ELC-11-1034Miami 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
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: Electrical
OWNER: Name (Fee Simple Titleholder):
Address: 11 S ®O A e gave
City: /(4421711 d State: Z �% Zip: __
Tenant/Lessee Name: ®/ Phone #:
Email:
Permit No.
Master Permit No.
arA --to(.1
Z.64411/6,24/ Y ' Phone #:
JOB ADDRESS: ///e /t1 &,9Y-
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name: i�& 2 Phone #: �d� � O �'�
Address: 46‘e9 90 5
City: a44/11'
,•�^� State: G- i Zip:
Qualifier' Name: �Al �/ i�'% Phone #:
State Certification or Registration #: % d0 // 9 ?Certificate of Competency #:
Contact Phone #: 1,15 756 Cad Email Address:
DESIGNER: Architect/Engineer: /isi.
Phone #:
Value of Work for this Permit: $ 4e a 06
Type of Work: Address ❑Alteration
Description of Wor
Square/Linear Footage of Work:
New epair/R- .lace
❑Demolition
****************************** ****0..*3*****
(9-
Submittal Fee $ Permit Fee $-i# CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
pc
TOTAL FEE NOW DUE $ 22..
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 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 a a reinspection fee will be charged.
ignature
Owner or Agent
The foregoing instrument was acknowledged before me this2r'cu
day of14 ,20I , by MO cg qoAatar
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
77,-777 VV7777-77-77-V,
* * * * * * * * * * * * * * * * * * * **
ill
The forego
day of
Contract
instrument was acknowledged before me thi
,2011 , by - of - /7
who is personal y known to me or who has produced
as identification and who did take an oath.
APPROVED BY r 9,4/ 0/ . -*A" Plans Examiner
Structural Review
(Revised 07 /10 /07XRevised 06 /10 /2009XRevised 3/15/09)
NOTARY PUBLIC:
Sign:
Print:
My Co
xpires: MARY PAT BRIGGS
MY COMMISSION # DD 979267
Bonded nm Notary Pubic U demdt ere
Zoning
Clerk
1
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Parcel Number
Applicant
11300 NE 2 Avenue Number: Garner Building 1121360010160 -22
Miami Shores, FL 33138 -0000 Block: Lot:
BARRY UNIVERSITY INC
Owner Infonination
Address
Phone
Cell
BARRY UNIVERSITY INC
11300 NE 2 Avenue
MIAMI SHORES FL 33161 -6628
Contractor(s)
MOODY ELECTRIC INC
Phone Cell Phone
(305)758 -2000
Valuation:
Total Sq Feet:
$ 6,800.00
0
1
Type of Work: NEW STAGE LIGHTS
Additional Info: 24 FIXTURES GARNER BLDG
Classification: Commercial
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$4.20
$3.06
$3.06
$1.40
$204.00
$3.00
$5.60
$224.32
Pay Date Pay Type Amt Paid Amt Due
Invoice # ELC -6 -11 -41155
06/16/2011 Check #: 18324 $ 224.32 $ 0.00
Available Inspections:
Inspection Type:
Final
Meter Box
Alteration
Relocation
Fire Alarm
Service Change
Underground
W. W.
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 responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated.
June 16, 2011
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Date
June 16, 2011
1