EL-18-3369Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Issue Date:11/08/2018
Parcel Number
[ 119 NW 110 ST, Miami Shores, FL 33168-4320 1121360030550
Contacts
Permit NO.: EL-11-18-3369
Permit Type: Electrical - Residential
Work Classification: Pool
Permit Status: Approved=
Expiration: 05/06/2019
PRISCILLA BRANCO HAISLEY Owner PRISCILLA BRANCO HAISLEY Applicant
119 NW 110 ST, MIAMI SHORES, FL 33168 119 NW 110 ST, MIAMI SHORES, FL 33168
Other:9546485602 Other:9546485602
STATE ELECTRICAL CONTRACTOR LLC Contractor
ARMANDO OJITO
1100 SW 97 AVE, MIAMI, FL 33174
Business: 7862567068
Description: POOL WIRING Valuation: Inspection Requests:
$ 2,000.00 305-762-4949
Total Sq Feet: 1,087.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$1.20
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.40
Permit Fee
$50.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$111.10
Payments Date Paid
Amt Paid
Total Fees
$111.10
Check # 15128 11/08/2018
$61.10
Check # 15131 11/06/2018
$50.00
Amount Due:
$0.00
Building Department Copy
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.
OW S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
gulatin nstruction and 7"w"
Futher re, I authorize the above named contractor to do the work stated.
LLtG� �i�1
Aut ized Sig ture: Owner / Applicant Contractor / Agent Date
November 413, 2018 Page 2 of 2
Miami Shores Village RECEIVED
Building Department Nov 08 2018
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 ,. e
Tel: (305) 795-2204 Fax. (305) 756-8972 ��
INSPECTION.LINE PHONE NUMBER: (305) 762-4949
T . F B,,/C�20-14
BUILDING f Master Permit No. r Y I ---b q
PERMIT APPLI ION Sub Permit No.
❑BUILDING ZIELECTRIC ROOFING REVISION ❑ EXTENSION RENEWAL
PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION [:]SHOP
�'qq III ^ CC5,, CONTRACTOR DRAWINGS
JOB ADDRESS: ac1 �• VW • -
City: Miami Shores County: Miami Dade Zip: a2> 1u p
Folio/Parcel#: (t" oll3(Q- 003-05 Ism Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: I
gal
Zone: BFE: 'I FFE:
OWNER: Name (Fee Simple Titleholder):
�� t�al� �C onon gal Phone#:(954) (eq f -SCADP
Address: lbq ���. It 4- -
City: K«M) SkOrkS State: qfl
Tenant/Lessee Name:
Email
Al,
ne#:
p: 331(0-S
CONTRACTOR: Company Name: � � A G � �� ' 6 i[// �(• L LCPhone#: rb
Address:
City:
Qualifier Name:
State Certification or Registration #:,g-4-(�!- 3001,5L 3 Certificate of Competency #:
DESIGNER: Architect/Engineer: vO L�-+S, �• Phone#: �3S�Q�"� A
^^''rr
Address.. Ila S •>\!>7 • �t 1 City: N1tc*q11 State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Permit Fee $
Radon Fee $
Training/Education Fee $
DBPR $
Notary
Double Fee $
Bond $ _
TOTAL FEE NOW DUE $
(Revised02/24/2014)
i ._ •r i ,J � � fi
Bonding Company's Name (if applicable)
4
Bonding Company's Addrefis
City State
f
Mortgage Lender's Naa (if applicable) _
Mortgage Lender's Adckess
City Af / .4 i 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. 4
"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 OVCOMMENCEMENT.',' `
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value &ceeding.$2560, 'the bpplicant 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 subjeci 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. t
Signature Signature
OWNER or AGEN ��ONTRACTOR
The foregoing inst ment was acknowledged before me this The foregoing instrument was acknowledged before me this
2D day of 20 % by .� day of g �� 20 /� by
1 c .ltl(,t �IS who is personally known to A IT� ��d who is personally known to
me or who has produced as me or who has produced as
., i c - may:.., 1 s ; .1' • ,. ,.., ° ' ' , .: . ;... ..: ° r , _ i
identification and who did t an oath. identification and who did take an oath.
NOTARY PUBLJt /J NOTARY PUBLIC:
Sign:
Sign:
Print: ��
Print:
Seal:Notary
r-sl
DORIS ANAYS tAARTINEZ
Public State of Florida
Commission p GG 250751
Seal: • •
_ .
t NA
NotaryPublic-StateofFlorida
Commission = GG 1128i7
My Comm. Expires Feb 14, 2021
My Comm. Expires Dec 15, 2019
,..,.
Bcrd@dthmuthAatioralActaryAsu.
APPROVED BY } /1/0!/ /,01ans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)