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RC-10-285Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 152605 Permit Number: RC -2 -10 -285 Scheduled Inspection Date: February 28, 2011 Inspector: Bruhn, Norman Owner: SAXON, JENNIFER Job Address: 277 NE 97 Street Miami Shores, FL 33138 -2403 Project: <NONE> Contractor: HOME OWNER Permit Type: Residential Construction Inspection Type: Final Work Classification: Alteration Phone Number rcel Number 1132060134280 Building Department Comments REPLACE KITCHEN CABINETS, FLOOR AND APPLIANCES. bounce check unpaid. do not place any inspections until payment is done. 8/27/2010 - STOP ORDER REMOVED. BOUNCED CHECK PAID. AS Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments February 28, 2011 For Inspections please call: (305)762 -4949 Page 9 of 33 Project Address Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 277 97 Street Miami Shores, FL 33138 -2403 1132060134280 Block: Lot: JENNIFER SAXON Owner Information Address Phone Cell JENNIFER SAXON 277 97 Street MIAMI SHORES FL 33138 -2403 Valuation: Total Sq Feet: $ 15,000.00 100 Approved: In Review Comments: Date Approved:: In Review Date Denied: Type of Construction: KITCHEN REMODEL Stories: Front Setback: Left Setback: Bedrooms: Plans Submitted: Certificate Date: Bond Retum : Occupancy: Single Family Exterior: Rear Setback: Right Setback: Bathrooms: Certificate Status: Additional Info: Classification: Residential Fees Due CCF DBPR Surcharge Education Surcharge Notary Fee Permit Fee - Additions/Alterations Radon Surcharge Scanning Fee Submittal Fee Submittal Reversal Fee Technology Fee Total: Amount $9.00 $0.50 $3.00 $5.00 $450.00 $0.50 $9.00 $50.00 ($50.00) $12.00 $489.00 Invoice # RC -2 -10 -37113 Invoice Total Amt Paid Amt Due $489.00 $489.00 $0.00 Check #: 1957 Building Department Copy For Inspections please call: (305)762 -4949 Available Inspections: Inspection Type: Final PE Certification Shutter Final Window Door Attachment Tie Beam Slab Termite Letter Framing Insulation Drywall Screw Shutter Attachment Window and Door Buck Ceiling Grid Fill Cells Columns Declaration of Use March 02, 2010 2 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 BUILDING PERMIT APPLICATION FBC 20 1.MMIVED FEB 2 4 zoia Y: Permit No. 10 —2a5 Master Permit No. Permit T pe: BUILDING ► OOFING Owner's Name e.&mpleTitleholder) :370,-) w* one #(3)°1—?g"--62 Owner's Address a 1 —_ City 4.4 ..- Li' tate Zip 31.2 Tenant/Lessee Name Phone # C3--) ') (p -1_11,„, Email If Al A.A. Job Address (where the work is being done) �� ,,) _ cr-) cs 4--- City Miami Shores Village County Miami -Dade FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name a vv 8 Zip 33i"6 Phone # Flood Zone fU 6 Contractor's Address City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. Contact Phone Architect/Engineer's Name (if applicable) E -mail Ifhone °" Value of Work For this Permit $ 15 000 Square / Linear Footage Of Work: Jo 10 Type of Work: DAddition Alteration ❑New ❑ Repair/Replace ❑ Demolition Describe Work: 1 1 a c e „ b i n f b e1 , /cX» 1 `a p I t Q✓1 ces e ********* * * * * * * ** * * * *,r * * * * * *x * *** * * * *** Fees**************** * * * * * *,r * * * * * * * * * * * * *,r * * * * *,r* Submittal Fee $ Notary $ 1ST V Scanning $ ! . 00 Double Fee $ Structural Review. $ Permit Fee $ CCF $ "I.00 CO /CC $ Training/Education Fee $ Radon $ O. S0 DPBR $ O' SO Violation date: Technology Fee $ P "� Bond $ Total Fee Now Due $ 453.00 See Reverse 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 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 The foregoing instrument was acknowledged before me this day of FR.6 , 20 in , by c 6Nn11 tr:1O-4. 1hi hit( who is personally known to me or who has produced FL t As identification and who did take an oath. \ \`,``o ottl iwn,,,"i� YO/ NOTARY PUBLIC: Print: My Commission Expires: * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY d ' J o, Go . `s- -_ cn c �,• for©'': ti�, ,s ... a1/ °/s��t��tit�i "O * * ** .********************************************* * * * * * * * ** * * * * * * * * * * * * * ** ** * * * ** Signature Contractor 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: Plans Examiner Zoning Engineer (Revised 07 /10 /07)(Revised 06/10/2009) Clerk checked NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO NO. STATE OF FLORIDA: COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Legal description of pro c�� ) /O cn erty and street/address: '1S M lOurvCt SS 1,101,-es 33T" 1111111111111111111111111111111111111111 :Ft4 2011.08011.22041 OR 81•. 27191 Ps 4686; (1ps) RECORDED 02/23/2010 14:52:35 HARVEY RUrV'II'Iv CLERK OF COURT MIAMI—GAGE COUWITYr FLORIDA LAST F'AGE 2. Description of improvement: Y.--t k4,' 4fYYY3 1 v14� 3. Owner(s) name and address: {7 ` l S �'iY) y - Mta..vY-1j S kc -cs, 1-1 R 12 RC Interest in property:OLov)..ens Name and address of fee simple titleholder: 4. Contractor's name and address: c. 2ri x'77 1a 14' CA- M 'inct ?913 - 5. Surety: (Payment bond required by owner from contractor, if any) S wA`i`. OF FLORIDA, COMITY OF DADE Name and address: Kt e\- iHFRERY CERTIFY that this is ofthe Amount of bond $ Ain 6. Lender's name and address: 7. Persons within the state of Florida designated by Owner u provided by Section 713.13(1)(a)7., Florida Statutes, Name and address: 9v' original ill i this office on 1 COUR 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and address: fl 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a d'rff- rent dat- is sp -ci ed) Si. atur-fxlswner Pnnt Owner's Name ���uuurr ,,�� Sworn to and subscribed before me this �.‘Dia of , 201iib. Notary Public Print Notary's Name My commission expires: 123.01 -52 PAGE 4 8/02 Prepared b Address: DT'? e rie/Y"1--n iia FEB 24 10 a /oe 1QLcuitAc .iikar-esi BY:San Seen 33 • • ••• • • • ••• •• •• • • • •• •• • • • • • • • • • • • • • • • • •• • • • • • • • • • ••• • • • • kLy; ''■:.' ,I. 1 • • • • 54. • • • ., • . • • • • • • • • • • • • • • • • • • • • • • •• • • ' •• • • • v • • • • • • • ' • • • •• ** •• • • • *** • • ••• • • Miami Shores Village APPROV BJECT 10 CCMPLIANCE WITH ALL FEDERAL ATE CC.,UN 1Y U S AND REGULATIONS GJI‘c\vo mo tgaN-eA arA ''Sotmcf wood Note: This drawing is an artistic interpretation of the general appearance of the design. It is not meant to be an exact rendition. e • ■ pty-E0472:P/2,.5- Designed: 9/26 Printed. 9/26/2 tjit Drawii • • ••• • • • ••• •• •• • • • •• •• • • • • • • • • • • • • • • • • • • • ••• • • • • • • • • • • • • • • ••• • • • • • ••• • • • • • • • • • • • • • •• • • • • • • • • • • • • • • • • • ••• • • • • • • • • • • • • ••• ••• • ••• • •• • • • •• ••• •• • • • • • • • • • •• • • • • • ••• •• Nom: This drawing is an artistic of interpretation of the general appearance the design. It is not meant to be an exact rendition. Designed: 9f261 Printed: 9126/2( FLEMING, JENNIFER Drawin . • ••• • • •••• • •• • • • •. .. • • • • • • • • • • • • • • • • ••• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •• • • • • • • • • • • • • • • • • • • • ••• • • • • • • .. a • • • • ••• ••• • ••• • .. • • • •. ... .. • • • • 0 • • .. • • .. • • • • • ... .. al- W3 ® ®l ® ® ®; •L Mir al if Note: This drawing is an artistic interpretation of the general appearance of the design, it is not meant to be an exact rendition. Designed: 9/26 Printed: 9/26/2, FLEMING, SENNiFEFt Drawit • • ••. • • • ••• •• •• • • • •• •• • • • • • • • • • • • • • • • • • • • ••• • • • • • • • • • • • ••• • • • • . • • • • • • • • • • • • .• • • • • • • • • • • •. • • ••• • •• • • • • • • • • • ••• ••• • ••• • •. • • • •• ••• •• • • • • • • •• • • • • • ••• •• Note: This drawing is an artistic interpretation of the general appearance of the design. it is not meant to be an exact rendition. 277 NE 97 Street Miami Shores, FL 33138 Jennifer Fleming Panel Schedule 1.) A/C 3.) A/C 5.) Microwave 7.) Lighting 9.) Refrig 11.) Kitchen APP 13.) Kitchen App. 15.) Kitchen App. 17.) Lighting 19.) Range 21.) Range Longman Electric EC 13003713 844 NE 98 Street Miami, FL 33138 50 Amp # 8 THHN 50 Amp #8 THHN 20 Amp #12 THHN 20 Amp #12 THHN 20 Amp #12 THHN 20 Amp #12 THHN 20 Amp #12 THHN 20 Amp #12 THHN 20 Amp #12THHN 50 Amp #8THHN 50 Amp #8THHN • • • • • • • • • • • . • • • ▪ • • • • ••• • • • • • • • • • •• • • • • • • • • • • • • • • •• ••• • • • • •• ••• •• . • • • • ••• •• • • 2.) Washer 20 Amp #12 4.) Lighting 20 Amp #12 6.) Dryer 30 Amp #10 8.) Dryer 30 Amp #10 10.) Lighting 15 Amp #14 12.) Dishwasher 20 Amp #12 14.) Refrig 20 Amp #12 16.) Lighting 15 Amp#14 18.) Water 30 Amp #10 20.) Water 30 Amp #10 277 NE 97 Street Miami Shores, FL 33138 Jennifer Fleming Existing 200 Amp Panel LOAD CALCULATION 2300 sgft x 3VA= 6900 Small Appliance 3000 Laundry 1500 Dishwasher 1200 Water heater 4500 Disposal 1000 Dryer 5000 Range 10000 • • • • • • • • • • • • • • • •• ••• ••• • •• • • ••• ••• • • • •• • • • • • • • •• • • •• ••• • •• • • • •• ••• •• • • • • • • • • . • • • • • • • • • •• • • • • • ••• •• 32000 -10000 22000 10000 x 40% 8800.00 8800.00 18800 10000 air conditioning 28800 full VA 28800 / 240 = 120 amperage Longman Electric EC 13003713 844 NE 98 Street • • • • �- • • •• • • • • • •••• • •• •• • • • • • • • •••• • •••• •• • • ._• • •• • • • • • • • • • •• • •• •• •• •••• • -• •••• • • •• • •••• • • •••• • • • j1 YYm At • f�ypr,-?- t'\ St dLe., daa■ Os/11e-9 e6C) 3 Close l era Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 136265 Permit Number: EL -2 -10 -287 Scheduled Inspection Date: February 28, 2011 Inspector: Devaney, Michael Owner: SAXON, JENNIFER Job Address: 277 NE 97 Street Miami Shores, FL 33138 -2403 Project: <NONE> Contractor: LONGMAN ELECTRIC INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number arcel Number 1132060134280 Phone: (305)758 -1211 Building Department Comments INSTALL GFI IN KITCHEN REMODEL AND LIGHTING Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments 6?p{W February 28, 2011 For Inspections please call: (305)762 -4949 Page 3 of 33 Project Address Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 277 97 Street Miami Shores, FL 33138 -2403 Owner Information Parcel Number 1132060134280 Block: Lot: Expiration: 08/29/2010 Applicant JENNIFER SAXON JENNIFER SAXON V: VVVXMOVAVV:, Address 277 97 Street MIAMI SHORES FL 33138 -2403 Phone CeII Contractor(s) LONGMAN ELECTRIC INC Phone (305)758 -1211 Cell Phone Valuation: Total Sq Feet: Type of Work: INSTALL G.F.I KITCHEN Additional Info: ELECTRICAL Classification: Residential Fees Due CCF DBPR Surcharge Education Surcharge Notary Fee Permit Fee - Additions/Alterations Radon Surcharge Scanning Fee Submittal Fee Submittal Reversal Fee Technology Fee Total: Amount $1.20 $0.50 $0.40 $5.00 $225.00 $0.50 $3.00 $50.00 ($50.00) $1.60 $23720 Invoice # EL -2 -10 -37115 Invoice Total Amt Paid Amt Due $237.20 $237.20 $0.00 Check #: 1957 Building Department Copy $ 1,200.00 100 For Inspections please call: (305)762-4949 Available Inspections: Inspection Type: Final Meter Box Alteration Relocation Fire Alarm Service Change Underground W. W. March 02, 2010 2 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 20 Permit Type; ELECTRICAL Owner's Name (Fee Simple Titleholder) Owner's Address 2 7? N E- cf Permit No. palm? I FER 2 4 ?OW BY: Et. Lo x'21 Master Permit No. , -t- �_ r%�Y ■✓i Phone #,3� ��c�r(, Lf� t City r--11 ai vv c. State rk Tenant/Lessee Name Email -[0N Y\ V && \ �6e.VS otA. -Lt . Job Address - (where the work is being done) 011 J v ` r 1 1" City Miami Shores Village County Miami -Dade FOLIO / PARCEL # Is Building Historically Designated YES NO Flood Zone Contractor's Company Name / x/06 -Mq{-v■ %74i7 G Phone # 305- 75 7SE °"P-17 Contractor's Address 2'1 t'/ q g .5 e-e. f4- City /1110.41/ y Ljo�r'L s State Zip 3 3) �I$ Qualifier Name ,4v( het e° Phone # 31.95 — 75,1 State Certificate or Registration No g C 13 00, 71, rt ficatc ofgt get09 loo. Contact Phone % $ s q 7 2— 136 if E -mail is-? G e_Bil /S4.- .0-e74- Zip rz, gv Phone # Zip `3 r2 Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ - f / ? ®C',o6 Square / Linear Foptage Of Work: Type of Work: ['Addition '21 Alteration ['New � ❑ Repair/Replace ❑Demolition Describe Work: �i3OYrd / 6 F ..i 1,- )(/ <ai' Submittal Notary $ Scanning $3'00 ee$ C01'00 Permit Fee $ Z 5 f�D CCF $ 1 'aO CO /CC Training/Education FFee $ 040 Technology Fee $ RO Radon $ d•S V DPBR $ 0 •SO Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ 1 ' 0 See Reverse side -+ ti 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 ha commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulatin; 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 al 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 $2500, the applicant muss promise in good faith that a copy of the notice of commencement . and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice. the inspection will not he approved and a reinspection fee will be charged. Signature wner or Agent The foregoing instrument was acknowledged before me this Signature g1-1/1-1...--- The for day of __C Z _, 2010, by nitf{N 9. Z. .�4+ I$( day of It —IS who is personally known to me or who has produced M- I p As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: ``����� 111 I I I I t ll/i/l /i • b My Commission Expires: *** * * *** ** aka«c*$ a *** *X>k *>.'v$eeg ***:k *3eek�4, )* APPLICATION APPROVED BY Plans Examiner (1)%° a v© °W= • A� ®ll/tlttllll10. who is p Contractor instrument was acknowl e , 20 10, by 1U ally known to me or who has produced tification and who did take an oath. OTA Sign: Print: My Commission Expires, �Jg�E a'r g 8< 0 UDA Rk 2 ak R *k kR kk #kkk kRRkR kaF aGstx1� yk R 2aV R k �1� /47 (41COgarti9604 # a k Rk k *** Engineer (Revised 07/10/071 Zoning Clerk checked Project Address Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Expiration: 08/29/2010 Applicant 277 97 Street Miami Shores, FL 33138 -2403 1132060134280 Block: Lot: JENNIFER SAXON Owner Information JENNIFER SAXON Address 277 97 Street MIAMI SHORES FL 33138 -2403 Phone CeII Contractor(s) PRONTO PLUMBING INC Phone Cell Phone (305)978 -7755 Valuation: Total Sq Feet: Type of Work: KITCHEN REMODEL Type of Piping: Additional Info: PLUMBING Bond Retum : Classification: Residential Fees Due CCF DBPR Surcharge Education Surcharge Notary Fee Permit Fee - Additions/Alterations Radon Surcharge Scanning Fee Submittal Fee Submittal Reversal Fee Technology Fee Total: Amount $0.80 $0.50 $0.20 $5.00 $100.00 $0.50 $3.00 $50.00 ($50.00) $0.80 $110.60 Invoice # PL -2 -10 -37114 Invoice Total Amt Paid Amt Due $110.60 $110.60 $0.00 Check #: 1957 Building Department Copy $ 500.00 For Inspections please call: (305)762 -4949 Available Inspections: Inspection Type: Top Out Re Pipe Main Drain Heater Water Service Final Water Main Lavatory Underground March 02, 2010 2 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 BUILDING PERMIT APPLICATION FBC 20 Permit Type: PLUMBING Permit No. Master Permit No. Owner's Name (Fee Simple Titleholder),. er). 1° ►` r ,' 5 . {�2 w� 1/4.1 Phone # Owner's Address tD'%'? ../04 J City N 1. t c, t.4 State Zip Tenant/Lesss °�eeName Email -�/�-f1/Yv VL"e;1 1jJ-4 • ytio FED 2 t 2)1 BYB P(_-_. IC' (3cS> 'iS (,G°t 7 Job Address (where the work is being done) 49"72 Alp: l') mss' 3— Phone # City Miami Shores Village County Miami -Dade FOLIO / PARCEL # Zip 33) 77g Is Building Historically Designated YES Contractor's Company Name .1314211-t) 7 Contractor's Address / 'L ) 3 C / w 1 ) �// ' l 3,316.% _ City � �i� . I'_ � � _ State j ��� > Zip Qualifier Name 4.10/../ Nf °, Phone # 3 ®j�� 9 ,2K 7 State Certificate or Registration No. C F c� J 4-3--b? L Certificate of Competency No. ---' Contact Phone `'—'� E -mail '---- NO Flood Zone Architect/Engineer's Name (if applicable) ..1 Rhone # *• .t `� ' A '� Value of Work For this Permit $ '54)®' Square / Linear Footage Of Work: Type of Work: ❑AA,ditionn ['Alteration ENew , / A Repaij/Replace Describe Work: ❑ Demolition * * * * * * * * * * * *, *** * * * * * * * * ** * * * * * * * ** * * ** Fees* * * * * * * * * * ** * ** * * ** * * ** *Na0 ** **** * *** * ** * * * * * ** 7 �i Submittal Fee $ 'LJ '00 Permit Fee $ /00 /L i.�'� CCF $ CO /CC $ Notary $ S-00 Training/Education Fee $ Technology Fee $ •10 Scanning $ '6100 Radon $ 0.50 DPBR $ O' Bond $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ CQ0'l00 See Reverse side —> Bonding Company's Name (if app Bonding Company's Address City Mortgage Lender's Name (if appli Mortgage Lender's Address City MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2nd AVE - MIAMI SHORES, FL 33138 PHONE (305) 795-2204; FAX (305) 756-8972 WWW.MIAMISHORESVILLAGE. - 5 PERMIT #. SUBMITTAL DATE: CLERK: NOTE: MUST PRESENT THIS CARD Application is hereby made to obt tify that no work or installation has TO PICK UP YOUR PERMIT commenced prior to the issuance in a penun auu ivai all wort( wm o-e perrormea 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 ,ic', the inspection will not be approved and a reinspection fee will be charged. Signature er or Agent The foregoing instrument was acknowledged before me this day of FAIS , 20 10, by srtANIN% ;oz. F•1. f rir\ l "t who is personally known to me or who has produced R --113 As identification and who did take an oath. NOTARY PUBL , : Sign: Print: My Commission Expires: Contractor The foregoing instrument was acknowledged before me this) day of �� t—' , 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: 011111M %® 6/2012 NOTARY - PUBLIC :�� Commission # •° rn u.. 2 ` Plans Examiner Zoning (Revised 07 /10 /07)(Revised 06/10/2009) Engineer Clerk checked