EL-16-2681Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit
Permit NO. EL -9-16-2681
Permit Type: Electrical - Residential
Work Classification: Pool - Private
Permit Status: APPROVED
Issue Date: 10/28/2016
Expiration: 04/26/2017
Parcel Number
Applicant
253 NE 101 Street
Miami Shores, FL 33138-2422
1132060134800
Block: Lot:
RICARDO J POL JTRS BERNARI
Owner Information
Address
Phone
Cell
RICARDO J POL JTRS BERNARDO J
253 NE 101 Street
MIAMI SHORES FL 33138-
253 NE 101 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone CeII Phone
INDUSTRIAL ELECTRICAL SYSTEM C 305/228-1384
Valuation:
Total Sq Feet:
$ 1,000.00
0
Type of Work: ELECTRIC POOL
Additional Info: ELECTRIC POOL
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
$4.50
$4.50
$0.20
$300.00
$3.00
$0.80
$313.60
Pay Date Pay Type
Invoice # EL -9-16-61526
09/29/2016 Credit Card
10/28/2016 Check #: 7566
Amt Paid Amt Due
$ 50.00 $ 263.60
$ 263.60 $ 0.00
Available Inspections:
Inspection Type:
Final
Light Niche
Bonding
Review Electrical
Alarms
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.
October 28, 2016
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Date
October 28, 2016
1
Miami Shores Village RECEIVED
Building Department sEP T
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
El BUILDING ELECTRIC n ROOFING
El PLUMBING ❑MECHANICAL ❑ PUBLIC WORKS
5 tie /0/ S�
JOB ADDRESS:
City:
FBC 20
Master Permit No. P- PP 1 (0 - Z(R P
Sub Permit No. I I - Z C08
❑ REVISION ❑ EXTENSION
❑ CHANGE OF
CONTRACTOR
❑ CANCELLATION
❑ RENEWAL
❑ SHOP
DRAWINGS
Miami Shores County:
Miami Dade Zip:
Folio/Parcel#: /r/.,3 .1t. 0/3 e5P Is the Building Historically Designated: Yes NO '
Occupancy Type: Load: Construction //Type: /% Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): ,.,e-/cL4 Phone#:
Address: p2 53 �� /0/ /
City: tiCC (, ..5"• --,es State: j Zip: 33/ 3e?
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: ��'Io-r'$ :
Address: /050 ,57e 2
Phone#:
City:e/ State:
Qualifier Name: it) 1 %L �%d�P%
Phone#:
Zip: 3_3/.3
State Certification or Registration #: EC 1.X00 z Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ (01,7)• 6 ) Square/Linear Footage of Work:
Type of Work: n Addition n Alteration FA New ❑ Repair/Replace ,.
Description of Work:
n Demolition
•
d
. r. • ;,i..0 . It lnlA �•
Specify color of color ttir'u filth.,
+*.wnr.y�go.wsi,r.�- 'i: •rte.'-"�—�rro.
Submittal Fee $ 5-0
Permit Fee $34®49 2
Scanning Fee $ Radon Fee $ (4 • 50
Technology Fee $ • 3 O
Structural Reviews $
(Revisadn7/74/7014)
CCF $ . 00 CO/CC $
DBPR $ q • 50 Notary $ 49"
Training/Education Fee $ • Double Fee $ $
Bond $ JO". 2
TOTAL FEE NOW DUE $ 2
CoG2 ' co -0
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 reins ec i>9<i fee will be charged.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of
/t-'44'Oo , who is personally known to
,20 46 ,by
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
as
Notary Public - State of Florida
•= Commission # FF 245464
gee My Comm. Expires Jun 30, 20 i y r
i, F OF Fl,`
Bonded through National Notary t
*****************************************
APPROVED B
IRcvicnr4111 Nn Nni Ai
Signature
CONTRACTOR
The foregoing instrument was acknowledged beforelme this
Z�!lday of , 20 /� , by
A'/!/ ' &9/('4, who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
E SALGUEIRO
blit - State of (lo,..
Commission # FF 245464
My Comm. Expires Jun 30, 201
"lil; :w
Bonded through National Notary Ass;
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3B 27/6 Plans Examiner
Structural Review
Zoning
Clerk