EL-15-1539 Miami Shores Village
JUN 2 2 2015
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 --
Tel:(30S)79S-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(30S)762-4949
FBC 20 L.®
BUILDING Master Permit No. 9c,I's _e I- -i 3
PERMIT APPLICATION Sub Permit No. EL o S-—Lq3 I
[]BUILDING M ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
[]PLUMBING ❑MECHANICAL ❑PUBLIC WORKS [] CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 165 NW 92 Street
City: Miami Shorgs County Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NQ
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): Phone#:
Address:
City. State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: All-State Data& Electrical Service Phone#: 954 804 8054
Address: 627 NW 21 Circle
qty. Boyton BeachZip:
33426
[Qualifier Name: A.J. Randazzo phone#: 954-804-8054
State Certification or Registration#: EC 0002816 Certificate of Competency M
DESIGNER:Architect/Engineer: Phone#:
Address: City: State Zip:
Value of Work for this Permit:$5'b d .tx:) Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New M Repair/Replace ❑ Demolition
Description of work: Electrical repairs as necessary to bring house up to code
I I t LCX8( r 1(1,4 c ?( L 6- P JD S P-K-y L4 C wTr,F- r.�'rruc Ptl.
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
IReWsed02/24/2024)
i
e .
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 ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES,BOILERS,HEATERS,TANKS,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 on 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 retarded notice of commencement must be posted at the Job site
for the first Inspection which occurs seven 17) days after the building permit Is issued. In the absence of such posted notice, the
inspection will not be approved and a r nspection fee will be charged
BRADLEY W.JENSEN Z��'
Signature nn Signature
OW R or AGENT CONTRACTOR
The foregoing instrument was acknowledged befo�e re The foregoing instrument was acknowledged before_me this
4 day of 20 day of b .20 S by
�j✓c �P.c, lA) .�iLL4�w` ,who is persona ly kn vii n to FILL, _�h°ty 12�� ,who is rsonally kno to
me or who has produced as me or who has produced as
Identification and who did take an oath. Identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: Print: �L✓` `�°��
Seal: GAIL HARRISON Seal:
Con miselon Number 196416 `� ALBERTO RIVERA
My C 9m 1E6xpkes _a. :*z MY COMMI88"#EE148=
May EXPIRES November 22.2015
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APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)