ELC-18-39•
1
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit
Permit NO. ELC-1-18-39
Permit Type: Electrical - Commercial
Work Classification: Addition/Alteration
Permit Status: APPROVED
Issue Date: 1/8/2018
Expiration: 07/07/2018
Parcel Number
Applicant
9007-9029 BISCAYNE Boulevard Number: 9 1132060110070
Miami Shores, FL 33138-0000 Block: Lot:
SHORE SQUARE PORPERTIES I
Owner Information
Address
Phone
Cell
SHORE SQUARE PORPERTIES LLC
696 125 Street
MIAMI FL 33161-
(305)779-8040
696 NE 125 Street
MIAMI FL 33161-
Contractor(s) Phone
WTH TECHNOLOGIES GROUP INC (407)951-7603
Cell Phone
Valuation:
Total Sq Feet:
$ 5,000.00
0
Type of Work: 2 NEW CIRCUITS WITH L5 -20R TWIST LO
Additional Info: 2 NEW CIRCUITS WITH L5 -20R TWIST LO
Classification: Commercial
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$3.00
$2.25
$2.00
$1.00
$150.00
$3.00
$4.00
$165.25
Pay Date Pay Type
Invoice # ELC-1-18-66059
01/05/2018 Credit Card
01/08/2018 Credit Card
Amt Paid Amt Due
$ 50.00 $ 115.25
$ 115.25 $ 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 AFFIDA I certi
construction and o g. Fut
foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
rize the above-named contractor to do the work stated.
Auth
ri ed Signature.. er / Applicant / Contractor / Agent
Building Department Copy
January 08, 2018
Date
January 08, 2018 1
fh. f Ar(,.,. 5313--1--f ,c---r
BUILDING
PERMIT APPLICATION
El BUILDING ELECTRIC
El PLUMBING ❑ MECHANICAL
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
,DECEIVED
JAN 052018
FBC2014 ) Q
Master Permit No. CG `-11 " 17— otb1 V
Sub Permit No.0 � - 3c31
❑ ROOFING ❑ REVISION ❑ EXTENSION
❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION
CONTRACTOR
JOB ADDRESS: yr) Off, 1 D (J CGk jY1€j
El RENEWAL
❑ SHOP
DRAWINGS
City: Miami Shores Count : Miami Dade Zip:
Fo io/Parcel#r) &&t1=11C6Pek Is the Building Historically Designated: Yes NO
Occupancy Type: Load:
Construction Type: Flood Zone:
BFE: FFE:
O(Address:
,W EN R: Name (Fee Simple.Titleholder): S ko (L 3 QJA-� VPhone#: 305- 3c) 474i A t
fD Gq c NE 1 z.S S4-
+City: NOn Ni -t& iii l r pc_ 33(kate: . FL Zip: 3 316 I
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: kYil } �1-, hci�l�g1�S Gtfz7Gt Phone#: 9s(-- 14 ,3
Address: 5q3 ,E,g51 5 e, R00.61 4'314
City: Ltric3UJO00L State:
Qualifier Name: .laireiS EdwZCd5
State Certification or Registration #: EL' iQd 79;6
DESIGNER: Architect/Engineer:
Address:
Value of Work for this Permif: $
Type of Work: ❑ A•dition 1!I Alteration
Zip: 3aa75o
Phone#: 407— .?•S 1 * 7603
Certificate of Competency #:
Phone#:
City: State: Zip:
Square/Linear Footage of Work:
;i3 00
Description of Work:
❑ New ❑ Repair/Replace
❑ Demolition
tocti ou- k-iS ,
Specify color of color thru tile:
50 pc,c
re I o ce;v-E:', \ •S -
Submittal Fee $
Scanning Fee $
Permit Fee $ Are, ea
OG
Radon Fee $
Technology Fee $
Structural Reviews $
(Revised02/24/2014)
1•
CCF $ 3 CO/CC $
DBPR $ Z .. Z S Notary $
Training/Education Fee $ Double Fee $
Bond $ �( c
TOTAL FEE NOW DUE $ L J • ZS
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."
r
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
NER or AGENT \�
The foregoing instrurH'ent was acknowledged before me this
day of 3 ANvatr
' 0 T -MAX: / , who is pers
me or who has produced (/
identification and who did take an oath.
(NOTARY PUBLIC:)
, 20 l Q
Sign:
Print:
Seal:
CONTRACTOR
The foregoing instrument was acknowledged before me this
by 14141 day of ,Sc.znu ry
own to CA
asem or who has produced
I�RGE A. DE LA ROSA
Notary Public - State of Florida
Commission # FF 948519
<o� My Comm. Expires Apr 23, 2020
Fvo"` Bonded through National Notary Assn.
APPROVED BY
(Revised02/24/2014)
identification and who d'
NOTARY PUBLIC:
Sign:
Print:
Seal:
as
CHRISTOPHER MATHEW LUBINSKAS
_ Commission # FF 924928
;.A.t , My Commission Expires
October 06, 2019
/ j
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r �:
Chf,is l-'✓b;nSkGS
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r'Z 3'ra-N I i3
Plans Examiner Zoning
Structural Review Clerk