EL-16-329 Permit No. EL-2-16-329
Miami Shores Village Permit Type:Electrical-Residential
10050 N.E.2nd Avenue NE
s twork Classification:Tem for Construction
I_ Miami Shores,FL 33138-0000 Per I
Phone: (305)795-2204
Petmrt;Staters:APPROVED'
F�ORtDp'
Issue Date:2/8/2016 Expiration: 08/06/2016
Project Address Parcel Number Applicant
1420 NE 103 Street 1132050310030
Miami Shores, FL Block: Lot: MARC AND ANNE LITZENBERG
Owner Information Address Phone Cell
MARC AND ANNE LITZENBERG 1420 NE 103 Street
MIAMI SHORES FL 33138-
1420 NE 103 Street
MIAMI SHORES FL 33138-
, �
Contractor(s) Phone Cell Phone
QUINTANA ELECTRIC BROTHERS IN( 305 986-5893 Valuation: $ 1,000.00
( ) (305)6815317
Total Sq Feet: 00
Type of Work:TEMP FOR CONSTRUCTION Available Inspections:
Additional Info: Inspection'Type:
Classification:Residential Final
Scanning: 1 Review Electrical
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due—
CCF
ue
CCF $0.60
DBPR Fee Invoice# EL-2-16-58596
$2.00 02/05/2016 Check#:2540 $50.00 $58.60
DCA Fee $2.00
Education Surcharge $0.20 02/08/2016 Check#:2541 $58.60 $0.00
Permit Fee-Additions/Alterations $100.00
Scanning Fee $3.00
Technology Fee $0.80
a
Total: $108.60
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
ertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
c 'pting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
i for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
DAVI I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
con o i Futhermore, I authorize the above-named contractor to do the work stated.
r
February 08, 2016
Aut Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
February 08, 2016 1
Miami Shores Village --_- - -=�
Building Department FEB 0,5 20%
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 $Y; ;
/ Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20/x✓
BUILDING Master Permit No/z(f I,S= �GZ�
PERMIT APPLICATION Sub Permit No._,�//�_ Z�
❑BUILDING LECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR � DRAWINGS
i1 IV t'[ <—
JOB ADDRESS:�"I� li �.��r�
City: Miami Shores County: Miami Dade Zi 3
Folio/Parcel#: Is the Building Historically Designated:Yes r NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
c �
OWNER: Name(Fee Simple Titleholder): o/�L(r( �1,7erj ler T_ h no e#^'i
Address:
City: V11 JnQd�S State: Zip: l d
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: Phone#:
Address:
City: D State:_ Zip:
Qualifier Name:C��yl ,2/'PT Phone#:z �
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ew ❑ Repair/Replace ❑ Demolition
Description of Work:.
�*n? aAty"tl;s".Teo! I.J.w;YS`.,T'•A � F d app.Y''•w+ .'x,,.
� .Zs�:ro.°' •,tt'4t'i'3.S .).S7a?. .'?!/P.�,!4�i;id+. '•s£i..r'+r• .
Specif -'edlor`of color''Viiu tile:
`'4:��''ASt:-i��"'+'ti 3s:�i7 �,. .,, Pyy.atr�w.�:r.rJJ'�Firt"A,?•"ti;^;, v. ? �d:
Submittal Fee$,S'�J ' Q� Permit Fee$ CCF$ r CO/CC$
Scanning Fee$ . W Radon Fee$ a• DBPR$ Notary$ �s
Technology Fee$ Training/Education Fee$ ' Double Fee$
Structural Reviews$ Bond$ /0 �r^--
TOTAL FEE NOW DUE$ GC9 to 6
(Revised02/24/2014)
.I
Bonding Com'pany'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
RESUL'TIN 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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
4
Signatur. Signature
—
0
kN E R or AG6T CONTRACTOR
The� 6 folegoing instrument was acknowledged before me this The ffor�egoing instrument wads acknowledged before me this
day of 20 1by ,JZ dayf� �r�G 20 6 by
�,x who is personally known to �'77 who is Czersonall rLknown to
me or who has produced o'-5-1 WO b -OAV nye or who has produced as
�•� identification and who did take an oath. identification and who did take an oath.
vv TARY PUBLIC: NOTARY PUBLIC:
Sig • 1
Print: Print: 1'�
NOT -$bW OF rL, MM
(_44440J.)
Seal: t COMMIOMOFP070112 Seal: COMMISSiON*F�1D112
EXPIRES 11/13!017 EXJPM 103=7
49NIXD"Il *40W10WM
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014) I