EL-18-582Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Pei
mit.
Permit NO. EL-3-18-582
Permit "7 Type: Electrical - Residential
Work Classification: Low Voltage
Permit Status: APPROVED
Issue Date: 4/11/2018
Expiration: 10/08/2018
Parcel Number
Applicant
1064 NE 97 Street
Miami Shores, FL 33138-
1132050170200
Block: Lot:
MARIE ROBSON
Owner Information
Address
Phone
Cell
MARIE ROBSON
1064 NE 97 ST
MIAMI SHORES FL 33138-2556
Contractor(s)
SOUTH DOM ELECTRIC INC
Phone
(305)626-5904
Cell Phone
Valuation:
Total Sq Feet:
$ 500.00
0
Type of Work: LOW VOLTAGE PERMIT FOR TV CONNECTIO
Additional Info: LOW VOLTAGE PERMIT FOR TV CONNECTIO
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Notary Fee
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
$0.60
$2.00
$2.00
$0.20
$5.00
$100.00
$3.00
$0.80
$113.60
Pay Date Pay Type
Invoice # EL-3-18-66699
03/06/2018 Credit Card
04/11/2018 Credit Card
Amt Paid Amt Due
$ 50.00 $ 63.60
$ 63.60 $ 0.00
Available Inspections:
Inspection Type:
Review Electrical
i
In co ideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pedal i g thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepti permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required r EL CTRICAL, PLUMBING) MECH AL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNE.
construct
IT: I certify t
g. Futher
information is accurate and that all work will be done in compliance with all applicable laws regulating
above -named contractor to do the work stated.
MornQUr
Author zed Signature! Owner / Applicant / Contractor /
Agen
April 11, 2018
Date
Building Department Copy
April 11, 2018 1
Questions/Comments/Concerns ?
Miami Shores Village Monique Smith, 786-253-2869
RECEIVED
M 0 6 ,01$
BY,
FBC 20
Master Permit No. 4-e• /( ', 7 ' 29 /0
Sub Permit No. EL ( "58 2_
❑ REVISION ❑ EXTENSION ❑ RENEWAL
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
BUILDING
PERMIT APPLI TION
❑ BUILDING ELECTRIC ❑ ROOFING
El PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS
JOB ADDRESS: 10(04 NC 9"7 S T
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores
County:
Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load:
Construction Type: Flood Zone: BFE:
FFE:
OWNER: Name (Fee Simple Titleholder): / ]° , `' aK C "" 46''° phone#:
Address: ' o Lt WE 1q7 •
City: kt l A14( s it—e2
State:
Tenant/Lessee Name:
Email:
Zip: 33 / 38
Phone#: 7062 i3 28�
CONTRACTOR: Company Name: C6 ► \—i PO AA t1
Address. 6--g &e/ 9 7 c.
City: A'1 f4 M , State:
Qualifier Name: �5 / v� 4 0-S
Phone#: 555 9
DESIGNER: Architect/Engineer:
Address:
Value of Work for this Permit: $ V 00
Phone#:
Zip: --�0 II
5
State Certification or Registration #:t1.75 G/ Certificate of Competency #:
Phone#:
City: State: Zip:
Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New
❑ Repair/Replace ❑ Demolition
Description of Work: 1,0 w VOLT A- P 1Ti _ -t / "./(%N C,770/ f
-f- BAD c wJ.i Ai & Fok. £ECvte r T`/ YS.r l - wl. fJG
"14 &JD Ce? e-Ceti'-
Specify color of color thru tile:
Submittal Fee $ 0 / Permit Fee $ /4 7' ' CCF $ CO/CC $
Scanning Fee $ Radon Fee $ CO•DBPR $ a'co Notary $ ' 4
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ W 3 • 60
(Revised02/24/2014)
Bonding Company,s Name (if applicable)
Bonding Company's Address
City 1 State Zip
Mortgage-L'ender's Name (f applicable)
Mortgage Lender's Address
_ r
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. 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 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 wi o . e approved and a reins ection fe ill be charged.
Signature
0 NER or
The foregoing instrument was acknowledged before me this
(o 'day of
20
Q N I lam. RN1,�,, is personally known to
me or who has produces --- lJ(2.4 i CA-CklAs
ident ication and who did take an oath.
NOT ! Y P : LIC:
AlbM
Sign'.
Print r
Seal:
vVYY
4,ItY Pc6,
o
oQ
• Of OP'
by
Notary Public State of Florida
Sindia Alvarez
My Commission FF 5E; 50
Expires 09/03/2018
######################################################
APPROVED BY
Signature
CONTRACTOR ti
ge
The foregoing instrument^was acknowledged before me this
O day of 'N t A/2. , 20 / & , by
`JET- 11 � f E.N ► "; 7v�i�t�i� personally known to
Oc.( Me or who has produced f
identification and who did take an oath.
NOTARY RUBLIC:
S
-{Ltltiny++?�r7'vF��atr+Ske�#zl`�
4�K##################:44::: 4�#VMOtacmmisliso
F�1►1kTFIo# rida
e ##F5Eio0
z %2 )40 --/ pians Examiner
Structural Review
Zoning
Clerk
(Revised02/24/2014)
Marie E. Robson
1064 NE 97 St.
Miami Shores, FL 33138
Monique H. Smith
1000 Quayside Terr., #1210
Miami, FL 33138
November 1st, 2017
Monique Smith has the right and power of attorney to sign for me, Marie E. Robson, regarding
permit applications for my property located at:
1064 N.E. 97th St.
Miami Shores, 33138.
Monique Smith will have the power of attorney related to work involved, including but not
exclusive to, applying for/obtaining any necessary permits needed as follows:
1) New roof permit
2) Exterior paint permit
3) New impact windows and door permit
4) New bathroom & kitchen permit
Marie E. Robson
Sworn & subscribed to me this 1st day of November 2017, by Marie E. Robson, who produced
identification and who did take an oath.
PRIYEN KHAMAR
NOTARY PUBLIC
REGISTRATION y 7736695
COMMONWEALTH OF VIRGINIA
MY COMMISSION tXPIRES
JANUARY 31. 2021
II/ol /'2oi4