EL-16-2874 Pet*Af '*2 74
Miami Shores Village Parrt11 ,Ye Elset6,44i-Residential,,
10050 N.E.2nd Avenue NE Worli C1a s}fa tfPt n;Adc ition/Alteration
Miami Shores,FL 33138-0000 ',
@t7'T?it Status.,APPROVED'.
`dab Phone: (305)795-2204
�oxtt>A
Expiration: / I17
Project Address Parcel Number Applicant
1350 NE 101 Street 1132050230020 ... `
DIRK&ELIZABETH PETERSON
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
DIRK&ELIZABETH PETERSON 1350 NE 101 ST '
MIAMI SHORES FL 33138-2611
Contractor(s) Phone Cell Phone Valuation: $ 1,200.00
LONGMAN ELECTRIC INC (305)758-1211
Total Sq Feet: 0
Type of Work:NEW HOT TUB POWER Available Inspections:
Additional Info: Inspection Type:
Classification:Residential Final
Scanning: 1 Meter Box
Alteration
Relocation
Fire Alarm
Service Change
Review Electrical
Underground
W.W.
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20 Invoice# EL-10-16-61747
DBPR Fee $3.38 11/04/2016 Credit Card $ 187.96 $50.00
DCA Fee $3.38
Education Surcharge $0.40 10/21/2016 Credit Card $50.00 $0.00
Permit Fee-Additions/Alterations $225.00
Scanning Fee $3.00
Technology Fee $1.60
Total: $237.96
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
constructiorya�d zoning. thermore,I authorize the above-named contractor to do the work stated.
1 November 04, 2016
Authorized Signature:Owner / Applicant /-Contractor / Agent Date
Building Department Copy
November 04,2016 1
Miami Shores Village 2 �®
� z � OCT®CT 21 ?��
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
FBC 20 N
BUILDING Master Permit No.2—Q--1 6-29?3
PERMIT APPLICATION Sub Permit NJEl ��
❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
,[CONTRACTOR DRAWINGS
JOB ADDRESS: 13 ��l 1_ I -1 e-�.t
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): f'k l7 C1_'-2CPA/ Phone#:30s_ 3?3 _ 775-5
Address: Sri /V o
J
City: /Lir J4��G� State: Zip: y 313
Tenant/Lessee Name: Phone#:
Emaik 9
CONTRACTOR:Company Name: LLq,4., kms! cr_tk Phone#: 3 4�;tr— Z"_ L
Address: q5- lilj6� )6 �. /
City: M, q.411 State: Zip: ?:;13/
Qualifier Name: NLi /'i /l e �G�<����il/ Phone#: 3g1!®
State Certification or Registration#: 1 -30037)3 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$120,0, Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ nA'lterationl I V1 New E:1Repair/Replace El Demolition
Description of Work: A/e k )�Of T G 190 blek
Specify color of color thru tile:
Submittal Fee$ �v -M Permit Fee$ �'°y ��� ��� CCF$ ( 2'G CO/CC$
Scanning Fee$ Radon Fee$ 3 3� DBPR$ 3 ' 36 Notary$��
Technology Fee$ Training/Education Fee$ 0• yo Double Fee$
Structural Reviews$ Bond$ jo
TOTAL FEE NOW DUE$ I 94 '
(Revised02/24/2014)
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 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 COMM£NC£MENT.»
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 Signature
qk�!� 4�z�'
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of I` 20 1 by day of s 2L 20 ) �=' .by
l 2- r J00�w�Aewho is personally known to ^'CL qe-I ®s .who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. Identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUILIC:
Sign 9 Sign.
e r
Print: �- Print: e 2-
Seal
: ,•�Oy°Ooh Notary PublnFlorlda Seal: '""�' Notary Public State of Florida
Michelle P . Michelle Perez
My Commisdr My Commission FF 000321ov n Expires 04/ or r�ds'� Expires 04/08/2017
ssssssssssssssssssssssssss��ks&ssssss�ssssssssssssssssssssssssssssssssssssssssssssss s s sssssssssss
APPROVED BY ��' ,�Plans Examiner Zoning
Structural Review Clerk