EL-17-27001
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit
Permit NO. EL -11-17-2700
Permit Type: Electrical -Residential
Work Classification: Alteration
Permit Status: APPROVED
Issue Date: 11/20/2017
Expiration: 05/19/2018
Parcel Number
Applicant
353 NE 91 Street
Miami Shores, FL
1132060136520
Block: Lot:
AMELIA COSTA
Owner Information
Address
Phone
Cell
AMELIA COSTA
353 NE 91 Street
MIAMI SHORES FL 33138-
353 NE 91 Street
MIAMI SHORES 33138-
Contractor(s)
LS CURTIS INC
Phone
(305)933-0683
Cell Phone
Valuation:
Total Sq Feet:
$ 500.00
0
Type of Work: REMOVE RANGE OUTLET
Additional Info: REMOVE RANGE OUTLET
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
$0.60
$2.00
$2.00
$0.20
$100.00
$3.00
$0.80
$108.60
Pay Date Pay Type
Invoice # EL -11-17-65643
11/14/2017 Cash
11/20/2017 Cash
Amt Paid Amt Due
$ 50.00 $ 58.60
$ 58.60 $ 0.00
Available Inspections:
Inspection Type:
Review Electrical
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 and zoning. Futhermore, I authorize the above-named contractor to do the work stated.
Authorized Signature: Owner
/ Applicant /
Building Department Copy
Contractor / Agent
November 20, 2017
Date
November 20, 2017 1
BUILDING
PERMIT APPLICATION
❑ BUILDING 0 ELECTRIC
PLUMBING ❑ MECHANICAL
JOB ADDRESS: 353 NE 91 Street
City: Miami Shores
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
❑ ROOFING
El PUBLIC WORKS
-INTER
NOV ,4 2017
FBC 2011 Sth
Master Permit No.t", L 17 1100
Sub Permit No.
❑ REVISION ❑ EXTENSION
❑ CHANGE OF
CONTRACTOR
❑ CANCELLATION
❑RENEWAL
❑ SHOP
DRAWINGS
County:
Miami Dade Zip:
Folio/Parcel#: Is the
Occupancy Type: Load:
OWNER: Name (Fee Simple Titleholder):
Address: 353 NE 91 Street
City: Miami Shore
Construction Type:
Building Historically Designated: Yes NO
Flood Zone: BFE: FFE:
. .-f:&6
Phone#: *- rig k 1—)53
Tenant/Lessee Name:
-1-tre_sc-11)In'xift4 kot
State: FI Zip: f5 133
Phone#:
Email:
CONTRACTOR: Company Name: L S Curtis Phone#: 305-933-0683
Address: 20341 NE 30 Ave 108
City: Aventura
Qualifier Name: Lewis Curtis
State: FI
Zip: 33180
Phone#: 305-933-0683
State Certification or Registration #: EC0003175 Certificate of Competency #:
DESIGNER: Architect/Engineer:
Address:
Value of Work for this Permit: $ 5'06
rC
Phone#:
City: State:
Zip:
Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace
Description of Work: /2e 7 v!/P /1-114)( w /
❑ Demolition
Specify color of color thru tile:
Submittal Fee $--0P3-1(A. Permit Fee $ lea ' c9 2
Scanning Fee $ Radon Fee $ 2_,
g/
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $'5.2
CCF $ CO/CC $
DBPR $ Z" Notary $
(Revised02/24/2014)
Q
3
a
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
OWNER or AGENT
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
II il' day of NOVeMb`pr , 20 11 , by 13 day of November 20 17 by
01C I 0 rem ODS who is personally known to Gvrs �.- s who is personally known to
1
me or who has produced 3 Yf \I 01 Y 11 P as me or who has produced / e. -a----5-4 as
identification and who . • . :.. oath. identification and who did take an oath.
NOTARY NOTARY PUBLIC:
CONTRACTOR
Sign:
Print:
Seal:
**********
, YANA7 PRIETO
t . • = MY COMMISSION # FF 214031
• - EXPIRES: March 25, 2019
Bonded Thru Notary Public Underwriters
APPROVED BY
(Revised02/24/2014)
Sign:
Print:
Seal:
CASSANDRA NEBBIA
Notary Public - State of Florida 6.
•`3 Commission # FF 979238
4•? My Comm. Expires Jul 25. 2020
,,,p
Bonded through National Notary Assn.
-...s....e. -E. v 4
*****************************************************************
Plans Examiner Zoning
Structural Review Clerk
001804
Local Business Tax Receipt
Miami -Dade County, State of Florida
-THIS IS NOT A BILL - DO NOT PAY
,5108006
BUSINESS NANIEILOCATION
L S CURTIS INC
20341 NE 30 AVE 108
AVENTURA FL 33180
RECEIPT NO.
RENEWAL
2427060
LBT
EXPIRES
SEPTEMBER 30, 2018
Must be displayed at place of business
Pursuant to County Code
Chapter 8A - Art. 9 & 10
OWNER SEC. TYPE OF BUSINESS
L S CURTIS INC 196 ELECTRICAL CONTRACTOR. _ PAYMENT LLEC
—. BY TAX COLECTOROt3
EC0003175.
Worker(s) 1
$45.00.wig-1/20H •
CREDITCARD-17-041201
This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license,
permit, ora certification of Iho holder's qualifications, to do business. Haider must comply with any governmental
or nongovernmental regulatory laws and requirements which apply to the business.
The RECEIPT NO. above must be displayed on alf,cornmercial vehicles - Miami -Gado Code Sec Ba -276,
for mare information, visit WV4.rniaridd#db'vev/flrxcUL24Lt