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EL-16-3031Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Pe mit Permit NO. EL -11-16-3031 Permit Type: Electrical - Residential Work Classification: AdditionlAiteration Permit Status: APPROVED Issue Date: 12/1/2016 Expiration: 05/30/2017 Parcel Number Applicant 437 NE 102 Street Miami Shores, FL 33138-2452 1132060170800 Block: 92 Lot: 17 & 18 MICHELLE HEADLEY Owner Information Address Phone Cell MICHELLE HEADLEY 437 NE 102 Street MIAMI SHORES FL 33138- (305)793-3445 437 NE 102 Street MIAMI SHORES FL 33138- Contractor(s) ATLANTIS ELECTRICAL CORP Phone CeII Phone (305) 551-4043 Valuation: Total Sq Feet: $ 300.00 35 Type of Work: BATHROOM REMODEL Additional Info: BATHROOM REMODEL 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 $2.25 $2.25 $0.20 $150.00 $3.00 $0.80 $159.10 Pay Date Pay Type Invoice # EL -11-16-61957 12/01/2016 Credit Card 11/04/2016 Credit Card Amt Paid Amt Due $ 109.10 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final Meter Box Alteration Relocation Fire Alarm Service Change Review Electrical Underground W. W. 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 t foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, II orize the above-named contractor to do the work stated. December 01, 2016 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date December 01, 2016 1 BUILDING PERMIT APPLICATION ❑BUILDING ELECTRIC 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 Master Permit ❑ ROOFING ❑ REVISION PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS JOB ADDRESS: 437 NE 102 Street Sub Permit ❑ CHANGE OF CONTRACTOR S1h FBC 20N No. a /0--S01 No.9( I(a-�C�30 ❑ EXTENSION ❑RENEWAL ❑ CANCELLATION ❑ SHOP DRAWINGS City: Miami Shores County: Folio/Parcel#:11-3206-017-0800 Miami Dade Zip: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: OWNER: Name (Fee Simple Titleholder): Michelle Headley Address:437 NE 102 Street BFE: FFE: Phone#: 305-793-3445 City: Miami Shores State: FLZip: 33138 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: Pk'fItQn iC F le,(, -h ) CGt 1 Address: 122O3 Sv'J 2 (f-T,rrace. Cr -p Phone#: 7R(p'•0-7°10 City: w\IGII(n1 Qualifier Name: c►rl GI S State: �L Q PerGZ • State Certification or Registration #: iL C V�j(70 � q 19 DESIGNER: Architect/Engineer: Phone#: Zip: 33I 15 Phone#: 7• i0 ' q1S• 6 -Po Certificate of Competency #: Address: City: Value of Work for this Permit: $ �� , Square/Linear Footage of Work: State: Zip:,, Type of Work: ❑ Addition n Alteration ❑ New Description of Work: ❑ Repair/Replace J,) n Demolition Specify color of color thru tile: Submittal Fee $ Permit Fee $ % rm/bis Scanning Fee $ Radon Fee $ 45 Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) CCF $ DBPR $ CO/CC $ Notary $ Double Fee $ Bond $ j TOTAL FEE NOW DUE $ ` 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 andaa reinspection fee jI be charged. Signature OWNER or AGENT The foregoing instrument was`acknowledged before me this SI. day of ©C-��9e � , 20 I t , by KIche\l-c cc►d1�y , who is personally known to me or who has produced DL On -f-AL as identification and who did take an oath. NOTARY P Seal: APPROVED BY (Revised02/24/2014) Signature CONTRACTOR The foregoing instrument was acknowledged before me this ' \ day of Oc t , 20 ilp , by 'FYGnUSCA PtXGz , who is personally known to me or who has produced DL Can as identification and who did to h. NOTARY PU Sign: Print: Seal: L/!` / . Plans Examiner `b REBECA M. PASTRANA MY COMMISSION # EE872624 EXPIRES: February 07, 2017 Structural Review Zoning Clerk