EL-18-1619Miami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit NO. E L-6-18-1' 619
Permit Type: Electrical - Residential
Work Classification::Addition/Alteration
Permit Status: APPROVED
Issue Date: 6/27/2018
Expiration: 12/24/2018
Parcel Number
Applicant
11200 NW 5 Avenue
Miami Shores, FL 33138-0000
3021360210890
Block: Lot:
PAUL LEWIS
Owner Information
Address
Phone
Cell
PAUL LEWIS
4320 CHARDONNAY Drive
ROCKLEDGE FL 32955-
Contractor(s)
SKY ELECTRIC, INC.
Phone
305-542-0060
Cell Phone
Valuation:
Total Sq Feet:
$ 100.00
151
Type of Work: NEW RECEPTICAL
Additional Info: NEW RECEPTICAL
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Amount
$0.60
$2.25
$2.00
$0.20
$150.00
$3.00
$0.80
Total: $158.85
Pay Date Pay Type Amt Paid Amt Due
Invoice # EL-6-18-67914
06/12/2018 Check #: 1206 $ 50.00 $ 108.85
06/27/2018 Check #: 1221 $ 108.85 $ 0.00
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, PL = G, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AEFIDAVIT: I c rtify that all' he foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
constr ion and more, I au horize the above -named contractor to do the work stated.
/u
Auth . :* i ' re: Owner / Applicant / Contractor / Agent
June 27, 2018
Date
Building Department Copy
June 27, 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
BUILDING
PERMIT APPLICATION
(BUILDING [Zi ELECTRIC ❑ ROOFING
❑PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS
JOB ADDRESS.: 11200 NW 5th Avenue,
Miami Shores
Folio/Parcel#:11-2136-021-0890
Occupancy Type:
Load: Construction Type:
OWNER: Name (Fee Simple Titleholder); Paul T. Lewis
Address:P•0• Box 254062 PAFB, FL. 32925
RECEIVED
JUN 12 2'3i3
1-\
Cb.
o��
Master Permit No. RC -4 " /a Y7
Sub Permit No. , — tvci
cIr
❑ REVISION ❑ EXTENSION ❑ RENEWAL 6, I `(o 19
❑ CHANGE OF CANCELLATION U SHOP
CONTRACTOR DRAWINGS
County,: Miami Dade Zip:
Is the Building Historically Designated: Yes NO
Flood Zone: BFE: FFE:
Phone#:
City: State: zip: PAFB Florida 32925
Cy!/►��
Tenant/Lessee Name: _l ' 0-I � rs, eue/ pek . Phone#:..__( 305, 75 y86!
Email:
CONTRACTOR: Company Name: 4
Address: 9a 41/4 /f? fy'
City: Al/r%ls'li
Qualifier Name:
State Certification or Registration it::
DESIGNER: Architect/Engineer:
Address:
State:
Phone#:
'
&.)-7GL
Value of Work for this Permit: $ /Q 0
zip: J.?47
Phone#:
Certificate of Competency #: 0
Phone#:
City: _._ State: Zip:
Square/Linear Footaf Work: / S f
Type of Work: ❑ Addition ❑ Alteration ❑ New
Description of Work: ��r''� t—eCL)
Repair/Replace n Demolition
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Permit Fee $ / ✓O s
Radon Fee $ -
Training/Education Fee $
CCF $ CO/CC $
DBPR $ pC • ?5. Notary $
Double Fee $ _-
Bond $
TOTAL FEE NOW DUE $ 108 • e s-
(Revi sedO2. /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.
Signatur
OWNER or AGENT
The foregoing instrument was acknowledged before me this
Zl day ofn
4y ,20/X ,by
AL.,/ / C� Wry who is personally known to
me or who has produced F7 �i✓�l.ar as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
;�4,:a+Syek,, KATHLEEN KELLEY/
• ..'l.
• A Commission # GG 058807
1,41 Expires December 29, 2020
•'f2 �'Q'•• Bonded ThruTroy Fain Insurance 800-385-7019
Signat
CONTRACTOR
The foregoing instrument was acknowledg efore4me this
20 ____ by
who is personally known to
me or who has produceLLIAtintilWit4K.Pas
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Prin
1
Seal:
APPROVED BY /2relk? /e Plans Examiner
day o
Zoning
Structural Review Clerk
(Revised02/24/2014)