EL-09-811 3
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000
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Phone: (305)795 -2204 P
toR�' j jsscuepaw ` Expiration: 11/10120 ^
Project Address Parcel Number Applicant
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500 GRAND CONCOURSE 1132060171440
Miami Shores, FL 33138 -2465 Block: Lot: PATRICK PENKWITT 4
Owner Information Address Phone Cell
PATRICK PENKWITT 500 GARND CONCOURSE
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MIAMI SHORES FL 33138 -2465
Contractor(s) Phone Cell Phone Valuation: $ 450.00
JAFE CONTRACTING CO (954)921 -6360
Total Sq Feet: 0
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Type of Work: EXT LIGHTS Available Inspections:
Additional Info: Inspection Type:
Classification: Residential Underground Rough
Final
Meter Box
Alteration
Relocation
Fire Alarm
Service Change
W. W.
Fees Due Amount Invoice # Total Amt Paid jDue
CCF $0.60 EL -5-09 -34814 $ 50.00 $ 50.00
Education Surcharge $0.20
Permit Fee - Additions/Alterations $160.00
Scanning Fee $3.00 EL - 5 - 09 - 34829 $ 117.80 $ 117.80
Submittal Fee $50.00
Submittal Reversal Fee ($50.00) Check #: 5540
Technology Fee $4.00
Total: $167.80
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated.
May 19, 2009
Authorized Signature: Owner / Applicant / Contractor / Agent Date
Building Department Copy
May 19, 2009 1
OL t
Miami Shores Village RCERVED
Building Department � 3 l oo9
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 d/
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING Permit No
PERMIT - APPLICATION Master Permit No
FBC 20($ 4#
tslrwef Pe=g vn% E't. 1A 07 aY 3 Tr
Permit Type Electrical
Owner's Name Fee Simple Titleholder t C�'�� I �.A1/
( p ) /Ph # _ ZS ..So 9
Owner's Address S �Ty f jt,Q C0fJC iE
City 4)!11 State � Zip
Tenant/Lessee Name Phone #
E -MAIL:
Job Address (where the work is being done)
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL # _I I Ro 4; to l - 7 YHO
Is Building Historically Designated YES NO
Contractor's Company Name ��F` p t 64 ✓-o , A (,O Phone #
Contractor's A d ess /
City ! s./ State zip 33 Q
Qualifier Name — j0S vy v t Phone # k ? 6AO
State Certificate or Registration No. lee 2 Z.j Certificate of Competerico ®S C&` / /U"
E-MAIL: : �' ll70
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ L 5 — - 0 d Square / Linear Footage O(Work:
Ty0e of Work: ❑Addition ❑Alteration ❑New Re ❑ air /R lace
_ 1 p �p ❑ Demolition
Describe Work: X — 71 To c vs A /- a P,) cu4/ " GJ 41 A 7'cS
xte &x4t.Y drxxkxxde 9r 4rxxxkxx& Yx9: ��xxx��x�xxx��Fees�'' �**' �' �' �* x�x�Xxx������Xxxx���x�����xx��x���x
Submit tee Fee $ Permit Fee $ CCF $ CO /CC
Notary $ Training /Education Fee $ Technology Fee $ 4
Scanning $ Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $ .
Structural Review. $ Total Fee Now Due $
F �
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 Zi
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: Asa 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 was acknowledged before me this
day of , 20a, by O)N6 �` n6i % day of , 200 by
w is p soma 1 kno me or who has produced o is
pona ly known me or who has prod d
As identifica�t�e:�A as identification and who did take an oath.
NOTARY PUBLIC: Anne Blakeman NOTARY P
GO do ll # DD49S 143 .Of Pv Notary Public stag or Florida
N -i l) 2Q09 ?° Sharon L Furtado
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� � 21h, t g , y Can ion 1651
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Sign: o-� ' Iia Sign:'Yµ �®
Print: Print: he4jfD onj v o
My Commission Expires. `j 1016 My Commission Expires:
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APPLICATION APPROVED BY G t Plans Examiner
Engineer
Zoning
(Revised 02/08/06)