EL-04-262 Miami Shores Village
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel: (305)795.2204 Fax: (305)756.8972
BUILDING Rti�O V ® Permit No.
PERMIT APPLICATI 1 , 9 2004 Master Permit No.
FBC 2001
Permit Type(circle): Building lectrical Plumbing Mechanical Roofing
Owner's Name(Fee Simple Titleholder) Je3uj r./J� e-�-e $ Phone#
Owner's Address Lt/. f'Y C e f
City /y1/lt'm% , �c ore S State -�iL . Zip
Tenant/Lessee Name Phone#
Job Address(where the work is being done) V/ wy/ /,0/.
City Miami Shores Village County Miami-Dade Zip
Is Building Historically Designated YES NO V'
Contractor's Company Name _ 'L!.✓ Phone# JP t 9 Z
Contractor's Address7",—*
City % 4 State Zip
Qualifier 4e L
State Certificate or Registration No. QD 1 44 z f Certificate of Competency No.
Architect/Engineer's Name(if applicable) Phone#
$Value of Work For this Permitl, 2. - Square Footage Of Work:
Type I AAM9 Al ration ❑Ne ❑Demolition,
-0—A BOJ AJ
Desc orki0. • 772 4 �ataN y-G �Y
+P010M •
UP
Submittal Fee I Permit Fee$ ®0 '� CCF$ A CO/CC
Notary$ Training/Education Fee$ Technology Fee$ ,sy
Scanning$ Radon$ Zoning Bond$
Code Enforcement$ Structural Plan Review.$
Total Fee Now Due$ V
(Continued on opposite side)
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip F{+
Mortgage Lender's Name(if applicable)
Mortgage Lender's ess
City State i Zip
Application is hereby made to obtain a permit to do the work and installations its•indicated. I certify that no work or
PP Y Pe installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the i tandards 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 wi I be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEM1 T 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 RECORD G YOUR NOTICE OF
COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exc ding$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochur will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencem nt must be posted at the job side
for the first inspection which occurs seven (7) days after the building permit is issued. In the ab rice of such posted notice, the
inspection wi of be approvedand a reinspection fee will be charged.
Si Signature
er or Agent Uctor
The foregoing instrument was acknowledged beforemethis 49f The foregoing instrument was acowledged before me this D9
day of 200W by day of D _ ,200 1 Y Mojel Jyt"
who is personally known to
me or whoda roduc Ivho is personally known tom who has produced
49
:T5 Z- 2`7' As identification and who did take an oath. as identifia Uon and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: �� �_' L ,� — 4�t Sign:
Print: Print: CARLOB A FENVMM
r
My Commission Expire Woiay hAft-aft of My Commiffiwwr. F Dec 16,2
�*�tiB*ii DrC 143= #DD 346"7
BO xbd By NQaondW ,
APPLICATION APPROVED BY: 2 2
0,j4-`Plans Eng
Engineer
Zoning
Chc 05/13/03
't
ADDENDUM TO BUILDING PERMIT APPLICATION
APPLICATIO)N�FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B.
'AINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING ELECTRICAL MECHANICAL
UNIT FEE ITEM UNIT FEE ITEM LN IT FEE `
TLE SWITCH OUTLETS SPACE HEATERS
LIGHT OUTLETS 41 CENTRAL HEATING
RECEPTACLES A/C (WINO)
SAL SERVICE TEWORARY A/C (CENTRAL)
ING FOUNTAIN SERVICE SIZE IN APS DUCT WORK
DRAIN SERVICE REPAIPAVER MICE REFRIGERATION
;E TRAPAPPLIANCE OUTLETS PROCESS AND PRESS PINK
%CEPTCR RANGE TOP UNDERGROUND TANKS
TORY OVEN ABOVE GROW TANKS
AY TRAY WATER HEATER U.F. PRESSURE VESSELS
iES WASHER MOTORS 0- 1 HP STEA..1 BOILERS
_R WTORS OVER 1- 3 HP HOT WATER BOILERS
POT/3 COMP. MOTORS OVER 3- 5 If MECHANICAL VENTILATION
RESIDENCE MOTORS OVER 5- 8 FP TRANSPORTING ASSEWLIES
SLOP WTORS OVER 8- 10 HP ELEVATORS/ESCALATORS
MY WATER CLOSET MOTORS OVER 10- 25 If FIRE SPRINKLER SYSTEMS
MOTORS OVER 25-100 HP COOLING TOWERS
.R CLOSET MOTORS OVER 100 If VIOLATION
RECT -WASTES A/C WINDOW REINSPECTION
A SUPPLY TO: AIR CONDITIONERS �
'C UNIT STRIP HEATER
!RE SPRINKLER GENERATORS TRANSFW%, (ERS
:ATER-NEW I%T. GENERATORS TRANSFMR ERS
_ATER-REPLACE GENERATORS TRANSFORMERS
kW4. SPRINKLER-WELL SPECIAL PURPOSE
iIM,IING POOL OUTLETS COMMERCIAL
ATER SERVICE SIGN TUBES
A CONNECTIONS SIGN TRANSFORMERS
.ITY-SEWER SIGN TIME CLOCK
A TY-WATER FIXTLRES
TIC TAW ANTENNA �
4Y TELEVISION CUTLETS
INFIELD, 4' TILE/RES. VIOLATION
S ABANDON SEPTIC TANK j REINSPECTION j
WE PIT CU. FT.
:i BASIN
CHARGE WELL
ESTIC WELL
A DRAIN
F INLET
AR WATER HEATER
E STANDPIPE
IPE
L PIPING
N SPRINKLER SYSTEM
RANGE
ER SET (GAS)
PIPING
Miami Shores Village Electrical Permit
10050 NE 2nd Avenue
Phone: 305-795-2204 Permit Number: EL2004-262 `
Printed:9/13/2004 Page 1 of 1
Applicant: JESUS JIMENEZ
Owner: JIMENEZ JESUS
JOB ADDRESS: 41 NW 106 ST
Contractor STATEWIDE ELECTRICAL Contractor's Address: 7588 W 33 LANE
Local Phone: 305-592-6965
Parcel # 1121360060210 Legal Description: 36 52 41 PB 41-78 DUNNINGS MIAMI SHORES EXT NO 2 LOT 13
Fees: Description Amount
FEE2004-9241 Building Fee $100.00
FEE2004-9242 CCF $1.20 Total Fees $�04,�
FEE2004-9243 Training and Education Fee $0.40 Total Receip 0
FEE2004-9244 Technology Fee $2.50
Total Fees: $104.10
Permit Status: APPROVED Permit Expiration: 3/8/2005 Construction Value: $1,200.00 p��
Work: REWIRE TO SMALL APPLIANCES 1 r""
�2Z
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: