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EL-16-2808 1It Miami Shores Village 10050 N.E.2nd Avenue NW Pt51 Miami Shores,FL 33138-0000 P a Parmli*StaP�f �i ' , Phone: (305)795 2204 r. 3? 11 1 Expiration: 5/16/2017 Project Address Parcel Number Applicant 162 NW 109 Street 1121360100220 LA GRISONI Miami Shores, FL 33168-4317 stock: Lot: CANOR PATO CAR Owner Information Address Phone Cell CANOR PATO CARLA GRISONI 162 NW 109 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 2,000.00 MESA BROTHERS INC (305)345-1974 . ... w _...__ ..__x_m._ .,. ,•,. . ._ Total Sq Feet: 0 Type of Work:POOL ELECTRICAL AND HOOKUP ELECTRIC Available Inspections: Additional Info:POOL ELECTRICAL AND HOOKUP ELECTRIC Inspection Type: Classification:Residential Final Scanning:1 Light Niche Bonding Review Electrical Alarms Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 DBPR Fee Invoice# EL-10-16-61672 $4.50 11/17/2016 Check#:13631 $265.20 $50.00 DCA Fee $4.50 Education Surcharge $0.40 10/17/2016 Check#:13550 $50.00 $0.00 Permit Fee-Additions/Alterations $300.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $315.20 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-named contractor to do the work stated. November 17,2016 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy November 17,2016 1 Miami Shores Village pzcT�j FE V Building Department OCT 1 7 201-!"I6 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Fax:(305)756.8972 By INSPECTION'S PHONE NUMBER:(305)762.4949 S FBC 20 1 { BUILDING Permit No., PP 1(0 m zOS - PERMIT APPLICATION Master Permit No?-,,e Z8 Permit Type: Electrical JOB ADDRESS: 16A MQ / 09 5T- City: Miami Shores County: Miami Dade Zip: 3� Folio/Parcel#: Y14)3 3&— 0/0-1 0,3X0 Is the Building Historically Designated:Yes NO ee' Flood Zone: OWNER:Name(Fee Simple Titleholder):_ 4cIGt 2. 0' "O'-k Phone#: Address: 1ALIJ 61 S City: � � it State: Zip: a3l d 6 Tenant/Lessee Name: N-� Phone#: Email: 7 CONTRACTOR:Company Name: k� /3wt &w ,.L Phone#: 3yS b 3v'�S Address: S-IS r10 10.3 City: k)--V�414� ee State'- Zip: Qualifier Name: 44 /7-Q >_ Phone#: 30� 3 y,s/ ?� State Certification or Registration#: 6013vO i8 97 Certificate` ofCompetency#: Contact Phone#: 305 3 4.T�9 t/ Email Address: MO ?qb A4is e AA, . - DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$ 2'DOo Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace ❑Demolition Description of Work: 1n Diez . end 14zo0 �cx� l c�cQ vi �e ���xx��xxx��xxx�xxx�xx�x��x�x�xx�xxmmxxFees�x�x�xxxxx�x�xx�xxxx��xxwmxxxxxx��x�x�xx�x�x Submittal Fee$ G Permit Fee$ �®d> "!9Z> CCF$-1 ' 2-0 CO/CC$ Scanning Fee$ 3' Radon Fee$ �DBPR$ o Bond$ Notary$- Training/Education Fee$ Technology Fee$ n() Double Fee$ Structural Review$ TOTAL FEE NOW DUE$_ QG5 ' ' Bonding Company's Name(if applicable) �4 Bonding Company's Address )-J / City State Zip Mortgage Lender's Name(if applicable) _ N 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 abigace--of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signatur or Agent Contractor The foregoing instrument was acknowledged before me this l Z The foregoin instrument w� by- It- cknowledged before me this day o �/LOJ lo,by L°orae a , day of _,20 , wh s personally kno t me or who has produced who is onally known to me o ho has produced ' As identification and who did take an oath. as I ation and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: 1 Print: r� Print: o� �,? ADA I •:, rlrlr �.� � ��rl My Commissio 'BxRIres P =� n9 My Commission WIRES:JAN 21,2016 �q:�a eidF .�:�erc it"y ^�,.,�^ Bonded iirough 1st State Insurance xmax+aw�w�wxwwww*�axuwwm**w���+v+pn�a�r+�N�e�wwxwxm�aw��w�a�+�*�*��xax��spxxa+rxwxr+�**�w�ww*�w�w�xwqx�w**wx�x*xax�� APPROVED BY plans Examiner Zoning Stnictural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)