EL-16-3453 errrt N£ - -345
Miami Shores Village ?lt 7pe Etlal•=Re� Rtf �_
10050 N.E.2nd Avenue NE
'It�ttfkf��'sif�ca##ign Aifiti��i
Miami Shores,FL 33138-0000
o� Phone: (305)795-2204
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Issue OW"Isa1T. Expiration: 07/05/2017
Project Address Parcel Number Applicant
650 NE 97 Street 1132060171640 CHAD BERSHIRE
Miami Shores, FL 33138- Block: Lot:
Owner information Address Phone Cell
CHAD BERSHIRE
650 NE 97 Street
MIAMI SHORES FL 33138-
650 NE 97 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 2,000.00
INDUSTRIAL ELECTRICAL SYSTEM C 305/228-1384
_...,. _ _..._. ....__.. .. Total Sq Feet: 0
i
Type of Work:REPLACE PANEL&METER CAN 200A Available Inspections:
Additional Info: Inspection Type:
Classification:Residential
Review Electrical
Scanning:1
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20 Invoice# EL-12-16-62451
DBPR Fee $2.25 01/06/2017 Credit Card $ 115.70 $50.00
DCA Fee $2.25
Education Surcharge $0.40 01/03/2017 Check#:1451 $50.00 $0.00
Notary Fee $5.00
Permit Fee-Additions/Alterations $150.00
Scanning Fee $3.00
Technology Fee $1.60
Total: $165.70
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,PLUMB G,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I ce that all the fore information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. the I authonz a above-named contractor to do the work stated.
January 06,2017
Authori d Si ature:Owner Applicant / Contractor / Agent ate
Building Department Copy
January 06,2017 1
Miami Shores Village -- -
y�` ° Building Department JAN 03 2011
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 201`
BUILDING ,r-L �/ _ ��,�� Master Permit No.
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION EJAENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
��rry CONTRACTOR DRAWINGS
JOB ADDRESS: )�.s' !?7
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: y
Construction Type: Flood Zone: BFE: FFFE: f A
OWNER:Nam1
Name(Fee Simple Titleholder): S ;a T[Q Phone#:,50.5 1 13 L�I`J79
Address: �p5(`� N` e !R],City: M;�1 YlQ� r%-S State: 7r-koYi Q Zip: 331_
Tenant/Lessee Name: Phone#:
Email: f /
Company Name: % Phone#: 30r-
CONTRACTOR: <
Address: l ALJ �5e S77—
City: State Zip: J
Qualifier Name: Phone#:
State Certification or Registration#: -L� (7``72 f�� Certificate of Competency M
DESIGNER:Architect/Engineer: Phone#:
Address• City: State: Zip:
Value of Work for this Permit:$ '/�"� °`�' Square/Linear Foota of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: � �- -C/ '���r�_
Specify color of color thru tile:
Submittal Fee$�� L� Permit Fee$ l����� CCF$ �'� CO/CC$
Scanning Fee$ / Radon Fee$ DBPKR$ Z-5 Notary$
'
Technology Fee$ I ° (// Training/Education Fee$ Q �i ® Double Fee$
Structural Reviews$ Bond$ �®
TOTAL FEE NOW DUE$ e
(ReAsed02/24/2014)
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 be app ed and a reins ection fee will be charged.
Signature Signature °'//'1'?t' mer
;CWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of I }�CLQ r b-Q Y 20 110 by a �� day of —✓A.sJ�eAl2Z ,20 by
rcaw W10i f ld^U who is personally known to AG�67o,x_ s ae"< who is personally known ts�
me or who has produced 1 )1 6V LV as me or who has produced as
identification and who did take an o identification and who did take an oath.
NOTARY P B - NOTARY PUBLIC:
Sign: Sign: e�2
Print: ' m Print:
YPRIET0 .'01 Notary u v
Seal: .y � Y FF 214031
Seal: _': Commission#FF 39767
�s MY CAISSION =9%p ey° My Comm.Exp.November 17,20'17
EXPIRES:March 25,2erwr
ThmNotenpub�Umienw>te� I, EondedThruNationalAssocaton-Florida
Bonded
APPROVED BY ��� /,r�d�/lv Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)