EL-17-2748Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit NO. E .=11-'x7.274$
Permit Type: Electrical - Resklentlal'
WorfcC/assification: Temp for. Test
5 NE 105 Street
Miami Shores, FL 33138-2030
Owner Information
....
GROUP 10 CAPITAL MANAGEMENT,
Parcel Number
/2017'__
Expiration: 05/19/2018
Applicant
1121360060090
Block: Lot:
Address
1680 MICHIGAN AVE Avenue
MIAMI BEACH FL 33139 -
Contractor(s)
B AND B ELECT CO
Phone
(305)970-5667
CeII Phone
Phone
GROUP 10 CAPITAL MANAGEMI
Valuation:
Total Sq Feet:
Type of Work: TEMP FOR TEST
Additional Info:
Classification: Residential
Scanning: 3
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
$9.00
$0.80
$114.60
Pay Date Pay Type
Invoice # EL -11-17-65696
11/17/2017 Credit Card
11/20/2017 Credit Card
Amt Paid Amt Due
$ 50.00 $ 64.60
$ 64.60 $ 0.00
Cell
Available Inspections:
Inspection Type:
Final
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 ." ify that .� e foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. F ermore, thorize the above-named contractor to do the work stated.
November 20, 2017
Authorized Signatu Owne / / Applicant / Contractor / Agent Date
Building Dep t Copy
November 20, 2017
1
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
AFFIDAVIT FOR 30 DAY TEMPORARY -ELECTRIC SERVICE
NOTE: ELECTRIC SERVICE WILL BE DISCONNECTED "WITHOUT NOTICE" UPON 30 DAY
TERMINATION UNLESS APPLICATION IS RENEWED.
It is understood that the temporary -electrical approval by the Miami Shores Village, Building Department given
in connection with the building being constructed under:
Building Permit N: e -12S6} Electrical Permit N: CL /f) .-/' 7
At Address: 5 A., j 57 2
For Owners: 5L. ce0-r e -f o
Miami Shores, FL
, and is being given only for
construction purpose or for testing the following equipment in said
structure:X..
The owner does herby agree to assume the responsibility of maintaining the installation in such manner that
there is no hazard to life or property. Such approval is in no event to be considered a RELEASE of said
structure for the purpose of use and occupancy, and no occupancy shall be granted or permitted until further
inspections have been called for and approved by the inspection divisions concerned, and/or a Certificate of
Occupancy or Completion is obtained.
The undersigned also understands that the temporary electric approval is subject to rescission and
ancellation and electric power can be cut off at the discretion of the building official and will be disconcerted of
1e building concerned is occupied before final inspections are approved and/or obtained a Certificate of
Occupancy or Completion. Note: Failure to comply with the provisions of this affidavit will result in your
being unable to obtain future Temporary for Test permits.
, being first duly sworn, depose and say that 1 am the owner of the
above described property, and that I agree that the structure covered in this agreement shall not be occupied
until the building contractor has obtained approval of final inspections and/or obtained a
Occupancy of Completion. Note: Failure to comply with the provis
being unable tpooin future Temporary for Test permits.
Signature of Own
I,ruLaU�'j�CCIA Ul4Qj ,beingdul
the above-described property and that the ele
if ternp�a�iceted_
Signature of Electrical Contractor
" yi@a@iftiov
€ M� ISSION #FF178894
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18
your
ose and say that I am the Electrical Contractor for
ill not create a safety hazard
Notary
I, V t4 ) 0 14 J i1 «0 ATI being first duly sworn, depose and say that I am the Building Contractor
of the above described property and that I will not permit occupancy of this building until final inspections have
been called for by the contractors and sub -contractors concerned and final approval by the inspection division
obtained and that I have the authority insofar as the owner of said pr • • - :: - ::: '.' ..ancy
until such final inspections,are'obtained and/or a Certificate of OccupanpS456% oA IQldnitiii F3E RIN
MY COMMISSION #FF178894
i?° ' EXPIRES • • •er 23, 2018
gnature of Building C,bntractor
Signature of Inspector
Signature of Notary
BUILDING
PERMIT APPLICATION
BUILDING fELECTRIC ROOFING I I REVISION
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
FBC 2019
Master Permit No. C 16 --
Sub
i Sub Permit No.
I _2 `7
❑ EXTENSION ❑RENEWAL
PLUMBING n MECHANICAL nPUBLIC WORKS ❑ CHANGE OF n CANCELLATION n SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 3 / f /05 7 't -c -- 1
City: Miami Shores ( County:
Folio/Parcel#: 11 /�
'13C)00 -)O070
Occupancy Type: Load:
OWNER: Name (Fee Simple Titleholder):
Address:
City:
Construction Type:
Miami Dade
Zip:
Is the Building Historically Designated: Yes
Sw rn <vr t wt.'"iJ
; nci Ani
State: Y
Flood Zone:
BFE:
NO
FFE:
Phone#: icy -"ice - S�z
Tenant/Lessee Name: Phone#:
Email:
Zip: "3 3Z'>
CONTRACTOR: Company Name:
Address:
City:
Qualifier Name:
8 avis 8 Et -(cc
State: /L-
K-
LK— 14 2 1> '-(L,; je >
Phone#: 335 M 10 ��G• 7
Phone#:
Zip:
3 3)7Z.
State Certification or Registration #: 2 01,0 ss "(1 `ai Certificate of Competency #: 51- Z
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 1 CaCC• C- Square/Linear Footage of Work:
Type of Work: Addition ❑ Alteration ❑ New n Repair/Replace
P ,fc T&S FT
Description of Work:
n Demolition
Specify color of color thru tile: i'
Submittal Fee $ Permit Fee $ / e ,e 0 CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ `v�. 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 be approved and a reinspection fee will be charged.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
( day of , 20 L , by ((,7 day of fk.-I b v
54, S r ei , whod'Cpprsonally known' to
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
me or who has produced as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
':i!7) 388-0153
IA M PELEGRIN
1 CO
MMifIOfJ #1T176894894
ES November 23, 2018
idaNntaryServlce.com
EXPIR
Finr•
ho is personally known to
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
1
as
EXPIRES August 23, 2019
44071 X 133 FlorktnNowyeervlw.00rn
***********************************************************************************************************
APPROVED BY
(Revised02/24/2014)
dans Examiner
Structural Review
Zoning
Clerk