EL-11-1275OVA Yy4a/
BUILDING
PERMIT APPLICATION
FBC 20
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 Type: Electrical
OWNER: Name (Fee Simple Titleholder):
Address: 3a; 1%4 G'6LSt
Ma ltGtt) 'Pam
Permit No. 27 —71-42 2 aS
Master Permit No.
Phone#: ,O5 - `i 5 r - ,4y )
City: 1w ia-mj Shove$ State: r-,
Zip: 33(3?
Tenant/Lessee Name: Phone#:
JOB ADDRESS: 363 N3 Cl (0-t-31
City: Miami Shores
Folio/Parcel #: 1 1 32-'0(0 01; �' O
Is the Building Historically Designated: Yes
County:
Miami Dade
CONTRACTOR: Company Name: ADT
Address: p�L0725 /14a ri-S WG�
City: rG l fairlo. -c- State:
Qualifier Name: 6- e- 9,L - £4.0 -,t' t re.l l t
State Certification or Registration #: E) POD D / Z/
Zip: 3;13f
Se-r✓ IGCS
�lC 7cLQ
Contact Phone#: 991 -d -toto -Sp S% Email Address:
Flood Zone:
Phone#: 4s "A610 -50.57
Zip: 3 30A-5
Phone#: 15-41- A-06 -5057
Certificate of Competency #:
My GP.QO(. co-t- caw)
DESIGNER: Architect/Engineer. Phone#:
Value of Work for this Permit: $ /OO- -"---. Square/Linear Footage of Work:
Type of Work: °Address ($Alteration °New ORepair/Replace °Demolition
Description of Work: 1 I) Oa-112M 0Y) 0C b et, 5(e o4a-i»
*********** * * * * * * ** * * * * * * * ** * * * * * * * * * * *I., ************* * * * * * ** * * * * * * * * * * * * * * * * * * * ** * **
e7
Submittal Fee $___� Permit Fee $ ''l' ` C" 6' CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ C.d �� L)
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.RCTRICAL 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 P-" YIN(' ICE 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 foregsting ' trument was acknowledged before me this 1
day of , 20 IL, by L1A E S t
who is personally known to me or who has produced
t.0 As ide
NOTAR
Ati
My Commission ) pires:
Sign:
Print:
* * * * * * * * * * * * * * * * * * * * **
APPROVED BY
/'ntractor
The foregoing instrument was acknowledged before me this /17/
day of 70 /5/ ,20_,by6eerYc�. o ti,12./
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission
******************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
iZ- 4_ arleir Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09)
i
*
t;„
oQ
*
Notary Public State of Florida
Aracelis Trinidad
My Commission D0945822
Expires 12/10/2013
*
Zoning
Clerk
To: Page 3 of 3
2011 -08-22 15:31:43 EDT Hunton and WIIliams From: Espersen, Deborah
=i izr
AUG 2 3 2011
VIA FAX: 305 -756 -8972
August 20, 2011
Miami Shores Village
RE: Permit EL11 -1275 (ADT)
383 NE 96 Street
Miami Shores, Fl. 33138
To whom it may concern:
This letter is to confirm that ADT will not be installing any new devices in our home and
therefore we will not be moving forward with obtaining a permit. Please withdraw any request
made by ADT for a permit to do work in our home.
Please don't hesitate to contact me at 305 - 536 -2704 with any additional questions.
any thanks,
9)(PiC
A / diAA
ace M. Mora
383 NE 96 Street
Miami Shores, Fl. 33138