EL-12-186130 9 54v/-3 9V
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 No. 'G L-12
Master Permit No.
RECEIVEi5
JAN 0 6 2012
Permit Type: Electrical
OWNER: Name (Fee Simple Titleholder): a/. -42 vr 12e,"7"1.-) Phone #:
Address: /VG= ? fr S74:
City /Xh / S's State: 7 Zip: 3.3/.30
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: S3 A/C" T .$71.
City: Miami Shores County: Miami Dade
Folio/Parcel #: // 3.4 Q /fi Q 93 Q
Zip: 9 -3/3 g5
Is the Building Historically Designated: Yes
NO Flo&1 Zone:
CONTRACTOR: Company Name: ADT SECURITY SERVICES Phone #:
Address: 10,785 MARKS WAY
MIRAp4AR, FL 33025
City: State: Zip:
Qualifier Name: .>%r°11 Phone #: 9.53/-2 533 3
State Certification or Registration #: Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer:
Phone #:
Value of Work for this Permit: $ / 9'9 - i2 0 Square/Linear Footage of Work:
Type of Work: Address Alteration Z New ❑Repair/Replace ODemolition
Description of Work: j2YS j4f // d. %�e'� O ,»v
Submittal Fee $ •
Scanning Fee $
Notary $
Double Fee $
Permit Fee $ / C t O CCF $ CO /CC $
Radon Fee $ DBPR $ Bond $
Training/Education Fee $ Technology Fee $
Structural Review $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
M rtgage Lender's Name (if applicable)
M rtgage Lender's Address
City State Zip
Ap
co
co
lication is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
enced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
traction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
LLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
O \VNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
ap licable laws regulating construction and zoning.
cc
ARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
PROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
NANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
CORDING YOUR NOTICE OF COMMENCEMENT."
No
pr
wh
for
ins
Si
ice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
mise in good faith that a co of the notice of commencement and construction lien law brochure will be delivered to the person
se property is subject to a 'a o. ment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
the first inspection which oc .rs seven (7) days after the building permit is issued. In the absence of such posted notice, the
ection will no b. -7� rove « a d a reinspection fee will be charged.
ature
wner or Agent
Th foregoing instrument was acknowledged before me this
da of fkAV , 20 IZ , by
wh • is personally known to me o has produced
As identification and who did take an oath.
N o TARY PUBLIC:
M Commission Expires. ,,, CWFUSTIAN=ALES
: MY COMMISSION ff EE 118853
EXPIRES: August 4, 2015
Bonded Th u Notary P&G UnderWrfters
APPROVED BY
Contractor
,
The foregoing instrument was aeknowdged before me thi
me or wha has , oduced
as identification andvock9 d'take an oath.
91.7itif'd Plans Examiner
Structural Review
(Revised 07 /10 /07XRevised 06 /10/2009XRevised 3/15/09)
NOTARY PUBL :
Sign:
Print:
My Commission Expires:
LATOYA L CARTER
4 MY COMMISSION # EE 13959?
EXPIRES: October 19, 2015
Bonded Thu No Public Ondereers
Zoning
Clerk
s
urity
end
Date: _December 7, 2012_
Contractor:
Permit Number:
Municipality:
Job Address:
2
Permit Cancellation Request
ADT SECURITY SERVICES, INC.
EL- 1 -12 -18
IAMI SHORES
558 N 94 ST
ADT SECURITY SERVICES, INC.
10785 MARKS WAY
MIRAMAR, FL 33025
0954) 266 -5027
/ Lisc #: EF 0001121
Please be advised this is a request to cancel the above referenced permit for a security system.
The permit is being canceled because:
The system was removed.
The system was never installed or upgraded by ADT.
Aduplicate permit was issued. The original permit # is
Then stomer is no longer monitored by ADT Security Services, Inc.
CIASIl ')P.,' (J) (a5-1 VC
Other: Explanation-
Signatur• of Contractor
Date: 12/7/2012 Printed Name: _George Manginelli_
No* bay
Customer#
309401394