ELC-17-1925 Fermat,N F� -7-17.1925
�sHO1 y�� Miami Shores Village 80nit Type"moctrical-66�erclal
10050 N.E.2nd Avenue
FMtia,4ftatr>n:Ai4ditiowA terat"ron =
Miami Shores,FL 33138-0000
�Permit Status:APPROVE>t
Phone: (305)795-2204
�CORN4'
l w I�'017 Expiration: 01/ / 01
Project Address Parcel Number Applicant
10000 BISCAYNE Boulevard 1132050200010
MIAMI SHORES VILLAGE
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
MIAMI SHORES VILLAGE
Contractor(s) Phone Cell Phone Valuation: $ 2,000.00
MOODY ELECTRIC INC (305)758-2000 Total Sq Feet: 0
Type of Work:REPAIR CONDUIT UNDER STEAM TABLE I Available Inspections:
Additional Info: 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-7-17-64709
DBPR Fee $2.00 08/01/2017 Credit Card $60.20 $50.00
DCA Fee $2.00
Education Surcharge $0.40 07/27/2017 Credit Card $50.00 $0.00
Permit Fee $100.00
Scanning Fee $3.00
Technology Fee $1.60
Total: $110.20
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERSFI AVIT: ify t tall the fo going information is accurate and that all work will be done in compliance with all applicable laws regulating
constructio zoning. u e re,I authoriz above-named contractor to do the work stated.
August 01, 2017
thorize gnature:owner / Applicant / Contractor / Agent Date
Building bepartment Copy
August 01,2017 1
Miami Shores Village �:�...r�
otY
BuildingDepartment
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel: (305)795.2204 Fax: (305)756.8972
INSPECTION'S PHONE NUMBER: (305)762.4949
BUILDING Permit No.
PERMIT APPLICATION Master Permit No. `)��
FBC 20
Permit Type: Electrical 6 L ` r
OWNER:Name(Fee Simple Titleholder): HAM) )VSO fe S 600 K(_`j W b Phone#:
Address: /®O®® �IS�U��►� u�
City: ic4lwll fl®t'e s State: f=L -Zip: 3313?
Tenant/Lessee Name: Phone#: ( 5) t5 236
Email:
JOB ADDRESS: I GO R i SCLII�I'1� 1�IG�
City: Miami Shores County: Miami Dade Zip. S/ -
Folio/Parcel#:
Is the Building Historically Designated:Yes NO Flood Zone:
CONTRACTOR:Company Name:_Mry)lu E l-rct y-I C nc Phone#: 3C S--l5FJ-LL Q
Address: 1C t V) Ak Oy C
City: T State: EL. Zip: �C7Z
Qualifier Name: Ph
one#:
C
State Certification or Registration#: C-Ccco I f a' Certificate of Competency#:
Contact Phone#: �`� �S(- ZCY�G Email Address: _ hn t� m�Q - �
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit:$ -Square/Linear Footage of Work:
Type of Work: ❑Address ®Alteration ®New ❑Repair/Replace ®Demolition
Description of Work: � ' -�14-te a22
��/1 e4 AI Lr141_1' /9.—A-) ..�'�-�r�
Submittal Fee$ Permit Fee$14255 00 CCF$ CO/CC$
Scanning Fee$ Radon Fee$ -2 ,Gb DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$ 6 ' 2-0
Bonding Company's Name(if applicable)
Bonding Company's Address
City State IV Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
City State Zi-
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 incompliance 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
Owner or Agent Contracto
The foregoing instrument was acknowledged before me this �� The foregoing instrument was acknowledged before me this—Z .t
�
day of Ute,MEL by �'A N"�0 day of t ,20 ij,by Yl0 l 'th �
who is personally known to me or who has produced who is personally known torr who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY U C: NOTARY PUBLIC:
Sign: Sign:
Print: Print: Ul
My Commission Expires: > go Py, Notary Public State of Florida My 'r s:
y = : Sindia Alvarez
My commission FF 156750
1aCA
,! o Expires 0910312018 +o o^ Notary ou��State of Flo Ida
} of w Rebeca Muno2
9 � cQ My commissi n FF
>x �� �x� ��>k�a� �� �>xi ����� �*
APPROVED BY 2L' ,YPlans Examiner Zoning
Structural Review Clerk
(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)