ELC-18-869Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
�m it
Issue
Permit NO. ELC-4-18-869
Permit Type: Electrical - Commercial
Work Classification: Addition/Alteration
Permit Status: APPROVED
: 5/23/2018
Expiration: 11/19/2018
Parcel Number
Applicant
689 NE 92 Street Number: 9-G
Miami Shores, FL
1132060430210
Block: Lot:
JOYCE D LANGE
Owner Information
Address
Phone
Cell
JOYCE D LANGE
689 NE 92 Street
MIAMI SHORES FL 33138-
(305)632-0200
689 NE 92 Street
MIAMI SHORES FL 33138-
Contractor(s)
R & A ELECTRIC
Phone
(305)331-3710
Cell Phone
Valuation:
Total Sq Feet:
$ 600.00
0
Type of Work: CHANGE OUT ONE LIGHT ONE GFI OUT AN
Additional Info: CHANGE OUT ONE LIGHT ONE GFI OUT AN
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Notary Fee
Permit Fee
Scanning Fee
Technology Fee
Amount
$0.60
$2.25
$2.00
$0.20
$5.00
$150.00
$3.00
$0.80
Total: $163.85
Pay Date Pay Type
Invoice # ELC-4-18-67032
05/23/2018 Check #: 1129 $ 113.85 $ 50.00
04/04/2018 Check #: 2613 $ 50.00 $ 0.00
Amt Paid Amt Due
Available Inspections:
Inspection Type:
Final
Meter Box
Alteration
Relocation
Fire Alarm
Service Change
Review Electrical
W. W.
Underground
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.
May 23, 2018
Authorized Signature: Owner / Applicant / Contractor / Agent
Date
Building Department Copy
May 23, 2018
1
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
S
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BUILDING Master Permit No. (_C e co
PERMIT APPLICATION Sub Permit No. UC, c 8 3(o ci
El BUILDING ELECTRIC ❑ ROOFING ❑ REVISION
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
JOB ADDRESS: ‘,747 2/ 9,e,'19
❑ EXTENSION ❑ RENEWAL
❑ CANCELLATION ❑ SHOP
DRAWINGS
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: ((- a 2.06 ..O113,oa/D Is the Building Historically Designated: Yes
Occupancy Type: Load: Construction Type: Flood Zone: BFE:
OWNER: Name (Fee Simple Titleholder): 0 C e_
Address: C g /V 6/ g �- 4/ 5 74,'�-mot 14 9 a
City: /j7/�ir9i' t�,4af -S State: CO
33/3k
NO
FFE:
Phone#: 340.S- y 3a- 0300
Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Com nyName: : X c ii-- 4r��i7'Z'G Phone#:(3�)33 `^ O
Address: • 0 ' ' %/3 85
City: ,1/ 4`"-// / State: Zip: g 0 3c h1 /
Qualifier Name: �0-416 Az'NO' //3 r , Phone#: `��5� 3 l 7-3 7/O
State Certification or Registration #: 400/i" 3/a.. Certificate of Competency #: 7 t 2 a�
DESIGNER: Architect/Engineer: r . , , Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $
ADD
Type of Work: ❑ Addition ❑ Alteration
Description of Work: (,f7OrI €- f>
an cl One, S'104-
•
Square/Linear Footage of Work:
❑ New
Repair/Replace
'11e et jar-....rshe _...SFr
it!, ♦s d.1S':c
•
❑ Demolition
Specify color of color.thr'u tile: °j
•
Submittal Fee $ PermifFee $ �✓
Scanning Fee $
Technology Fee $
CCF $
Radon Fee $ DBPR $
Training/Education Fee $
Structural Reviews $
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
Bonding Company'.s:Name (if applicable)
f_ . }P
Bonding Company's; Address
City 1 State
Zip
Mortgage Lender's Name (if applicable) .
r
Mortgage Lender's Address
City ' J 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. — . .,F r
• ti
I V
"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 ofn.buildinestimated-value` pp g permit.with'an exceeding $2500, the'opplicant must
promise in goodfaith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose ro ert is subject to attachin nt "Also, -a certi ►ed'co o the iecorded notice ofcommencement must be' `osted at.the job site
p P Y J f 4 PY f+ p
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.,
/ 1 `-
day of
O1GP, IGIm,
Uor who has produced
identification and who did take an oath.
20
nally known to
NOTARY PUBLIC:
Sign.
Print:
Seal:
APPROVED BY
•
(Revised02/24/2014)
CONTRACTOR
The foregoing instrument was acknowledged before me this
by (Z>�"+-� /day, of . P`�P , 20 (g- , by
V - LUI S , who is'personally known to
as me or who has produced U —3)f E t e t N
identification and who did take an oath.
NOTARYPU: C:
Ir>• * '`gip: MAHARAI K. GONZALEZ -�'
;�•'' '
� . MY COMMISSION # GG 044602
�` :,�; EXPIRES: November 2, 2020,
••:yF ig iee't Bonded T ru Notary Public Undenwiters
in
n:
al:
•
..
4/4772-Ig Plans Examiner
Structural Review
ti. 'r Y r� Notary r'•`yPbl is State of Florida
▪ Sindia Alvarez
• My Commission FF 156750
. sits 09/0312018
Zoning
Clerk