ELC-16-2835 Pe r»l E :: -104 6-2835
Miami Shores Village PeXij�#7,y Elac'tnqal-CO*oer+jar
10050 N.E.2nd Avenue NEOso ^i ) D.,
Miami Shores,FL 33138-0000
Permit Sta44 A P P R OVED
e= e Phone: (305)795-2204
FioRioA
Expiration: 05/14/217
Project Address Parcel Number Applicant
9501 NE 2 Avenue 1132060133920
DVS LLC
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
DVS LLC 9400 NE 2 Avenue (305)756-3711
MIAMI FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 50.00
ART SIGN COMPANY (954)763-4410
Total Sq Feet: 0
Type of Work:CONNECT TO EXISTING ELECTRIC Available Inspections:
Additional Info: Inspection Type:
Classification:Commercial
Final
Scanning: 1 Review Electrical
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60
DBPR Fee $2.00 If1VOICe# ELC-10-16-61703
DCA Fee $2.00 11/15/2016 Credit Card $58.60 $50.00
Education Surcharge $0.20 10/18/2016 Credit Card $50.00 $0.00
Permit Fee $100.00
Scanning Fee $3.00
Technology Fee $0.80
Total: $108.60
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 15, 2016
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
November 15,2016 1
Miami Shores VillageCIFI ,-=J -
Building Department OCT 18 OiG
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tly.
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(30S)762-4949
FBC 2®
BUILDING Master Permit No.%'r"j 4('0— %�
PERMIT APPLICATION Sub Permit No. FLS- 1 —?- S-55
❑BUILDING 1% ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
/��,� CONTRACTOR DRAWINGS
JOB ADDRESS: 6 QT O( Ale ? AP9
City: Miami Shores b County: Miami Dade Zip:
Folio/Parcel#: //-;7,000i.3 �glgJ Is the Building Historically Designated:Yes NO x
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): �G° Phone#:
Address: "r,761 ly 16�5,,'sr
City: !yi 4 l ��/Y� � Q State: r-5,6 Zip:
Tenant/Lessee Name: Now/ (S��D4Y,W Phone#:
Email:
CONTRACTOR:Company Name: 14a c�N(��.,j Phone#:
Address:. (��✓�7(/� r�'W" �
City: State: %G• Zip:
Qualifier Name: Phone#:
State Certification or Registration#: '�J�DDOD J � Certificate of Competency#:
DESIGNER:Architect/Engineer: /UN Phone#:
Address: �� ��� city: Stater zip:
Value of Work for this Permit:$ 15-0 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration 2 New ❑ Repair/Replace ❑ Demolition
Description of Work: &NAJ 6;r--r 10 60
Specify color of color thru tile:
Submittal Fee$45X)/L)22 Permit Fee CCF$_ • (o® CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Z Notary$ XJ
Technology Fee$ Training/Education Fee$ 2 o Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ 9 •
7777
(Revisedo2/24/2014)
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 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 a appy dzrretnspeetion fee will be charged.
1
Si toe Signature
R or AGENT CONTRACTOR
The pregoing i s ment was acknowledged before me this The foregoing Instrument was acknowledged before/me this
day of AJC U_UL 20 by dayof S07 20 lE� b
y— y
I"ok'i - Oa00L?11411 who is personally known to a/p� * 41&94 ,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 PUBLIC
r
Sign:
Print: 122 E/nr Cp Print: KIM GARRETT
.�o a Notary Public- a e
Seal: yk ELIZABETH EIORRIAGA Seal:
A-...
.� ;•= Commission#FF 98144
'E MY COMMISSION N FF953536 ac; My Comm.Expires Jun 3,2020
EXPIRES January 25.2020 wFP,11110% Bonded through National Notary Assn.
aFk�k�+:Rkk�k%kik.k#ekkkkkk=Rkkhbdkkdtak:h:R�.kik:k%Ykk�xc�t#Xs#hkkxe•kkk8tok#des R�
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revisedo2/24/2014)