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EL-06-2961 (3) Miami Shores Village ®.-- Buil C040ding Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Fax:(305)756.8972 BUILDINGPermit No. �� PERMIT APPLICATION DEC 0 7 2006 as Permit No. FBC 2004 BY------- - -- Permit Type(circle): Building Elec Plumbing Mechanical Roofing Owner's Name(Fee Simple Titleholder) ' S 6-r7 Phone Owner's Address_� 4-7 {_) -IL-0A City_ �1► ; rw- State Zip TenantlUssee Name Phone# Job Address(where the work is being done) O Q4 Z NE Ve-- "t ,k City Miami Shores Village -Dade_ Miami-Dade Zip FOLIO/PARCEL# Is Building Historically Designated YES NO r/ Contractor's Company Name 1-1 t'S,J_r/O e TI2 i C SyS T 6 JZ ; Phone# -Ma r l (P G G CL Contractor's Address I (4 Q 's T State r(— Zip f(o S Qualifier Name Q '-$/.1- Phone# �� 2.r L (o C v (o State Certificate or Registration No. 2 U® 1 3 Certificate of Competency No. 0 0 00 [q (7 S H Architect/Engineer's Name(if applicable) Phone# Value of Work For this Permit$ l f-DO `— Square/Linear Footage Of Work: Type of Work: ❑Addition Alteration ❑New ❑ Repair/Replace ❑Demolition Describe Work: Y� ,A=3 Oe2 P//-1'7 Submittal Fee$ Permit Fee$ .SGvr D'O CCF$1 Q CO/CC Notary$ Training/Education Fee$ e q Technology Fee$ 071-35 . Scanning$ / Radon S DPBR$ Zoning$ Bona$ Code Enforcement$ Double Fee S Structural Review.$ Total Fee Now Due$� . See Reverse side I ow V Jsk f5bM Bonding Company's Name(if applicable) Bonding Company's Address City State Zi ` P 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 Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument wasknowledged before me this-POPP day of ,20_,by day of 9� ,20 by , who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as id ti ion and who did take an oath. NOTARY PUBLIC: NOT AR C: FOWDEZ lh�COMMIMN I DD 348468 Sign: Sign: iny�vember7,2008 Print: Print.. ra'FOFE @@fl@@@ ThN 899981 NUIM My Commission Expires: My Commission Expires: APPLICATION APPROVED BY: ` Zs Examiner Engineer Zoning (Revised 02/08/06) ADDENDUM TO BUILDING PERMIT APPLICATION AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM.IF A MASTER PERMIT HAS BEEN OBTAINED,THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS. PLEASE CIRCLE O DISCIPLINE APPLIED FOR: PERMIT# PLUMBING ELECTRICg5� MECHANICAL ITEM UNIT FEE ITEM UNIT FEE ITEM UNIT FEE BATH TUB SWITCH OUTLETS SPACE HEATERS DISHWASHER ILIGHT OUTLETS CENTRAL HEATING DISPOSAL IRECEPTACLES A/C (WIND) FLOOR DRAIN I SERVICE TEMPORARY A/C(CENTRAL) GREASE TRAP ISERVICE SIZE IN AMPS I DUCT WORK INTERCEPTOR I SERVICE REPAIR/METER CHANGE IREFRIGERATION LAVATORY JAPPLIANCE OUTLETS PROCESS AND PRESS PIPING LAUNDRY TRAY RANGE TOP UNDERGROUND TANKS CLOTHES WASHER OVEN JABOVE GROUND TANKS SHOWER WATER HEATER JU.F.PRESSURE VESSELS SINK.POT/3 COMP. MOTORS 0-1 HP ISTEAM BOILERS SINK,RESIDENCE. MOTORS OVER 1-3 HP I HOT WATER BOILERS SINK,SLOP. MOTORS OVER 3-5 HP IMECHANICAL VENTILATION TEMPORARY WATER CLOSET MOTORS OVER 5-8 HP ITRANSPORTING ASSEMBLIES URINAL MOTORS OVER 8-10 HP ELEVATORS/ESCALATORS WATER CLOSET IMOTORS OVER 10-25 HP IFIRE SPRINKLER SYSTEMS INDIRECT WASTES MOTORS OVER 25-100 HP lCOOLINGTOWERS WATER SUPPLY TO: MOTORS OVER 100 HP IVIOLATION A/C UNIT A/C WINDOW IREINSPECTION FIRE SPRINKLER JAIR CONDITIONERS HEATER-NEW INST. ISTRIP HEATER HEATER-REPLACE IGENERATORS TRANSFORMERS LAWN SPRINKLER-WELL IGENERATORS TRANSFORMERS SWIMMING POOL IGENERATORS TRANSFORMERS WATER SERVICE ISPECLAL PURPOSE SEWER CONNECTIONS OUTLETS COMMERCIAL UTILITY-SEWER SIGN TUBES UTILITY-WATER ISIGN TRANSFORMERS SEPTIC TANK ISIGN TIME CLOCK RELAY IFIXTURES FAINFIELD,4"TILE/RES. JANTENNA PUMP&ABANDON SEPTIC TANK TELEVISION OUTLETS SOAKAGE PIT CU.FT. VIOLATION CATCH BASIN REINSPECTION DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET(GAS) GAS PIPING -�~ Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 4 Phone: (305)795-2204 Fax: (305)756-8972 tomb Permit Permit Status: APPROVED Issue Date: 12/29/2006 Expires: 06/27/2007 Permit Number: EL-12-06-2961 Owner's Name: DONNA WILSON one: Permit Type: Electrical - Residential Parcel#: 1132060171220 Work Classification: Addition/Alteration Block: Lot: Job Address: 9942 4 AVE Street Section: PB: Miami Shores Village, FL Contractor(s) Phone Primary Contractor Total Square Feet: 0 MESA ELECTRIC SYSTEMS CORP 305-279-5498 Yes Total Valuation: $ 1,500.00 Re uired Ins ections Additional Information Alteration Type of Work: Additional Info: Underground RoughW W Classification:Residential Service Change Meter Box Fire Alarm Relocation Final 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. Fees Due Amount Invoice Number Amt Due Amt Paid CCF $1.20 EL-12-06-27135 $158.35 Education Surcharge $0.40 Total: Permit Fee-Additions/Alterations $150.00 �p Scanning Fee $3.00 �8 10 PAID Technology Fee $3.75 "1� C� Total: $158.35 �� Building Department File Copy NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS,STATE AGENCIES,OR FEDERAL AGENCIES. Applicant Signature