EL-17-2257` 5ytiOR
FCORiDA
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit No. EL-9-17-2257
Permit Type: Electrical - Residential
erillmit Worts Classification: Pool - Private
Permit Status: APPROVED
Parcel Number
Issue Date: 12/4/2017 1 Expiration: 06/02/2018
Applicant
10125 BISCAYNE Boulevard 1132050190190
BISCAYNE 10125 LLC
Miami Shores, FL 33138-2647 Block: Lot:
Dwner Information Address
BISCAYNE 10125 LLC 10125 BISCAYNE Boulevard
MIAMI SHORES FL 33138-
10125 BISCAYNE Boulevard
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone
INDUSTRIAL ELECTRICAL SYSTEM C 305/228-1384
ype of Work: NEW POOL ELECTRICAL
dditional Info: NEW POOL ELECTRICAL
lassification: Residential
canning: 1
Fees Due
Amount
CCF
$0.60
DBPR Fee
$4.50
DCA Fee
$3.00
Education Surcharge
$0.20
Permit Fee - Additions/Alterations
$300.00
Scanning Fee
$3.00
Technology Fee
$0.80
Total:
$312.10
Phone Cell
(786)390-3177
Valuation: $ 800.00
Total Sq Feet: 0
Pay Date Pay Type Amt Paid Amt Due
Invoice # EL-9-17-65105
09/19/2017 Credit Card $ 50.00 $ 262.10
12/04/2017 Credit Card $ 262.10 $ 0.00
Light Niche ""`CU
Bonding 4W
Review Electrical
1411Cf(� f0
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, ROOEING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is
construction and zoning. Futhermore, I authorize the above -name
land that all work will be done in compliance with all applicable laws regulating
to do the work stated.
December 04, 2017
Authorized Signature: Owner / App
Building Department Cc
/ Agent
December 04, 2017 1
Miami Shores Village -CTA rED
Building Department SEP 19 2017
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 8Y:� _ 4 , )
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20 I �-
BUILDING Master Permit No. ��t' I1�'SS
PERMIT APPLICATION Sub Permit No. 0�L
❑BUILDING IYELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 16125 131-C Vnl✓ Bivd
City: Miami Shores /� County: Miami Dade zip: 3308
Folio/Parcel#: ( I - 3ZD5' - 0i-1 - 01 Q 0 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Bi-C40y ?, i 1 Z s u-C Phon
Address: I (oj V rfl 1 r n lO/In *16TV D-1
City: M 1 aA'1( oea &k State:
Tenant/Lessee Name: �
Email: cla • %°ne_ e-nL I @ o"I
CONTRACTOR:
tCompany
�1Name: �r�l t
Address: /l SD ' '`w 01t .JT
r-L
ne#:
3)
ri 01 61S�V4 Phone#: �45 9 96 0121
City: I ` i �7 State: "r
Qualifier Name: 7o (_ ( -11 Phone#:
State Certification or Registration #: -CC (�U 2( � �- Certificate of Competency #: _
DESIGNER: Architect/Engineer: Phone#:
Address: Q City: State:
Value of Work for this Permit: $ O OO Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demo r
Description of Work:
Specify color of color thru tile:
c�
Submittal Fee $ ' ._:O DCA ) Cl Permit Fee $
Scanning Fee $ Radon Fee $ ' OLo
Technology Fee $ Training/Education Fee $ .
Structural Reviews $ _
ip: 1"-lS
CCF $ CO/CC $
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ Z 6 Z • id
(Revised02/24/2014)
F�
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
Zi
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. A
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMEWN;
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU WIT
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDI
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
The foregoing instrument was acknowledged before me this
day of 2y4 20 11 by
who is personally known to
me or who has produced C�,)L ue(1eAeAas
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: v�
A-41�C�VVV^
Signature
CONTRACTOR
The foregoing instrument was acknowledged before e�
day of �` I 120 ---LL by 440
Ae,sav- COV \l e/� , who is personally known to
me or who has produced CZ-- S� as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: 04.1- 9
Print: InQ it—r�
Seal: osrnoe Lorena Rivera Seal:
"Commission#FF059658 NA01NC AGUAS
,Expires: Oct. 03,2017 MY COMMISSION # GGo9)0407
WWW.AnONNOTARY. 'ri•
APPROVED BY��&-O-'plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)