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EL-15-1262�` gNORfS t�! Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit No. EL-5-18-1262 Permit Type: Electrical - Residential ri Work Classification: Pool - Private Permit Status: APPROVED Issue Date: 511412018 1 Expiration: 11/10/2018 rIVjC -UU1V*b Parcel Number Applicant 1569 NE 104 Street 1122320320160 Miami Shores, FL Block: Lot: ALAIN & CARLY GONZALEZ Owner Information Address Phone Cell ALAIN & CARLY GONZALEZ 1569 NE 104 Street (786)277-9756 MIAMI SHORES FL 33138- 1569 NE 104 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone ADVANCED SECURITY INNOVATION (786)302-1175 /pe of Work: PERFORM ELECTRICAL WORK FOR POOL dditional Info: PERFORM ELECTRICAL WORK FOR POOL lassification: Residential cannina: 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 Valuation: $ 500.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due I Invoice # EL-5-18-67510 05/11/2018 Credit Card 05/14/2018 Credit Card $ 50.00 $ 262.10 $ 262.10 $ 0.00 Avauaoje Inspection Type: Final Light Niche Bonding Review Electrical 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 t ' formation is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. ermore, I a thorize the abov amed contractor to do the work stated. May 14, 2018 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy May 14, 2013 1 Miami Shores Village RECEIVEI Building Department MAY 11 70 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 CI INSPECTION LINE PHONE NUMBER: (305) 762-4949 co k-11 BUILDING PERMIT APPLICATION ❑BUILDING 9�KECTRIC ❑ ROOFING FBC M4 Master Permit No q s, Sub Permit No.t�p I ( z CO Z ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ PLUMBING ❑ MECHANICAL [::]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP �/ CONTRACTOR DRAWINGS JOB ADDRESS: 1 din ~I IV j O l S ) . City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE: OWNER: Name (Fee Simple Titleholder): I`%-t 1 Q,- Py (� ��Z" � Phone#: Address: �—L (w I C)L} R j , City: State: G Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: 14-Q tlWAJ6JJ71 S_(�F Phone#: 301 Address: 633z//)0 5(0 S City: Y) 0,-2-14-C State: lr�_t = Zip: 3 V /o Qualifier Name: c /ism -/7/a-yz"f0 Phone#: l'�� - —//7f State Certification or Registration #: 6-C- /3 00 (0Sq% Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: DO Value of Work for this Permit: $ J (10 " Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Zeair/Replace /❑ Demolition Description of Work: d7i� Specify color of color thru tile: Submittal Fee $ Permit Fee $ ©Qi C, ('j CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ 4 ' Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name,(if applicable) Mortgage Lender's Address Zip 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. Signature /Signature OWNER or AGENT The foregoing instrument was acknowledged before me this day of VOLA 20 �, by eli em7, . k iss peers�o�nalllly kknown to me or who has produced l LXJf t J 1 as identification and who did take an oath. C: Print: Seal: CONTRACTOR The foregoing instrument was acknowledged before a this _1 day of Q ACA0 20 1 by YYDsgwho is personally known to or who has produced 7 ` l i as identification and who did take an oath. NOTARY PUBLIC: /\ rA M, __... MY COMMISSION # GG 04460211 print: Bwded�Public Underwriters Seal: MY COMMISSION # GG Bonded Thru Notary Public Underwriters **s********rs*s*:s*rsssss*s*****s**sss■ss**s*sas*s***********s******s*ssss***s*::*:*:s*:ssssr***�****r**ssr* !B APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)