ELC-10-1088BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type: Electrical
Owner's Name (Fee Simple Titleholder) I"1 dm aFes
Owner's Address 1® OSO JJ 2 � ^ 2. �Q�
n
City I r l I ( �j State Yt/
Tenant/Lessee Name
E -MAIL:
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Job Address (where the work is being done) 60106u,
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL #
Is Building Historically Designated YES NO
Contractor's Company Name rY1a ,0 loc. Phone # &QS - 752 -2000
Contractor's Address Gb i w o ST
City (A1 PCn(k■
Qualifier Name
at) NO mbca
State Certificate or Registration No.
E -MAIL:
Ee
State
Architect/Engineer's Name (if applicable) /()/ 4
Value of Work For this Permit $
Type of Work: ['Addition ['Alteration ❑New
Describe Work:
2 6 0 amp m e - F e r r'fai
Permit No.E. C 10 -ion
Master Permit No.
hone #
Zip 33(3
Phone #
��-- Zip 3 31 �D
Phone# 3oS-1S1-2 x
Certificate of Competency No.
Phone #
Square / Linear Footage Of Work:
EI
❑ Demolition
******** * * *xxxxx * * *xzzzzxxxxxzxxxx *xxxx F 9C*** x xxzxxxxxxxx *xxxxxxxx *xz *xx * * * * * * ** * * **
Submittal Fee $ Permit Fee $ G CCF $ CO /CC
Notary $ Training /Education Fee $
Scanning $ / Radon $ DPBR $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $
Technology Fee $
Zoning $
See Reverse side -->
r (NTITOrgD
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
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 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.
Owner or Agent
State
The for oing instrument was acknowledged before me this The fore +oing instrument was acknowledged before me this fc
day of 20 10, by day of �� , 20 ��, by ® � o�/1c
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.
NOTARY PUBLIC:
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
APPLICATION APPROVED BY:
(Revised 02 /08/06)
Contractor
PO A
a Sign:
• I 1°° Print:
My Commission Expires: S 'c ° Ss �✓ ° ° °" My Commiss
da �.
y rS �"°' c �y0
rrx* xxx xxx******x* *—.*****xx*******'x c l u''x ='`;' a i xr xxxxxxrxxxxx>ex***.
Zip
i 14A4
mons
PAT BRIGGS
'Tl' PA
mss: MY COMMISSION 9 DD 979267
. EXPIRES: May 11 20,14 xx
�A�761inii
Plans Examiner
Engineer
Zoning
Scheduled Inspection Date: September 21, 2010
Inspector: Devaney, Michael
Owner: VILLAGE, MIAMI SHORES
Job Address: 10000 BISCAYNE Boulevard
Project: <NONE>
September 20, 2010
Miami Shores, FL
Contractor: MOODY ELECTRIC INC
Building Department Comments
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 146147 Permit Number: ELC -6 -10 -1088
For Inspections please call: (305)762 -4949
Permit Type: Electrical - Commercial
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132050200010
Phone: (305)758 -2000
200 AMP METER REPAIR FOR PUMP AT GOLF COURSE
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
P/
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