REV-16-2607 Miami Shores Village
Building Department 6EP 2 1 201b
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY. __=J
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 2014
BUILDING Master Permit No. T-P—kG 0R
PERMIT APP LIC TION Sub Permit NoID)I(D- 7_4�0�
❑BUILDING LECTRIC ❑ ROOFING EVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
�, o CONTRACTOR DRAWINGS
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JOB ADDRESS:�� l9 Iy P— �7 S
City: Miami Shores County: Miami Dade Zip: 31 3
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Constructio,,n``Ty1pe: Flood Zone: BFE:q FFE:
OWNER:NamGe� (Fee Simple Titleholder �2 W V���40 f�( Phone#:
Address:
City: Olt 0-rA o r,--S State: i� 1 Zip: 3 51
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: �c.S 5 Phone#:
Address:2_S C/
City:_'m l fL y 1 State: Zip:.
Qualifier Name: l;_�c4-119 G Sa S S_o 2!!� Phone#: 3 Y 6/ yZ
State Certification or Registration#: E C D t9 0 Z S° 2 7 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: Q Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: x no v,�_ w r 11 c v j<J S d- svjA'!('�s OJI Rower �'� r S-L
G,J-
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Specify color of color thru tile:
Submittal Fee$ 0 Permit Fee$ �Vl®G CCF$ CO/CC$
Scanning Fee$ - �� Radon Fee$ DBPR$ Notary$ 'CID
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ Q
tRPvkPdn7/94/7n141
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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
'C OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
Z day of 2 ,20 by day of (`�( �- ,20 k , by
�N-h"Et e N who is personally known towho is personally known to
me or who has produced TL-M UGE L)VENTS as me or who has produced -DIOJ t� Lt lENZtas
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PU IC:
Sign: =ZSign:
Print: S(mDl :Qu1,KQ Print: SI NCAA A�XAPLR-
Seal: Seal:
Side ANata rotosr°L�o Notary public State of Florida
Q My Commiam€t 1675.0 . Sindia Alvarez
pfpo�� Exphe809103P$Ota My Commission FF 156750
�? a E ireS 0 910 312 0 1 8
APPROVED BY ✓ 21 S19710'-" Plans Examiner Zoning
Structural Review Clerk
tP—,;—An,)/oe mm A
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y
JEFF ATWATER
CHIEF FINANCIAL OFFICER STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS'COMPENSATION
*•CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW*
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law.
EFFECTIVE DATE: 9@6/2016 EXPIRATION DATE: 9/26/2018
PERSON: SASSON ISAAC
FEIN: 650323151
BUSINESS NAME AND ADDRESS:
SASSON ELECTRIC INC
2501 NE 195TH ST
MIAMI FL 33180
SCOPES OF BUSINESS OR TRADE:
LICENSED ELECTRICAL W1131
CONTRACTOR
Local Business Tax Receipt
Miami—Dade County, State of Florida
—THIS IS NOT ABILL—DO NOT PAY LBT
2625920
BUSINESS NAME&OCATION RECEIPT NO. EXPIRES
S
SASSON ELECTRIC INC RENEWAL EXPIRES
30, 2017
2501 NE 195 ST 2754225 Must be displayed at place of business
MIAMI FL 33180 Pursuant to County Code
Chapter 8A—Art.9&10
OWNER SEC.TYPE OF BUSINESS
SASSON ELECTRIC INC 196 ELECTRICAL CONTRACTOR. By TAX C RECEIVED
ECOOO2527 BY TAX COLLECTOR
Worker(s) 1 $75.00 08/02/2016
CREDITCARD-16-045381
This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license,
Permit or a certification of the holders qualifications,to do business Holder must comply with any governmental
or nongovernmental regulatory laws and requirements which apply to the business.
The RECEIPT N0.above must be displayed on all commercial vehicles—Miami—Dade Code Sec Be-276.
For more information,visit www miamidade.govhaxcollectorr-
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD
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CAG ik' �•�
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EC0002527
The ELECTRICAL CONTRACTOR: �.
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31,2018
SASSON;ISAAC @1 ,� ❑
SASSON ELECTRIC INC 'y
2501 NE 195TH STREET •
MIAMI FL 33180