EL-08-615 (2) ��. Miami Shores Village
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10050 N.E.
2nd Avenue
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( L 33138-0000
Miami Shores F
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Phone: -
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305 795 2204
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Ex iration: 'i Q�'I"i
12008
Project Address Parcel Number Applicant
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9963 NE 4 Avenue Road 1132060171250
Miami Shores, FL 33138- Block: Lot: CARYN LUBETSKY
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CARYN LUBETSKY 9953 NE 4 Avenue Road (305)756-6373
MIAMI SHORES FL 33138-
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Contractor(s) Phone Cell Phone Valuation: $ 1,200.00
JC ELECTRIC INC (305)754-6949 •'
.....................................................................................
Total Sq Feet: 0
Type of Work:ELECTRICAL Available Inspections:
Additional Info:GARAGE ADDITION Inspection Type:
Classification:Residential Meter sox
Alteration
Service Change
Fire Alarm
Relocation
Final
Underground Rough
W.W.
Fees Due Amount Total Amt Paid Amt Due
CCF $1.20
Education Surcharge $0.40
$o.00 $0.00 $ 0.00
Permit Fee-Additions/Alterations $150.00 I•, ��e�;>, ;;.:.,;y
Scanning Fee $3.00 Payment Type:
Technology Fee $3.75
Total: $158.35
AN2Main
In consideration of the issuance to me of this permit,I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining
thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this
permit I assume responsibility for all work done by either myself,my agent,servants,or employes. I understand that separate permits are required for ELECTRICAL,
PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning . Futhermore,I authorize the above -named contractor to do the work stated .
April 14, 2008
Authorized Signature:Owner / Applicant J Contractor / Agent Date
Building Department Copy
Monday,April 14,2008 1
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Miami Shores Village APR 0 8 8
Building Department '
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972
BUILDING Permit No. s
PERMIT APPLICATION Master Permit No. 'Z
FBC 2004
Permit Type: Electrical
Owner's Name(Fee Simple Titleholder) 4: c#A le, Phone# 16
Owner's Address t/
City A.-Y P f State Zip /14G
Tenant/Lessee Name Phone#
E-MAIL:
Job Address(where the work is being`done) '� �iJ l.rP4 A14r Xz%-Lj
City Miami Shores Village County Miami-Dade Zip 3 l
FOLIO/PARCEL#
Is Building Historically Designated YES NO�C ,
Contractor's Company Name Xt &(Q Phone#
Contractor's Address g GtiJ
City env%^% State P'1 Zip
Qualifier Name C. 1e,e��. , a,✓i, Phone# -f -0,5-
State
,5-State Certificate or Registration No.Sc ey-o CIO VA—, Certificate of Competency No.
E-MA
Arch Engineer's Name(if applicable) b Alut CA"M ka s_ Phone# r '`7��l•Z 3 t
Oil-
Value of Work For this Permit$ Z,tYD Square/Linear Footage Of Work:
Type of Work:. .,DAddition ❑Alteration ]New Re air/Re face �] Demolition
"- � p p
Describe Work: R.J 4 iQwAr41 j?6rx.S A&AV f`
4�st����ex*aY3exxoYxirx,nY deueYa4&�s�u�r drx,raYac��aYeYxlrFeeslrsk&xMa�vs o4�rdexxz&4x�sYxaaxae a4�e#aY�C��r Y dra4 sYsY dr arxxs4a4xdrxu
Submittal Fee$ Permit Fee$ CCF$_LQ CO/CC
Notary$ r'- Training/Education Fee$ 0AU Technology Fee$
Scanning$ Radon$ DPBR$ Zoning$
Bond$ Code Enforcement$ Double Fee$
Structural Review.$ Total Fee Now Due$
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: 1 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 ins coon whit sev days after the building permit is issued In the absence of such posted notice, the
inspection w' root 'eon
ve d r nspecti n fee will be charged
Signatur Signature
O ner or Agent .� Contractor
The fo oing' strumen ac nowledged or me this 6 The foregoing instrument was acknowledgedbefore me this�?k
day ofr ,20_,by day of WxffJA 200?' by a.C. RWV-q titz
o is onallyknownto or w4 has produce/ who i nally known a or who has produced
As identification and who did take an oath. as ide ititandotvh8vXdU1W,0ffi0fth.
` Batnera A Estep
NOTARY PUB NOTARY PUBL ( 4 My Cornmtssion DD5105H
OF Expires 0,1129!2010
Sign: Sign:
Print: Print: SRO
REW
My Commission Exp i 4 BrrH L K=M1 My Commission Expires:
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APPLICATION APPROVED BY. ' Plans Examiner
Engineer
Zoning
(Revised 02/08/06)