EL-16-3102Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Parcel Number
Applicant
1561 NE 103 Street
Miami Shores, FL 33138-
1132050310220
Block: Lot:
M2J4 HOLDINGS LLC
Owner Information
Address
Phone
CeII
M2J4 HOLDINGS LLC
1561 NE 103 Street
MIAMI SHORES FL 33138-
(786)290-8051
660 NW 125 Street
NORTH MIAMI FL 33168-
Contractor(s)
RAVEN ELECTRIC INC
Phone Cell Phone
(305)951-1210
Type of Work: LOW VOLTAGE 3 TV CABLES
Additional Info: LOW VOLTAGE 3 TV CABLES
Classification: Residential
Scanning: 1
,
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
$0.60
$2.00
$2.00
$0.20
$100.00
$3.00
$0.80
$108.60
,
Pay Date Pay Type
Invoice # EL -11-16-62049
11/17/2016 Credit Card
11/14/2016 Check #: 14705
Amt Paid Amt Due
$ 58.60 $ 50.00
$ 50.00 $ 0.00
Available Inspections:
Inspection Type:
Review Electrical
1
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 zo ;;, . Futhermore, I authorize the above-named contractor to do the work stated.
Auth • rize . Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
November 17, 2016
ate
November 17, 2016 1
LI LI �(� �(0 Miami Shores Village
L,M Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 S"
FBC 20 ISI
BUILDING Master Permit No.?C-5_ !CO- (Q6
PERMIT APPLICATION Sub Permit No. 1 1 (C)- 310 Z .
El BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑MECHANICAL ❑PUBLIC WORKS El CHANGE OF El CANCELLATION ❑SHOP
�CONTRACTOR DRAWINGS
JOB ADDRESS: 4,[6 / /7 � �- f 3#e. 143 s /,
City: Miami Shores County: Miami Dade Zip:
NOV 1 4 016
BY. !d
Folio/Parcel#: /1 -.62 -6 x -43/-11 '221' Is the Building Historically Designated: Yes
Occupancy Type: Load: Construction Type: Flood Zone: >l BFE:
5,3 /3F
NO')4*
FFE:
OWNER: Name (Fee Simple Titleholder): a. -J 4 ap(divita , L 1-4-i ' iC one#: 5 4t - 11340
Address: 4,00 • (Ai • (a.-514 - (^
City: r{ 7k ti vt i State: Zip:
po�
--6/:�
�/ Tenant/Lessee Name: A I Phone#: !a�'lt) "�5 I
Email: kaRK Le& GpS(it f-oc. co rr\
CONTRACTOR: Company Name: (v2 \\ � �� Phone#: SOs 1 �U
Address: 3 C11 • J `J' (`\ \ e_.
City: .'4-- . \.`LL State: V:2A.— Zip: S \ 6 � '
Qualifier Name:r. Cid • J�7
• .i', i wl 2. Phone#:X-57:5137- /127 /e)
State Certification or Registration #: t (24 30057)- 3 4- Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ are— Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration
Description of Work: /461t-e,ak)//4 9=-
gi New ❑ Repair/Replace
—3l Flo/r%1/
❑ Demolition
Specify color of color thru tile:
Submittal Fee $ 50• c Permit Fee $ At9o, 0o CCF $ 0 • 60 CO/CC $ 0
Scanning Fee $'3' G3 Radon Fee $ R .. 00 DBPR $ a, CP Notary $
Technology Fee $ 0 Training/Education Fee $ 0 . 2-0 Double Fee $ 0
Structural Reviews $ 9 Bond $ e
TOTAL FEE NOW DUE $ 8. VJ0
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address V
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
Iv
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 an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
14a k I(ER AE 1 A
The foregoing instrument``'was acknowledged before me this
0 day of AJ fLf'►1 Def , 20 / 60 , by
Qk, IC who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Signature
Th
/ CONTRACTOR
The foregoing instrument was acknowledged before me this
__IfL day of yidig , 20 ((D , by
444 who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Printa1"
Seal:
******************
APPROVED BY
(Revised02/24/2014)
4,$)'¢y c . DAMAAYI VEGAA
.t, ,., ;,: MY COMMISSION # FF 214016
EXPIRES: April 1, 2019
'P oa ak?a� Bonded ThN Notary Public Underwriters
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/6/4'fr'a Plans Examiner Zoning
Structural Review
Clerk