EL-18-2202Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit
Permit NO:- EL-8-18-2202
Permit Type: Electrical - Residential
Work Ctassifi atfon: Low Voltage
Permit Status: APPROVED
Issue Date 8/012018
Expiration: 02/26/2019
Parcel Number
Applicant
671 NE 105 Street
Miami Shores, FL 33138-2053
1122310120100
Block: Lot:
CAROL INVEST USA INC
Owner Information
Address
Phone
Cell
CAROL INVEST USA INC
671 NE 105 Street
MIAMI SHORES FL 33138-
(305)747-3098
671 NE 105 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone
CASSIA ELECTRICAL CONTRACTOR: (954)650-5840 (954)274-6277
Valuation:
Total Sq Feet:
$ 1,200.00
100
4
Type of Work: DIG TRENCH FROM HOUSE ACROSS CUL-DE
Additional Info: DIG TRENCH FROM HOUSE ACROSS CUL-DE
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
$1.20
$2.25
$2.00
$0.40
$150.00
$3.00
$1.60
$160.45
Pay Date Pay Type
Invoice # EL-8-18-68595
08/20/2018 Credit Card
08/30/2018 Credit Card
Amt Paid Amt Due
$ 50.00 $ 110.45
$ 110.45 $ 0.00
Available Inspections:
Inspection Type:
Review Electrical
i
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.
August 30, 2018
Authorized Signature: Owner / Applicant / Contractor / Agent
Date
Building Department Copy
August 30, 2018
1
BUILDING
PERMIT APPLICATION
C I BUILDING
ELECTRIC
PLUMBING —1 MECHANICAL
JOB ADDRESS: 671 NE 105 St.
City:
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
ROOFING
PUBLIC WORKS
�
FBC Q20
Master Permit No. j` , v \ ei -\?_ 1
REVISION
Sub Permit No. IL" g—t8"ltra,
EXTENSION I RENEWAL
CHANGE OF n CANCELLATION n SHOP
CONTRACTOR DRAWINGS
Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11-2231-012-0100
Occupancy Type:
Is the Building Historically Designated: Yes NO
Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Carol Invest USA Phone#:
Address: 990 Biscayne Blvd.
city: Miami State: FI. Zip: 33132
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: Cassia Electric Phone#: (954) 650-5840
Address: 8261 NW 48 St.
City: Lauderhill
Qualifier Name: Glenworth Walker
State: FI.
Zip: 33351
Phone#: (954) 650-5840
State Certification or Registration #: EC 13005907 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 1,200 Square/Linear Footage of Work: 100 L/F
Type of Work: I I Addition E I Alteration New U Repair/Replace I I Demolition
Description of Work: Dig trench from house across cul-de-sago the telephone pole to install two 1" PVC pipes
for phone and data lines
Specify color of color thru tile:
Submittal Fee $ 50 Q t ( Permit Fee $ 43-0i 6 a CCF $ 1 2-0 co/us
Scanning Fee $ 3 Radon Fee $ Z • ea4 DBPR�]$ 2 • �5 Notary $ 0
Technology Fee $ 1 - 6° Training/Education Fee $ 0 it! 6 Double Fee $
Structural Reviews $ N Bond $LY
TOTAL FEE NOW DUE $ 1 0 . 4 s
(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: 1 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
OWNER or AGENT
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
3
day of (� gt , 20 1 b , by
/! Rtia-o �tiu 1 t , who is p rsonally kne to �7Ie I.JO✓�� �W(jW , who is personally known to
me or who has produced as me or who has produced I» IA.Nap285.0031$O as
identification and who did take an oath.
NOTARY PUBLIC:
day of UsaUbt , 20
identification and who did take an oath.
NOTARY PUBLIC:
Sign: Vet:CA—_52A ft -
Print: LUCA C—►• )ths,
Seal: ,,,„
' `'""" ` e LUCIA G ISASI I
7', .l*i MY COMMISSION #FF182628 i
' ,' �`. '„
;,� d�. FXPIWS* DBcem¢gr 19,aU
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(407) 398-0153 FloridallotaryySjervice.codm * f.
APPROVED BY 3'Ai C, / - Plans Examiner
$
by 3
Structural Review
Sign:
Print: LUU 1 I3CI5L__,
Seal: se.riti ••s, LUCIA G ISASI
;*I MY COMMISSION #FF182628
;�,•.1 EXPIRES December 10, 2018
**** *1(trAt E98018Z**xrtieritieNe4uAC4 Q.Rt<***
Zoning
Clerk
(Revised02(24/2014)