SA1 C. Phone#: 3ar Vic - 49 °r 1 Address: 1 4 Ski rise. osi tN L a- dO #'r City: A). Pg t APIs' State: F+ Qualifier Name: 46o-r-4,4601 T L4400 Se. State Certification or Registration #: 1c e.. 13 6 0 a 0 ?9 Certificate of Competency #: Contact Phone #: Email Address: RSA- 12-602 AM e®• Co. t Zip: 33I8I Phone #: •3 T4s -'+911 DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 65. — Square/Linear Footage of Work: Type of Work: ❑Address Description of Work: ❑Alteration ❑New ❑Repair/Replace AiDemolition Submittal Fee $ epet 9 Permit Fee $ / C> ,4 t' CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ PJ 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 FT,ECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDmONERS, 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 PAYNG 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 Owner or Agent The foregoing instrument was ac 'bwledged lefore me th, , 20 d_I , byGP�l day of who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commiss APPROVED BY b►AYP,1 Notary Public State of Florida . Many EUuii T Cuul,uw,Ai < My Commission DD981329 p' 140 Expires 08/07/2014 Signatur C • ntractor The foregoing instrument was acknowledged before me this /SK' day of f -C,6 . , 20 /r , by Ad TN diary who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: 4r�Jc // Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Sign: Print: My Commission Expires Zoning Clerk CERTIFICATE OF INSURANCE This certifies that ® STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois ❑ STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois insures the following policyholder for the coverages indicated below: Name of policyholder A J L Electric, Inc. Address of policyholder 12408 N. Bayshore Dr. N. Miami Beach, FL 33181 -2431 Location of operations same as above Description of operations Electrical Contractor - Anthony J Lupo Jr. The policies listed below have been issued to the pofcyholder for the policy periods shown. The insurance described in these policies is subject to all the terms exclusions, and conditions of those policies The limits of liability shown ma have been red ced b d POLICY NUMBER TYPE OF INSURANCE • POLICY PERIOD Effective Date Expiration Date y u y any par claims. LIMITS OF LIABILITY (at beginning of policy period) 98BBF936 -7 Comprehensive Business Liability 05/15/10 05/15/11 BODILY INJURY AND PROPERTY DAMAGE Each Occurrence $ 1, 0 0 0 , 0 0 0 General Aggregate $ 2, 0 0 0, 0 0 0 Products - Completed Operations Aggregate $ 2 , 0 0 0 , 0 0 0 This insurance includes: 0 Products - Completed Operations 0 Contractual Liability • Underground Hazard Coverage 0 Personal Injury • Advertising Injury IN Explosion Hazard Coverage • Collapse Hazard Coverage • General Aggregate Limit applies to each project • • EXCESS LIABILITY • Umbrella • Other POLICY PERIOD Effective Date Expiration Date BODILY INJURY AND PROPERTY DAMAGE (Combined Single Limit) Each Occurrence $ Aggregate $ 98BFJ084 -2F Workers' Compensation and Employers Liability 05/15/10 05/15/11 Part 1 STATUTORY Part 2 BODILY INJURY Each Accident $ 10 0 , 0 0 0 Disease Each Employee $ 10 0 , 0 0 0 Disease - Policy Limit $ 500,000 POLICY NUMBER TYPE OF INSURANCE POLICY Effective Date Expiration PERIOD Date LIMITS OF LIABILITY (at beginning of policy period) Name and Address of Certificate Holder Miami Shores Village Bldg Dept 10050 NE 2nd Avenue Miami Shores, FL 33138 558 -994 a 2 -90 Printed in U.S.A. If any of the described policies are canceled before its expiration date, State Farm will try to mail a written notice to the certificate holder 30 days before cancellation. If, however, we fail to mail such notice, no obligation or liability will be imposed on State Farm or its agents or representatives. Representative /5/,20 /v AC "5054877 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL1 CONTRACTORS LICENSING BOARD SEQ #L100727o1454 DATE BATCH NUMBER LICENSE NBR , 3: 07/27/2010 108015579 EC13002089.� The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter Expiration date: AUG 31, 2012 LUPO, ANTHONY J JR A J L ELECTRIC INC 12555 BISCAYNE BLVD, #826; +. NORTH MIAMI FL 33181 CHARLIE CRIST GOVERNOR DISPLAY AS REQUIRED BY LAW CHARLIE '.:LIEM INTERIM SECRETARY NORTH MIA F L O R I D A City of North Miami 776 N.E.125 Street • North Miami, FL 33161 • 305 - 893 -6511 Business Tax Receipts Issued Date: 10/1/2010 Expiration Date: 9/30/2011 Business Tax Receipt #: BT- 002364 A J L ELECTRIC, INC. 12555 BISCAYNE BLVD BOX 826 NORTH MIAMI, FL 33181 ELECTRICAL CONTRACTOR Business Name / Address: A J L ELECTRIC, INC. 12555 BISCAYNE BLVD, BOX 826 NORTH MIAMI, FL 33181 City Clerk NOTICE: BUSINESS TAX RECEIPT MUST BE TRANSFERED WHEN BUSINESS IS MOVED OR SOLD. NON - TRANSFERABLE • POST IN A CONSPICUOUS PLACE • NON - TRANSFERABLE �t' n �t�It11 1 1 1 II(11411II( I1111l1l 11111111 III 111111111 1812£ 13 IWVIW H1dON 928 XOH QA18 3NAV3SIE 55521 S3dd Odfll S3WVf ANOHINV • 3NI 01d10313 if b 08VMEIO3 ION 00 1 S /d3ANOM 680ZOO2133 #31V1S 0- 00L2OZ 'ON J413031:1 1VM3N3N 3015 1:13H10 33S 00'51;0000 100£6001060 OIOZ /h0 /80 :NO1031100 xV1 A .Nno0 3aY0 -IWYIW 03AI303N 1N3WAVd 'SNOLL - VOW11VfO S.N3010H 3141 d0 N0LLV3ULL1i30 V ION SI SIH1'MV1 AS 0SMflOSN 3SN3011 l0 11W1:13d 1:13H10 ANV WOW N30loH 3141 1dNISX3 11 S300 NON 'S31110 NO A1Nf100 3141 d0 SMV1 ONINOZ NO ANOIV1f1O31:1 ONLLSIX3 ANV 31V1OIA O1 N3alol 3141 11WN3d 10N S300 11%141303N XVl 5531415119 8010V 81NO3 1V31 1V3IN1d11vVef s1 x1141 sseu(sne o adA1'oas 3NI 3Id10313 Iry kl3NMO IWVIW H121ON 181£2 dQ 3dOHSAV8 N 80hZI 3NI 3I813313 Iry NOLLV0O1 / 3WVN SS3NISn9 Orlando 12/23/2010 MR. Norman Bruhn Miami Shores Village Building department 10050 N.E 2nd ave Miami Shores FL 33138 -0000 77 0 7 127 4r &r FEB 102011 Re: Parcel 1121360080040 Cancel permit number RC -9 -09 -1570 and EL -9 -09 -1571 request. Dear Mr. Norman, The work initiated under the above referenced permits has been canceled and the area restored back to its original state. The work had involved the addition of an unauthorized partition between the living room and dining room and did not involve any structural changes /modifications. The permits were applied for and a rough in inspection was approved. Final inspections (INSP- 90468, 124004 and 124372) were denied due to lack of access. The tenant's contractor removed the partition and restored the area back in its original state before vacating the property. During our telephone conversation, I was advised by you to apply for a demolition and electrical permits for the removed partition and restored electrical connection. Considering the costs involved with the permits and to secure access on multiple occasions to the property, I hereby request cancelation of the referenced wall permits and that the inspection of the electrical work associated with the restoring the wall be performed under the kitchen electrical final inspection. I will re- extend the requested permits RC -7 -08 -1359 and EL- 7- 08- 1391as soon as funds become available. Regards an spy holidays, Armand Yvel Owner 138 NW 106st Miami Shores, FL 33150 Te1:407- 694 -9504 Email: Armand.Yvel(cgmail.com A P sel - f Miami Shores Vi114ge °� Building Department �! 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC20 Permit Type: BUILDING ROOFING. Owner's Name (Fee Simple Titleholder) Permit No. 12 £`q - 09-157o Master Permit No. Owner's Address 771 4'. / r / o ( 14 3 City / /P 4--+n : '-5-A o''-c '' State / -Jc - Zip - % ,-L' MA r A j�'-e. (4'1444 A Phone# 3 % `)S) 6 / r lay Job Address ,(where the work is being done) 7 .3 MIA City �A V'e j Miami Shores Village County Miami -Dade Zip .7 JJ 5 -6 !' FOLIO / PARCEL # /2" 2 (3 6- `- to? - ,;,m oA 0 _____et Is Building Historically Designated YES NO Flood Zone Phone # ). '7 C /jt Tenant/Lessee Name Email �`+ kl le Contractor's Company Name d'iLiki pl ^Avr ' i fAr7 Phone # (5. 91 5 f `a _ v Contractor's Address /9 z 't {(� . .- ' City r(:1 - •" l ; State ' rt> Qualifier Name t:-..-7,e6;641 4/4,e`,) y s_ Phone # : C.- C " r° i State Certificate or Registration No. 'Contact Phone etency No. C CO, 26 Architect/Engineer's Name (if applicable) Value of Work For this Permit $ ` v �° Square / Linear Footage Of Work: Type of Work: ❑Addtion a ❑Alteration �9 ❑New ;��Repair/Replace ❑Demolitgn Describe Work:q �` 1/ /� e �Jal �,.�i A� a� 7 w.� 04,. e/ `71St ***************************************Fees******** ******* ****** * ** * * * * ****** * * * *4}* ** ** il° Submittal Fee S.5 0 ' Permit Fee $ . 0)4 CCF $ 6 U u CO /CCI $ Notary $ b • tp-6 Training/Education Fee $ 113 Technology Fee $ '5 3 Scanning $ 73 . Radon $ DPBR $ Bond $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ 1 VI i 4 �,' 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. 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 POR 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 issuan '4 building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice o • ; nt and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certi he recorded notice of commencement must be posted at the job site for the first inspect on which occurs seven (7) days after" se jermit is issued. In the absence of such posted notice, the inspection wil no e approved and a reinspection fee will be char Signature AID Signatur Owner or Agent �n ®ontractor The foregoing instrument was acknowledged before thi The foregoing ins. u. € cnowledged before me this ZO day of , 20D"l, by 1 rmanoi use , day of S' .1P . whp is personally known to me or who has produced L who is personally kn �Fk `I 20 e g has producedrLr L 20 BAs identification and who did take : , .. th 12. 01-12-0 as ide "� `n ,, t . , ho did take an oath. NOT a - ;� LIC: NOTARY PUBLI Sign: L ....LA: 1- - ' I' Sign: Print: My Commission Ex ires: APPROVED BY Ca Fo 4::1)1S 00�'243q y Commission Expires: /6:7:PC" Plans Examiner Zoning Engineer (Revised 07 /10 /07)(Revised 06/10/2009) Clerk chepked Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305). 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit Type: ELECTRICAL Owner's Name (Fee Simple Titleholder) . ( � Permit No. Master Kermit No. Owner's Address / 3 o , City c.e3, St r:,Pc-) State Fib Tenant/Lessee Name Email ✓l `t µn Zip Job Address (where the work is being done) (7 /if " A Ciiter Miami Shores Village Coun FOLIO/ PvARCEL # /Q/ °" , ;/ ,, Is Building Historically Designated YES Phon Phone # -0 ). 6/66 / f4 mi -Dade Zip ? (S c NO Contractor's Company Name R Z,' �1ra. -a es 7 41,444erwt.grAvriNehone # Contractor's Address /e.(2 A °r City f/'l-1 Qualifier Name b f e.i //;„, State Certificate or Registration No. 's° C Contact Phone ,fir State Flood Zone Zip :31/x'( Phone # 73 &' S e 1 mpe4ncy No.i ( -2 0 Architect/Engineer's Name (if applicable) Value of Work For this Permit $ 4/6" Type of Work: ❑Addition ❑Alteration Describe Work: jai r ' to E -mail Square / Linear Footage Of Work: �epair/Replace ❑ Demolition ❑New e ******** * * * * * ** * * * * * * * *** * * * * ** *** * * * ** Fees********** * * * * * * * *:v * * * * *** * * * * * * * * * * * * ** *** eV �^ Permit Fee $ /t 6, 49 CCF $ Training/Education Fee $ Submittal Fee $ Notary $ Scanning $ : d.6) Double Fee $ Radon $ Structural Review. $ DPBR $ Violation date: CO /CC $j Technology Fee $ '1, 00 Bond $ 13, 61 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. 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 WIT YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR .NOTICE _ CEMENT." Notice to Applicant: As a condition to the issuance of a building': promise in g d faith that a cop e notice of commencement and co whose proper is subject to achment. Also, a certified copy of the recorded notc for the first i p ection w ch occurs seven (7) days after the building permit is issu inspection will �. be %roved and a re- inspection fee will be charged. / s, Signature ��a "ItW' Qwner or Agent d value exceeding $2500, the applicant must ochure will be delivered to the person ncement must be posted at the job site ed. n the absence of such posted notice, the The f ee� oing instrument was ac owledged beefoor�(m,/ day of VC�� , 20 U-', by (YY1 ''v` `"1 t--C , who is personally known to me or who has produced Fuel /� L. ©Io-D Contractor The foregoing instrument was ac dged before me this23(d Q 4— dayof ,20�� -�►4L� who is personally known to met' ^� %:o'fle As i : ; tification and who did take an oath. Q of i 2 0 as identification Voita. 7cj NOTARY PUBLIC: +� Sign. Print: My Commission Expires: * * * * * * * * * * * * * * * * * ** APPROVED BY Sign: Print: My Commission Expires: ******************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** 3 Se'" ©.Plan Examiner Engineer (Revised 07 /10 /07)(Revised 06/10/2009) Zoning Clerk checked