REV-16-2118A
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
❑ BUILDING 0 ELECTRIC ❑ ROOFING
❑PLUMBING D MECHANICAL El PUBLIC WORKS
JOB ADDRESS: 1223 NE 102nd street
City: Miami Shores County:
JLL 2% 2016
FBC 20 (k•-
Master Permit No20._( 6- (S co
Sub Permit No. ! NiKy'
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
Miami Dade
Zip:33133
Folio/Parcel#: Is the Building Historically Designated: Yes
Occupancy Type: Load: Construction Type: Flood Zone:
OWNER: Name (Fee Simple Titleholder): Dan & Maryanne Dammrich Phone#: 3055886381
Address: 1223 ne 102nd street
NO
BFE: FFE:
Miami Shores FL 33138
City: State: Zip:
Tenant/Lessee Name: Phone#:
Email:
G
CONTRACTOR: Company Name: Me Electrical Contractor
14242 SW 154th Court
Address:
786-385-5637
Phone#:
Miami FL 33196
City: State: Zip:
Mario Guidetti
Qualifier Name:
ER1305049
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$300
$ Square/Linear Footage of Work:
Type of Work: ❑ Addition 0 Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Level 1 Alt: 8 new bedroom recessed light (2 BR), 4 new living recessed light,
Description of Work:
Replace fan with light fixture in family room (on previous plan was just going to remove fan),
786-385-5637
Phone#:
1 new bathroom recessed Tight (L=$300, M=$300)
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ . .. L" li CCF $ CO/CC $
Scanning Fee $ 61• Radon Fee $ DBPR $ Notary $ $ • CZ
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ i e GO
(Revised02/24/2014)
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 b ° approved and a reinspection fee will be charged. n
Signatur
NER or AGENT
The foregoing instrument was acknowledged before me this
2G.day of J U , 20 `� , by
.�(,c,INO)AMMrizt who is personally known to
r
me or who has produced P._R �C'I%s
identification and who did take an oath.
NOTARY PUB :
Sign:
Print:
Seal:
Notary °ub(ic State of Florida
Sindia Alvarez
My Commission FF 156750
Expires 09/03/2018
****+k8*****
APPROVED BY
(Revised02/24/2014)
tiv
Signature
CONTRACTOR
The foregoing instrumentwasacknowledged before me this
0 71 day of /lU `Y ,20______ G , by
t`vl A 9-(,o VU I per; , who is personally known to
me or who has produced h- bak4&( lAv as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
#*******t***
eislvrioi MY MERCEDES ISIN # CAFF 055368
re EXPIRES: January 19, 2018
Plans Examiner Zoning
Structural Review Clerk