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RC-13-2102 (3)Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 RECEIVED DEC 13 2013 Permit No. / 3 -097.-72, Master Permit No.)? _/, _ c/ Permit Type: Electrical r� OWNER: Name (Fee Simple Titleholder): ��a d�'�-d` / 4 Phone#: gv.5. a f��' - Address: City: o1,10/21-44State: TG Zip: Tenant/Lessee Name: / f /L Phone#: Email: JOB ADDRESS: ggor.9-5 ,'d2-4 44/ `o z Ok • City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO /k'. Flood Zone: CONTRACTOR: Company Name: Pfgiee.,&-e---/iv/. Phone#: i55gaCXx Address: (OCA % /t44') qD T City: dState: 7/1e5-z/dig- • --.73-1).) --r— /"le)o Qualifier Name: State Certification or Registration #: )1199 . Certificate of Competency #: Contact Phone#: 005 7 8 vac) Email Address: DESIGNER: Architect/Engineer: /4d5r/4 ' ,4SS)G , Phone#: Phone#: Zip: g1/3 -d 758".c' Value of Work for this Permit: $ Type of Work: DAddress Description of Work: 0p 2 ❑Alteration &v �- has �oLr a�o/%D/T 6& Square/Linear Footage of Work: *Kew ❑Repair/Replace 42, 6fto{i to slr••`-Id v K ` 1/1 aa ❑Demolition PlekI S J 7 /aD t'o' pie �,,a a• . .022.,,.)/04„...6, pc/1 *�*****************************Fees***' ** * * *� *************** 3tA-S1') Submittal Fee $ � cic) Permit Fee $ 2 as/ e' CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ &Les«?6 Bonding Company's Name (if applicable) Bonding -Company's Address City State Zip Mortgage Lender's Name (if 'applicable) Mortgage Lender's Address Al 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 appy d ar : :inspection fee will be charged. Signature Owner or Agent Contractor The foreg • g instrument was acknowledged before me this _/ The foregoing instrument was acknowledged before me this /1 day of le , 20, 3, by O74t • [ �Anok • day of 02 , 20 '3by Sohn - who is personally known to me or who has produced who is personally known to As identification and who did take an oath. as ide NOTARY PUBLI : NOTARY P IC Sign: Print: My Co c mission Exp ********************** APPROVED BY Notary Public • State of Florida My Comm. Expires Aug 31, 2015 • Commission 9 EE 92676 Sign: Print: My Commission Expi roduced y• *ndMlw . e "'°f1tiV Bonded � �6j00MM��B�Th�Oepaoath. �Yp 6/A-tr UndPnt.ters P�# MARY PAT BRIGGS t.t v COMMISSION # DD 979267 EXPIRES: May 11, 2014 • 6 Thru Notary Pubic Underwriters ***************************************************************************** 1,c ..2G:/3, 400/11,111 5 Plans Examiner Structural Review (Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Zoning Clerk Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-204524 Permit Number: EL -12-13-2797 Scheduled Inspection Date: January 26, 2015 Inspector: Devaney, Michael Owner: CASSOLA, OMAR Job Address: 9325 N BAYSHORE Drive Miami Shores, FL 33138 - Project: <NONE> Contractor: MOODY ELECTRIC INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: New Phone Number Parcel Number 1132050270540 Phone: (305)758-2000 Building Department Comments NEW ELECTRICAL FOR ELEVATOR Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Inspector Comments January 23, 2015 For Inspections please call: (305)762-4949 Page 2 of 34