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EL-06-2799Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795 2204 Fax: (305) 756.8972 11119100_ . BUILDING PERMIT APPLICATION FBC 2004 NOV 1 7 no BY:.. Permit No Et..■ Cel — ,2-T:1(3 Master Permit No. Permit Type (circle): Building Electrical Plumbing Mechanical Roofing Owner's Name (Fee Simple Titleholder) j&-. / /9 &(J Phone # Owner's Address 917c- c'� 4� �'4 �- //2)4 City 4f/ `l� 5' 'X ( State (1 A l Zip Tenant/Lessee Name Phone # 05/ S77377j° ". °Y 1/0-7a3/ Job Address (where the work is being done) City ami Shores Village FOLIO / PARCEL # County e/ Miami -Dade / Zip Is Building Historically Designated YES NO Contractor's Company Name S'& 'C)4l- i 6f / 22 Phone # (3/'C 0?-C9--‘ ' ' City e 4 /if f ' State / Zip �� yf Qualifier Name 004/64/6) 0 4/t,gC(J Phone # Sop 7 7,477 State Certificate or Registration No. EP 2 9O c3/ 44' Certificate of Competency No. l Contractors Address (6 2 f j C 2'/'., ArchitectfEngineer's Name (if applicable) Phone # Value of Work For this Permit $ Type of Work: ❑Addition a Describe Work: f//�llbG %Pa" �: god — Square /Linear Footage Of Work: ['Alteration L t ew ❑ Repair/Replace ❑ Demolition le 7"L, D-Xc�._° t f / 2 S?Z-,2 6 SAC- - i'2 x ". /�;; / ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees * * * * * * * * * * * * * * * *** * * * * *** *** * * *** * * * ** * ** Permit Fee $ CCF $ t',210 CO /CC Training/Education Fee $ - Technology Fee $ .5°70 Radon $ DPBR $ Zoning $ Submittal Fee $ Notary $ 600 Scanning $ ZOO Bond $ Code Enforcement $ 1 Structural Review. $ Total Fee Now Due $) 0D- L ;�am/ C� Double Fee $ See Reverse side -* Bonding Company's Na Bonding Company's Ad City (if applicable) ss State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Addre s City Application is hereby m commenced prior to the construction in this jurisdi WELLS, POOLS, FURN OWNER'S AFFIDAVI applicable laws regulating "WARNING TO 0 PAYING TWICE FO CONSULT WITH COMMENCEMENT." Notice to Applicant: As promise in good faith tha whose property is subject for the first inspection w inspection will not be app Signature State Zip e to obtain a permit to do the work and installations as indicated. I certify that.no work or installation has ssuance of a permit and that all work will be performed to meet the standards of all laws regulating lion. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, CES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC I certify that all the foregoing information is accurate and that all work will be done in compliance with all nstruction and zoning. R: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, UR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must a copy of the notice of commencement and construction lien law brochure will be delivered to the person attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site ich occurs seven (7) days after the building permit is issued In the absence of such posted notice, the ved and a reinspection fee will be charged. 0 The foregoing instrument day of 4A'-Nd.ct_, 204 or Agent owledged before me this 2 ��WLL P.G7� f as ac 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: * * * * * * * * * * * * * * * * * * * ** APPLICATION APPRO (Revised 02/08 /06) 4°4A6y ;•••R N% JUDITHA.FARNEY t`r * MYCQMMISSIQN #DD385019 EXPIRES: January 10, 2009 D BY: The foregoing instrument was acknowledged before me this day of 42 -- % , 20 t6,, by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: �� J 0 PUB,].C, OF FLORID �L , , n6666 b�� f ��1 dnl My Commission Expires. 2010 G Engineer Zoning f. k ADDENDUM TO BUILDING PERMIT APPLICATION AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEEN OBTAINED, THE OWNERS NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS. PLEASE CIRCLE 0 DISCIPLINE APPLIED FOR: PLUMBING ELECTRICAL PERMIT # MECHANICAL ITEM UNIT FEE ITEM UNIT FEE ITEM UNIT FEE BATH TUB SWITCH OUTLETS SPACE HEATERS DISHWASHER LIGHT OUTLETS CENTRAL HEATING DISPOSAL RECEPTACLES NC (WIND) FLOOR DRAIN SERVICE TEMPORARY A/C (CENTRAL) GREASE TRAP SERVICE SIZE IN AMPS DUCT WORK INTERCEPTOR SERVICE REPAIR/METER CHANGE REFRIGERATION LAVATORY APPLIANCE OUTLETS PROCESS AND PRESS PIPING LAUNDRY TRAY RANGE TOP UNDERGROUND TANKS CLOTHES WASHER OVEN ABOVE GROUND TANKS SHOWER WATER HEATER U.F. PRESSURE VESSELS SINK. POT /3 COMP. MOTORS 0 -1 HP STEAM BOILERS SINK, RESIDENCE. MOTORS OVER 1 -3 HP HOT WATER BOILERS SINK, SLOP. MOTORS OVER 3 -5 HP MECHANICAL VENTILATION TEMPORARY WATER CLOSET MOTORS OVER 5-8 HP TRANSPORTING ASSEMBLIES URINAL MOTORS OVER 8 -10 HP ELEVATORS/ESCALATORS WATER CLOSET MOTORS OVER 10-25 HP FIRE SPRINKLER SYSTEMS INDIRECT WASTES MOTORS OVER 25-100 HP COOLING TOWERS WATER SUPPLY TO: MOTORS OVER 100 HP VIOLATION NC UNIT NC WINDOW REINSPECTION FIRE SPRINKLER AIR CONDITIONERS HEATER -NEW INST. STRIP HEATER HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL GENERATORS TRANSFORMERS SWIMMING POOL GENERATORS TRANSFORMERS WATER SERVICE SPECIAL PURPOSE SEWER CONNECTIONS OUTLETS COMMERCIAL UTILITY -SEWER SIGN TUBES UTILITY -WATER SIGN TRANSFORMERS SEPTIC TANK SIGN TIME CLOCK RELAY FIXTURES FAINFIELD, 4" TILE/RES. ANTENNA PUMP &'ABANDON SEPTIC TANK TELEVISION OUTLETS i SOAKAGE PIT CU. FT. VIOLATION CATCH BASIN REINSPECTION DISCHARGE WELL ,S&--92/70 s k / 2 DOMESTIC WELL jejfa�� I %�V y AREA DRAIN ROOF INLET r SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) GAS PIPING Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 '00001111111110...: Inspection Date: 01/16/2008 Inspector: Devaney, Michael Owner: DAVIS, JEFFREY AND YASMIN Job Address: 9275 BAYSHORE Drive N Miami Shores Village, FL Project: <NONE> Contractor: SECURITY PLUS INDUSTRIES Block: Permit Type: Electrical - Residential Inspection Type: Final Work Classification: New Phone Number (305)577 -3777 Parcel Number 1132050270570 Lot: Phone: (305)666 -0864 Building Department Comments WIRING FOR 10 TV JACKS WIRING FOR 12 STERED SPEAVER JACKS WIRING FOR4 TELEPHONE JACKS WIRING ONLY IRAN 17 2000 Passed Inspector Comments /0„ /.. /Y J't „.. d� Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid . until Tuesday, January 15, 2008 Page 2 of 2