ELC-17-1223 ant
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Miami Shores Village Pel Eco + mrnr+ rcial
10050 N.E.2nd Avenue NE1-,9ftI;Addilt tIlllAltertatlan
Miami Shores,FL 33138-0000
17171 Status.'A _
Phone: (305)795-2204 k �
Expiration:
Project Address Parcel Number Applicant
9140 NE 8 Avenue Number: 1H 1132060440250
Miami Shores, FL Block: Lot: LADYE KING
Owner Information Address Phone Cell
LADYE KING 4880 CANDACRAIG
ALPHARETTA GA 30022
Contractor(s) Phone Cell Phone $ 1,100.00
Valuation:
LONGMAN ELECTRIC INC (305)758-1211
Total Sq Feet: 0
Type of Work:AS PER ENGINEERING PLANS EXISTING O Available Inspections:
Additional Info:AS PER ENGINEERING PLANS EXISTING O Inspection Type:
Classification:Commercial Final
Scanning:1 Meter Box
Alteration
Relocation
Fire Alarm
Service Change
Review Electrical
W.W.
Underground
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20 Invoice# ELC-5-17-63901
DBPR Fee $2.25 05/04/2017 Credit Card $50.00 $110.70
DCA Fee $2.25
Education Surcharge $0.40 05/23/2017 Credit Card $ 110.70 $0.00
Permit Fee $150.00
Scanning Fee $3.00
Technology Fee $1.60
Total: $160.70
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.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 nd zoning. Futhermore,I a thorize the above-named contractor to do the work stated.
May 23,2017
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
May 23,2017 1
Miami Shores Village
Building Department RECEIVED
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 MAY o 4 1017
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 C
�E
FBC 20P
BUILDING Master Permit No.CC _ A-I ?- " 06
PERMIT APPLICATION sub Permit No. b C. L-4 _ t222
❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
n�CONTRACTOR DRAWINGS
Ing ADDRESS:
City: Miami Shores County: Miami Dade Zi : 43(J
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE:� FFE: Q�/�
OWNER: Name(Fee Simple Titleholder): J' • �-AE KI' R Phone#: tl/c) -4 Vv4�
48bo ,rai
Address: 1_ /t
City: hQ,r State: �//
Tenant/Lessee Lame: L" Phone#: 0�- 7(-/J 4 0`
Email: C.�
CONTRACTOR:Company Name: o //`SAN �� he +7Z - L341
Address: s
City: State: zip..
c
Qualifier Name: Phone#: .?
State Certification or Re istration#: �' Certificate of Competency#:
DESIGNER:Arch'it6e Engineer: l4.�G w Phone#: -71&`3 t q 0 61 le d
Address: `1 City: : ,r r s.�'Zip:= f
Value of Work for this Permit:$ CO,- c= Square/Linear Footage of Work:
Type of Work: ❑ Addition Alteration_ ElNew ElRepair/�R�"eplace ❑ Demolition
Description of Work: A.6 � � YIVCGR � E) ►fiM 00ttT&BYt ON IG +V
IQ
1� W 1�t�Gc�,) (��'� ot- oJcdOvtic�aw�'�-e- • , -
Specify color of color thru ile:
Submittal Fee$ 1 lermit Fee$ t C' CCF$ CO/CC$
Scanning Fee$ Ijaclon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
f Ravicatin7/7a/?m m
I
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 approved and a reinspection fee will be charged.
Signature Signatur
OWNER or GENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
-2 —7 day of 20 20J by 2 day of V- k CJ 20 1-1 by
4Dyr rM Zr WV--I K'v("'- who is personally known to M; V1Qf iI ) - LW who is personally known to
me or who has produced ���(L't��S Ir-�C��®15�- as me or who has produced T)-('i V'l'% �1�`Q `� as
identification and who did take an oath. eb�aa5� ea�ae . identification and who didtakean.oath.
�IpViON�.
NOTARY PUBLIC: NQTARY
Sign: r,� p1t5 ' i� Sign:
Print: i i-Te� At��� .F `,4°4'�° Print: on
l L,
Seal: y 14 Seal:
Seal: . YMADYPRIETO
ISSION 4 FF 214031
�o;= EXPIRES:March 25,2019
Q.11,' 0`1 Bonded Thm Notary Pubk UndervrtNers
APPROVED BY �f ���� Plans Examiner Zoning
Structural Review Clerk