EL-12-2238r P I
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
Permit Type: Electrical
JOB ADDRESS
FBC 20 k
NOV 2 7 2012
Permit No. FLOL, '—Q
Master Permit No.
City: Miami Shores County: Miami Dade Zip
Folio/Parcel#: _) ,. 1^ ,'_
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): ¢,, J'� c Phone#: "
Address: It1 wt..
City: i�'� `t ^i ``.) `�� 5 State: c___ Zip: s l 3j
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: 2 Phone#:
Address:
City: State: Zips
Qualifier Name: �� /��` C./��_s Phone#:
State Certification orRegistration#: Q Jl44� Certificate of Competency #:
Contact Phone#- � �� Email Address: - A42&�n(0 a2i
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ �? V Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace.- ❑Demolition
Description of Work:
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Fee S:k:k;k�;k:k�:k:k%kx%k�==k:<:g:kk-%k%k�%kk�;k=k'�=�=�%e%;:>kx;k%k=r•=k
=l� � %k=k =k %k %k
'l
Submittal Fee $' �'�
Permit Fee $
!� G'�� G' CCF $
CO/CC $
Scanning Fee $
Radon Fee $
DBPR $
Bond $
Notary $
Double Fee $
Training/Education Fee $
Structural Review $
Technology Fee $
TOTAL FEE NOW DUE '51K
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will s be approved and a reinspection fee trill be char-oed.
Si
Owner or Agent
The foregoing instrument was acknowledged before me this r
day of �1J� �,- , 2011 , by
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARYLIC:
Print:
My Commission Ex
M'COMMB$" 4EE18 43
EVM8 Avd 02.2018
11
Signatur
I�VOV12—,g
Contractor
The foregoing instrument was acknowledged before me this
day of 20�by '
%% "
,�---->
who is personally known to me or wh�`�itQcc a®
as identificatiqi' ditak®®i�.
�'g N� ��Gca
NOTARY PU LIC: ,�°`'��'� • U.
* eye aa,(,S,. to
of ,,,
s
Print: L 1,,
My Commission Expires:
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APPROVED BY %� �st'� �/-Tlans Examiner Zoning
Structural Review
f Kevised ?/ I _'/'_01?)(Recised (l7! A O/O7)(ltecised O(�11 O!?0(19l(Recise�l 3/ i ii(19r
Clerk
t~
t*
•
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will s be approved and a reinspection fee trill be char-oed.
Si
Owner or Agent
The foregoing instrument was acknowledged before me this r
day of �1J� �,- , 2011 , by
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARYLIC:
Print:
My Commission Ex
M'COMMB$" 4EE18 43
EVM8 Avd 02.2018
11
Signatur
I�VOV12—,g
Contractor
The foregoing instrument was acknowledged before me this
day of 20�by '
%% "
,�---->
who is personally known to me or wh�`�itQcc a®
as identificatiqi' ditak®®i�.
�'g N� ��Gca
NOTARY PU LIC: ,�°`'��'� • U.
* eye aa,(,S,. to
of ,,,
s
Print: L 1,,
My Commission Expires:
%k%k%k��$=��*�.k$=��%k�:k��%k��=:==F-X��=k>F-Y>1=�I-�k�:k<:k=k%K=k�,=k%k=k.k'���:k:Y•�k:k-K�:.6x%k=k�=k%��=:k%k%k�ck%k�=k�f==k%k �k �k=k-k=k>k#=k=k�:K=k-K%F-%k %K�=k:k �:k :k %k %l;k=k�=K =k:k�K
APPROVED BY %� �st'� �/-Tlans Examiner Zoning
Structural Review
f Kevised ?/ I _'/'_01?)(Recised (l7! A O/O7)(ltecised O(�11 O!?0(19l(Recise�l 3/ i ii(19r
Clerk
CUMULATIVE SUBSTANTIAL IMPROVEMENT
VERIFICATION WORK SHEET
In accordance with FEMA regulation and Miami Shores Village Flood Damage Prevention Ordinance the costs of all
improvements must be monitored. The costs of any improvements in the past 12 months and the costs of any proposed
improvements must be shown on the worksheet. The cost of improvements must include demolition, raw and finished
materials (include those donated), labor (including volunteer and self -performed), construction supervision and
management, and overhead and profit. A list of items the costs of which are to be included as well as those excluded is
attached for your reference. (A Copy of the Contract must be attached)
h �
PROPERTY OWNER:—— ---
PERMIT #
ft
ADDRESS:,�'_�_.- — —
FOLIO NUMBER _' ti Ca'.' :'h.-ttLCKSD ZONE:___
BASE FLOOD ELEVATION: FREEBOARD: EAST OF FL.CCCL:
COST OF PAST IMPROVEMENTS (12 MONTHS):
COST OF PROPOSED IMPROVEMENTS:
(ATTACH COPY OF CONTRACT)
TOTAL CUMULATIVE COST OF IMPROVEMENTS (past and proposed):
VALUE OF PRINCIPAL
OWNERS SIGNATURE:
PLANREVIEWER:
PLAN REVIEWER SIGNA
Created on June 2009
TURE (attach appraisal):
DATE: l t -I1 /1")
TE:
` ADMIONAL SERVICES RIDER
12UiEOOnnHn
CUSTOMER JOB
ACCOUNT NO NOR31
is part of and is to be attached to by and between ADT LLC dba ADT Security
THIS RIDER r/
made �h� the Contract ("Contract") made Services ("ADT"), with offices at
Address
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f
0,
1
1 do
r
Cr rv` ` �? c ' Ep f 3
City State ZIP
and Customer
("Customer") `' ' t U
Business Name
1 11
("Customer")
for service in the Premises of the Customer at LLI
City m ZIP- ("Premises")
tate L_LrL—L_!_l
The Customer hereby requests, and ADT agrees, to install the following additional protection. ='l ti.....
j7�?
The Customer hereby agrees to pay ADT, its Agents or Assigns the sum 9,11
� � t
{
payable upon the signing of this Rider an 6hebalance payable upon completion of this installation, and to pay the additional sum
of Z7,t"L1,4"v�V ,AV, \I/
per annum.
The parties hereto mutually agree that this Contract, of which this Rider is made a part, is and shall be and remain in full force and effect in
accordance with all the terms and conditions thereof.
THIS RIDER REQUIRES FINAL APPROVAL OF AN ADT AUTHORIZED MANAGER BEFORE ANY EQUIPMENT/SERVICES MAY BE PROVIDED. IF APPROVAL '
IS DENIED, THIS RIDER WILL. BE TERMINATED AND ADT'S ONLY OBLIGATION TO YOU WILL BE TO NOTIFY YOU OF SUCH TERMINATION AND REFUND'
ANY AMOUNTS -PAID IN ADVANCE.
ADT LLC 01�jp ADT SECURITY E ICE
Rep
tD No.
ADT Representative
Accepted and Copy Received By:
Customer
Name
X m
Customer Signature
02012 ADT LLC dba ADT Security Services.
Administrative, Copy Alt rights reserved. (04/12),
t
Arlenis Silvera
From: rescfrost@comcast.net
Sent: Thursday, May 23, 2013 12:53 PM
To: Arlenis Silvera
Subject: Electrical Permit EL -11-12-2238 at 426 Grand Concourse
May 23, 2013
Re: Electrical Permit EL -11-12-2238 at 426 Grand Concourse
To the Miami Shores Building Department,
I am the owner of the home at 426 Grand Concourse in Miami Shores. My sister and I inherited the
home from our late aunt and uncle, long time Shores residents Bill and Virginia Kelly. This is not our
primary residence, but we visit a few times a year. My family was there in December and January and
my sister's family was there in March. We've been coming to the home since I was a baby who was
bathed in the sink, and I'm 44 years old now. We cherish fond memories there.
An electrical residential permit was taken out for an ADT security system and we have received a
notice that an inspection was not performed and needs to be taken care of. ADT told me that
everything was complete, but obviously ADT was incorrect. I know that we need to take care of it. The
permit number is EL -11-12-2238.
Our neighbors told us about the letter from your department regarding the inspection, as it was
misdelivered to 430 Grand Concourse. We weren't informed of the letter until Thursday, May 16, or
we would have made contact with you earlier.
My wife and I have spoken with Arlenis. I am sending this letter to request an extension on the
inspection until we can come to Miami to be there for the inspector. If this request is approved, I can
make arrangements to come sometime in July.
I thank you for your consideration of this request.
Respectfully, 0 40�
Rob Frost
4752 Calumet Dr.
Knoxville, TN 37919
865-525-1303
865-862-0208 office direct dial