EL-17-1331 Permita �L- 4 74��1
sx;° �,� Miami Shores Village 1,21Pelmit 7,)t a Electrical-Ree14�9i tl
�. 10050 N.E.2nd Avenue NW
>� #1an Service Change
Miami Shores,FL 33138-0000=
Phone: (305)795-2204 t7?�`, `td11tJ_APPROVED
F�o*�RtiD�' ��
�,
issue Dow611)2017 Expiration: 11/28/2017
Project Address Parcel Number Applicant
170 NW 97 Street 1131010250030
Miami Shores, FL 33150- Block: Lot: ROBERT ROSENWALD JR
Owner Information Address Phone Cell
ROBERT ROSENWALD JR 170 NW 97 Street (305)790-8449
MIAMI FL 33150-
170 NW 97 Street
MIAMI FL 33150-
Contractor(s) Phone Cell Phone Valuation: $ 1,600.00
MESA BROTHERS INC (305)345-1974
Total Sq Feet: 0
Type of Work:OVER HEAD CONVERSION,SAME AMPERAGE 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
DBPR Fee Invoice# EL-5-17-64022
$2.25 05/15/2017 Credit Card $50.00 $110.70
DCA Fee $2.25
Education Surcharge $0.40 06/01/2017 Credit Card $ 110.70 $0.00
Permit Fee-Additions/Alterations $150.00
Scanning Fee $3.00
Technology Fee $1.60
Total: $160.70
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELW. rt
NG,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFt all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction ane,I authorize the above-named contractor to do the work stated.
June 01, 2017
Author—ii4d Si nature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
June 01,2017 1
��os) 21 `� � � 5� �
Miami Shores Village
Gv,o Building Department
artment
- �
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 —
Tel:(305)795.2204 Fax:(305)756.8972 - ---
I
INSPECTION'S PHONE NUMBER: (305)762.4949 j
FBC 20'
BUILDING Permit No.
PERMIT APPLICATION Master Permit Noa `I43I
Permit Type: Electrical
JOB ADDRESS:_140 1240/ 7? 9 1
City: Miami Shores County: Miami Dade Zip: 331,5'
Folio/Parcel#: //—310/- 0 3.- 00,30
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee
•Simple Titleholder): �� c R b�,r w1 d Phone#:_lm-' -,or-2-3
Address: r7 ,/4/tJ -5
City: ✓n ,cL�+-i •' S j,es.rr S State: ]`I O r.'J zip: 7-21) 3 O
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: 1`'I-C�Uc Il /L�y Phone#: 3c�Sr-63o-�---2,-5 �(q
Address: )LIS S'(.2) %o 3 re,
City: vis L State: zip: '33/
Qualifier Name: P-0C16,1Phone#: SOS 31-15- 9 7
State Certification or Registration#: C�� �� Certificate of Competency#: 1t
Contact Phone#: C6- -;0-3 SLI Email Address: rM gAL3 IU- ,
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit:$ 16 O 4`7 Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ONew ❑Repair/Replace ❑Demolition
r
Description of Work:
' O
x•�xx.x•x•xx.x��x��x•�x��x.•xw��x•x�x•x�xx�•x•xxx�x•Feesxxxxx.x�.x�xxx�.x.x���.x��•x�x��xax.x�x•.x�x•xx•x�.x•xux•x
Submittal Fee$ Permit Fee$ %����04"1 CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$-V 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 ELECTRICAL WORK:,PLUMBING,SIGNS,
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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 issue.---&-the-absence of such posted notice, the
inspection will not be approved and a reinspe i n fee will be charged.
N ,
Signature Signature-
Owner
i atureOwner or Agent Contractor
The foregoing instrument was acknowledged,befo me this,� The foregoingi trument was cknowl ged before e thisr
, / a
day of j� 20! by YLku�
s '
who is personally known to me or who has produced_ who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
NANCY TEJAOA
.,MY COMMISSION OFFO84758
Sign: �, Sign: EXP ES:JAN 29,201a
YP Y - e insurance
Print: Print: iJ�GC
My Commissio 'ES:JAN 21,201a My Commission Ex/ires: ��
sanded rough 1st State Insurance
APPROVED BY / Plans Examiner Zoning
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)