EL-04-109 73?Q3 - . t2i `1
Miami Shores Village
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel: (305)795.2204 Fag: (305)756.8972
RECENED
BUILDING P 6 2004 Permit No. F i 2 b0q_CJq'
PERMIT APPLICATIO Master Permit No. 564
FBC 2001
Permit Type (circle): Building lectrical Plumbing Mechanical Roofing
Owner's Name(Fee Simple Titleholder) 1AILIho Phone# 54=
Owner's Address 124 All--
City EXJZJQ�y State (�'Cr Zip 3 3 <3 S
Tenant/Lessee Name Phone#
Job Address(where the work is being done) 12-13 IBJP— 9't,/ 's
City Miami Shores Village County Miami-Dade Zip
Is Building Historically Designated YES NO _
Contractor's Company Nam f S"tl � G'� LCtaS' r�' Phone#E-?c
Contractors Address
City t l_�-�. i-`-� Statet�-
Qualifier
Architect/Engineer's Name(if applicable) Phone#
$Value of Work For this Permit f Square Footage Of Work:
Type of Work: ❑Addition ❑Alteration ts�ew ❑ Repair/Replace ❑Demolition
Describe Work: J70 0 .
Submittal Fee$ 5Q-C- Permit Fee$ /s`��G�j CCF$ /v'J CO/CC
Nota $ Training/Education ducation Fee$
Notary g/E D Technology Fee$
Scanning$ Radon$ Zoning Bond$
Code Enforcement$ Structural Plan Review. $
Total Fee Now Due$i f U_
(Continued on opposite 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 AP
licant: 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 b„ject- attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first ins on whi, occurs seven (7) days after the building permit is-issued. In the absence of such posted notice, the
inspection witl'n be apps dq6 ed and a reinspection fee will be charged.
r
Signiue Signature
Owner r Ait Contractor
The foregoing in ment, 5 acknowledged before me this The foregoing instrument was acknowledged before me this 526'day of 11-; 20 by day of ,20 6)6�by e--
who
-who is personally own to me or who has produced who is personally known to me or who has produced
i nonation and who did take an oath. f""h e an oath.
NOT P B C: NOTARY P ,I V!,100.1111
l�,
•q
Sign: Si i-
Print: Pri d,a4
Mary Chaviano
My omnussion Expires:,�'N"ON �Cwv"w DDOM28 My ommission Expires:
� ih�`t �k,X99::r��**�r�e**��**�:�*��***��*�t***�*�t*:�*���*:�:���:��*�*��:e����*���*:r�
as
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
APPLICATION APPROVED BY: -�8�J°/a 11
s Examiner
Engineer
Zoning
Chc12/15/03
i
Miami Shores Village Electrical Permit
10050 NE 2nd Avenue -- -
Permit Number: EL2004-109 `
Phone: 305-795-2204
Printed:5/25/2004 Page 1 of 1
Applicant: URQUTA HERNANDEZ
Owner: HERNANDEZ URQUTA
JOB ADDRESS: 1213 NE 94 ST
Contractor SANSON ELECTRICAL PLUS INC Contractor's Address: 3995 SW 4 ST
Local Phone: 305-443-8808
Parcel # 1132050100020 Legal Description: MIAMI SHORES BAY VIEW PB 40-16 LOTS 2 & 3 LOT SIZE 150.00 X 125.00 OR
Fees: Description Amount
FEE2004-5242 Building Fee $150.00 Total Fees $164.
FEE2004-5243 CCF $0.60 Total Receipts: $0.00
FEE2004-5244 Training and Education Fee $0.20 )
FEE2004-5245 Technology Fee $3.75 (�
Total Fees: $154.55
by
Permit Status: APPROVED Permit Expiration: 10/23/2004 Construction Value: $500.00
C
Work: ELECTRICAL FOR POOL \
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:
a