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EL-18-1194Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Parcel Number Permit No. EL-5-1$-1194 M Permit Type: Electrical - Residential Work Classification: Alteration Permit Status: APPROVED Issue Date: 5117/2018 1 Expiration: 11/13/2018 Annliran4 1050 NE 96 Street 1132060143520 Miami Shores, FL Block: Lot: JOHN CAMP Owner Information Address Phone Cell JOHN CAMP 1050 N. E., 96 ST. (305)530-0050 Contractor(s) Phone Cell Phone KELLY BENSON ELECTRIC INC (954)921-5400 of Work: NEW KITCHEN RENOVATION -NEW LIGHTING onal Info: ification: Residential ling: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $4.20 $3.38 $2.25 $1.40 $225.00 $3.00 $5.60 $244.83 Valuation: $ 6,350.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amit Due Invoice # EL-5-18-67418 05/04/2018 . Credit Card $ 50.00 $ 194.83 05/17/2018 Check #: 21433 $ 194.83 $ 0.00 Available Inspections: F spection Type: view Electrical Ll 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,_PJ,-UMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFI A that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction a u*er re, I authorize the above -named contractor to do the work stated. May 17, 2018 AAhonzed S1 ture:Owner / Applicant / Contractor / Agent Building epartment Copy May 17, 2018 or w Miami Shores Village �\ Mr �� Building Department g p . 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 1TANa \ Tel: (305) 795-2204 Fax: (305) 756-8972 �f INSPECTION LINE PHONE NUMBER: (305) 762-4949ftt4. BUILDING PERMIT 7LICATION ❑BUILDINGELECTRIC ❑ ROOFING FBC 20 I `i Master Permit No. Y-C- I -17 r Sub Permit No.L I P--, I t 1 9 ❑ REVISION ❑ EXTENSION RENEWAL PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: /D So Nfr 91 Folio/Parcel#: 1 / 3 2. o 6 o I � 3 rz y Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Sim le Titleholder) d�A Phone#: 61 Address: ��Sw /j (J� City: /"/4m) 5b State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: 1�� !Y `��Y�/ vC��`'C �� 41� Phone#: / !7 7- V_�" G Address: lea 30 X City: L/�✓ Qualifier Name: State Certification or Regi DESIGNER: Architect/Engineer: _Zip: 513. L Al !Q e#: 4s' _ � V _VV 5' / n #: r"?"(� -0 / ID Certificate of Competency #: one#: Address: City: State: Zip: Value of Work for this Permit: Square/Linear Footage of Work: Type of Work: ❑ Addition Altera%tion ❑ New ❑ Repair/Replace ❑Demolition Description of Work: �C�!�2� ,)�L�U1//I'L�Dn, Specify color of color thru tile: Submittal Fee $ Scanning Fee $ Technology Fee $_ Structural Reviews $ Permit Fee $ ©� CCF $ Radon Fee $ DBPR $ ' Training/Education Fee $ CO/CC $ Notary $ Double Fee $ _ Bond $ (Revised02/24/2014) TOTAL FEE NOW DUE $ 1 Q -I - S-3 i 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 E. 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 wnove occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not I appand areinspection fee will be charged. 1/1 Signature C UT kilo. The fojregoUo trument s Y 1f t me or who has produced now edged before me this 20 1� by who s.personally known to as identification and who did take an oath. NOTARY PUBLIC: Sign: r Print: C Ft n U -��f ►•, Seal: ******** APPROVED BY CATHERINE A. DUFFIN Notary Public - Statr of Florida Commission # GG 194296 Av Comm. noires Md� 14, 2021 Signatu The foregoing instrument was acknowledged before me this ��tt 3r day of �NIQV 20 , by VMJJ 1 G h who is personall known to J me orQho has produced r t 1�C`QMS as ident"'cat' NOTARY BLIC: Sign: Print: Seal: ******************************** >0 *1 t Yle Plans Examiner Structural Review did take oath. �V na YANADYPRIETO MY cOMMISSION # FF 214031 EXPIRES: March 25, 2019 f •0'F1'tCd?� Bonded Thru Notary Public Underwriters ************************* Zoning Clerk (Revised02/24/2014)