EL-04-51Miami 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 No. +e lac° IFS J
Master Permit No. D-603 - 7 86
Permit Type (circle): Building lectrica Plumbing Mechanical Roofmg
Owner's Name (Fee Simple Titleholder) VI LA- 4GE is 6T__. rv1/44i D 6/. Phone # 3r S- 96S- 5893
Owner's Address % S 5 AY /4S Sr �i z
City Wt. r State Zip 33
Tenant/Lessee Name Phone #
Job Address (where the work is being done) lair- 13 9 AY 6 jog— Sr
City Miami Shores Village County Miami -Dade
Is Building Historically Designated YES NO g
( WA
zip 33!
Contractor's C o m p a n y N a m e y 4 - r z . , 4 „ r 1 L rcrsc..1 P h o n e # !- 7 V o t o
Contractor's Address
City State
Qualifier
17-4`13 . a ..
Zip
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Permit >hit P a
Square Footage Of Work:
Type of Work: DAddition ❑Alteration ETew
Describe Work: 3U t TG, —
❑ Repair/Replace ❑ Demolition
****************************F *, * ** * * * * * * * ** * * * * * ** * * *le* **
CCF $ . d CO /CC
/ 6, 0 0 Technology Fee $ 0 .
Zoning Bond
Submittal Fee $ .00 Permit Fee $ z /e-
Notary $ Training/Education Fee $
Scanning $ Radon $
Code Enforcement $ Structural Plan Review. $
Total Fee Now D
scF 14
• (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 constriction 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 2.3
day of , 20 v ' , by 73L'
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY
Sign:
Print: P. APR.14 006
My Commission Expires:
Contractor
The foregoing instrument was acknowledged before me this 2-3
day of PC-& . , 20 0 y, by ,t/-C- n., -.2.J
who is personally known to me or who has produced
as identification and who did take an oath.
My Commission Expires:
**************,**************.*****************,***********,****,***,***,************, * * ** * * * * * * ** * * * * * * * * * * * * * *** *,*
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
*************** * * * * * * * * * * * *** * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
Chc 12/15/03
******************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Plans Examiner
Engineer
Zoning
I
1
BUILDING AND ZONING DEPARTMENT
10050 N.E. SECOND AVENUE
MIAMI SHORES, FLORIDA 33138 -2382
TELEPHONE (305) 795-2204
FAX (305) 756 -8972
AFFIDAVIT FOR 30 DAY TEMPORARY ELECTRIC SERVICE
(To be executed by Owner and/or Tenant, Bum & E1ecteical Contractor)
NOTE: ELECTRIC SERVICE WILL BE DISCONNECTED "WITHOUT NOTICE"
UPON 30 DAY TERMINATION UNLESS APPLICATION IS RENEWED
It is understood that the temporary- electrical approval by the Miami Shores Village, Building & Zoning Department
given in connection with the building being constructed under:
Budding Permit No. 0)603- 7 i%6 Electrical Permit No. 2- 003 - f g' 1
at address:
1.191 - /3o 1 AF /as- Sr-
for owners: V I 1t4 6- b cz N.44.
is being given only for construction purposes or for testing the following installations being made in said structure:
Sub - paragraph 4501.3 (d) (3) of the South Florida Building Code provides for a 30 day maximum approval only in an
URGENT NECESSITY for electric cunent exists. Necessity shall include the use of current for irrigation, security,
humidity control, emergency power and lighting, such as for testing or conaitruction purposes, provided the Electrical
Contractor and owner do hereby agree to assume the responsibility of maintaining the installation in such a manner that
there is no hazard to life and property.
Such approval is in no event to be considered a release of said structure for purposes of use and occupancy, and no
occupancy shall be granted or permitted until final inspections have been called for and approved by the inspection
divisions concerned, and an occupancy permit obtained.
The undersigned also understand that the temporary- electric approval is subject to rescission and cancellation, and
electric power can be cut off at the discretion of the Budding and Zoning Department and will be disconnected if the
budding concerned is occupied before final inspections are approved and occupancy permit obtained.
I, 'Su /#,J S�r. Ants c c , being first duly sworn,
depose and say that I am the owner of the above described property, and that I agree that the structure covered in this
agreement shall not be occupied until the building contractor has obtained approval of final inspections.
Sworn and subscribed before me this 22
day of_1.1 , as
Notary Public, State ofFloricaat "a NOTARYSEAL
SIELI A E DOVE
My Commission Expires: : NOTARY
Fir 1.qt STATE OF FLORIDA
ATURE OF OWNER
COMM::%3ION NO. DD108558
MY COMMISSION EXP. APR. 142006
Page 1 of 2
t(iF NOTARY PUBLIC
30 DAY TEMPORARY- ELECTRIC SERVICE (continue)
T _ r
1,
:Li at/ V , being first duly sworn,
depose and say that I am the E1ethical Contractor for the above described property and that the electrical installations as
now existing will not create a safety hazard if temporary-service is connccte, ; 1 „/-
Sworn and subscribed before me this 23
day of ,
Notary Public, of Florida
My commission expires:
SIGNATU'E.E ;F ELECTRICAL CONTRACTOR
OFFICIAL NOTARY SEAL
SHELIA E DOVE
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO.
MY COMMISSION EXP. APR. 14,2
,p,eit,i4 rr.,P irn ourrie groeme.. 604USTa0C TI OA.J being first duly sworn,
depose and said that I am the Building Contractor of the above described property and that I will not permit occupancy
of this building until final division obtained and that I have the authority insofar as the owner of said property is
concerned to prohibit occupancy until such final inspections are obtained.
Sworn and subscribed before me this
day of F , Zee y
Notary Public, State of Florida at Tiw e
My Commission Expires: OFFICIAL-NOTARY SEAL
SHELIA E DOVE SI ATURE OF-NOTARY PUBLIC
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. DD108558
MY COMMISSION EXP. APR. 14,2006
ATURE OF BUILDING CONTRACTOR
SIGNATURE OF ELECTRICAL INSPECTOR
Release to FLORIDA POWER & LIGHT CO.
Date: by: (name)
Page 2 of 2
Date:
To: (name)
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 2/27 /2004
Electrical Permit
Permit Number: EL2004 -51
Applicant: VILLAGE DEL MAR DEVELOPMENT
Owner: DEVELOPMENT VILLAGE DEL MAR
JOB ADDRESS: 1291 -115 (8. 105 ST.
Contractor DOUG HEDDEN ELECTRIC, INC. Contractor's Address: 2200 N. W. 118 AVE.
Local Phone: 888- 672 -7177
Parcel # 1122320270010
Legal Description:
Page 1 of 1
Fees: Description Amount
FEE2004 -2078 CCF $0.60
FEE2004 -2085 Technology Fee $20.25
FEE2004 -2087 Building Fee $810.00
FEE2004 -2128 Training and Education Fee $16.00
Total Fees: $846.85
Total Fees: $846.%0
Total Receipts:" &Oo
7? :
Permit Status: APPROVED Permit Expiration: 8/21/2004 Construction Value: $845.00
Work: 30 DAY TEMP
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: