EL-05-2180
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building
Owner's Name (Fee Simp e Titleholder) 1
Owner's Address 1 0 4 . 7 7 1C 4- sera-
r
Permit No. � - 2 18
Master Permit No. 15 ,� ° 1 67
Plumbing Mechanical Roofmg
Phone# (1/4 06/ Co
City M f br
Tenant/Lessee Name
State °rZ- Zip -5513 0
Phone #
Job Address (where the work is being done)
City Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES NO
Contractor's Company Nalme L,� �, (\ \QR
I one # -30:� 7610 c;-2.29-9._
�( 9l'�
ek30 -k
Contractor's Address
City 1 State
Qualifier " j r Q -Q
1
Zip 3 3/
3?
State Certificate or Registration No.
Oc..)lt0 a�
Architect/Engineer's Name (if applicable)
$ Value of Work For this
ermit
Type of Work: ['Addition
Describe Work:
Certificate of Competency No.
Phone #
teration
Xi Cc f
)6-0o
❑New
Square Footage Of Work:
❑ Repair/Replace
5
❑ Demolition
Submittal Fee $
Notary $
Scanning $ 3
****************************Fees******************************
Permit Fee $ Acre
raining/Education Fee $ CJ . 4 0
CCF $ 1.20 CO /CC
Technology Fee $ a • �•
Radon $ Zoning Bond $
Code Enforcement $
Total Fee Now Due $
(Continued on opposite side)
Structural Plan Review. $
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 r 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 AhFIUAVIT: 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
Owner or Agent
The foregoing instrument was acknowledged before me this
day of ,20_,by
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires: My Commission Expires:
Signature :.Z'
Contractor
The foregoing instrument was ajknowledged before me this
day of .49411.1E- , 2011 by
who is personally known to me or who nassproduce f el4
'fication and ' o did take an oath.
NOTARY PUBLIC
Sign:
Print: 656
************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * ** ***********,********* * * * * *** * * ** * * ** * * * * * * * * ** * * * **
APPLICATION APPROVED BY:
Chc 05/13/03
Plans Examiner
Engineer
Zoning
.ADDENDUM TO BUILDING PERMIT APPLICATION
(AN APPLICA�3I0N FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B.
OBTAINEDf THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ELECTRICAL
MECHANICAL
ITEM
BATH TUB
UNIT
•
FEE
ITEM
SWITCH OUTLETS
UNIT
J
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS.
l®
CENTRAL HEATING
DISHWASHER
-
RECEPTACLES
?j
A/C (WINO)
DISPOSAL -
SERVICE TEMPORARY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN AMPS
DUCT WORK
FLOOR DRAIN
SERVICE REPAIR/METER CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
L
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
SHOWER
MOTCRS OVER 1- 3 HP
HOT WATER BOILERS
SINK, POT /3 COMP.
MOTCRS OVER 3- 5 HP
MECHANICAL VENTILATION
SINK, RESIDENCE
MOTORS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTCRS 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
MOTCRS OVER 100 FP
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 COMMERCIAL
WATER SERVICE
.
SIGN TUBES
SEWER CONNECTIONS
SIGN TRANSFORMERS
UTILITY -SEWER
SIGN TIME CLOCK
UTILITY -WATER
_
FIXTIRES
SEPTIC TANK
ANTENNA
RELAY
TELEVISION OUTLETS
DRAINFIELD, 4* TILE/RES.
VIOLATION
PUMP & ABANLON 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
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 7/5/2005
Electrical Permit
Permit Number: EL2005 -218
Applicant: NOEMI GARCIA
Owner: GARCIA NOEMI
JOB ADDRESS: 10430 NE 3 AVE
Contractor ASCUNCE ELECTRICAL CONSTRUCTION INContractor's Address: 1041 NE 78 RD, #1
Local Phone: 305/756 -2892
Parcel # 1121360130450
Page 1 of 1
Legal Description: MIAMI SHORES SEC 5 PB 10-47 LOT 1 & E1/2 OF LOT 2 BLK 120 LOT SIZE
Fees: Description Amount
FEE2005 -9197 Building Fee $150.00
FEE2005 -9198 CCF $1.20
FEE2005 -9199 Training and Education Fee $0.40
FEE2005 -9201 Technology Fee $3.75
FEE2005 -9202 Scanning Fee $3.00
Total Fees: $158.35
Total Fees: $158.35
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration: 12/26/2005 Construction Value: $1,500.00
Work: ADD LIGTHING AND RECEPTABLES
JUL 1 5 MD
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: