EL-18-1270Permit NO. EL-5-18-1270
REs y� Miami Shores Village
Sc, 10050 N.E. 2nd Avenue NE
PeriniPermit
Permit Type: Electrical - Residential
Miami Shores,
Work Classification: Temp for Test
FL 33138-0000
States: APPROVED
Phone: (305)795 2204
�ORIDA
Issue Date:611612018 1 Expiration:11111/2018
Project Address 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
e of Work: TEMPORARY FOR TESTING - 30 DAYS
itional Info:
ssification: Residential
nning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Notary Fee
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
$0.60
$2.00
$2.00
$0.20
$5.00
$100.00
$3.00
$0.80
$113.60
Valuation: $ 100.00
Total Sq Feet: 0
Pay Date Pay Type Amt Paid Amt Due
Invoice # EL-5-18-67520
05/15/2018 Credit Card $ 63.60 $ 50.00
05/14/2018 Credit Card $ 50.00 $ 0.00
Available Inspections:
Inspection Type:
Final
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 the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoninQ_— uthermore. I authorize the above -named contractor to do the work stated.
Authorized Signature: Owner / Applicant
Building Department Copy
/ Contractor / Agent
May 15, 2018
1
Miami Shores Village RECIFM77
Building Department LJAY 1 2018
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Y•
13
Te . ( 051 795-2204 Fax. (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20
f�
BUILDING Master Permit No.V_C1
PERMIT APPLICATION Sub Permit NoT_ I R --1
❑BUILDING • ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: IS(40l IV e l O 4 S I
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): pi 4, Py Phone#:
Address: I S&C, i�� C34 S 1 �
City: S State: Zip:
Tenant/Lessee Name:
Email
CONTRACTOR: Company Name: AD 11IN C2n 16Wk,11 / Phone#: ��f✓ y`r6 r ���
Address: 833q .ouJ 5-6 ,r,l
City: State: Zip:
Qualifier Name: c/yJ'� ������'� Phone#:
State Certification or Registration #: CCL / 7Dn l S 7
g Certificate of Competency #:
DESIGNER: Architect/Engineer:
ne#:
Address: City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ffAlteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: TL,s� �/z 9ru/ �'d
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Technology Fee $,
Structural Reviews $.
Radon Fee $
Training/Education Fee $
DBPR $
Notary
Double Fee $
Bond $
W
TOTAL FEE NOW DUE $
(Revised02/24/2014)
9
V.
Bonding Company's Name (if applicable)
' a
Bonding Company's Address
' City
- - -_- - L 4tl State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
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 (74 u 46z:�,"
OWNER or AGENT
CONTRACTOR
The foregoing instrument was acknowledged before a this The foregoing instrument was acknowledged before me this
-I day of 20 , by �� day of 20 � by
J kjO i n LlMi70 personally known to --t (ARP 12)0 Y I lU)CN o is personally known to
me or who has produced t' l Qn as �Y{e or who has produced -1'1 / �Q�) as
identification and who did take an oath.
NOT
Print: ,' '" "`• MAHARAI K. GONZALEZ
My COMMISSION # GG 044602
Seal: o EXPIRES: November2, 2020
%;FOF Fro,".••' Bonded Thru Notary Public Underwriters
identification and who did take an oath.
NOTARY PUBLIC:
Si
MAHA
MY COMMISSION # GG 044602
Print: os
E
°•'
12620
Bonded Thru Notary public Underwriters
Seal:
************************************************************************************************************
APPROVED BY /SyIY�/ / g Plans Examiner
Structural Review
Zoning
Clerk
(Revised02/24/2014)
Electrical Permit N:
Miami Shores, FL
, and is being given only for
construction purpose or for testing the following equipment in said
structure:
The owner does herby agree to assume the responsibility of maintaining the installation in such manner that
there is no hazard to life or property. Such approval is in no event to be considered a RELEASE of said
structure for the purpose of use and occupancy, and no occupancy shall be granted or permitted until further
inspections have been called for and approved by the inspection divisions concerned, and/or a Certificate of
Occupancy or Completion is obtained.
The undersigned also understands that the temporary electric approval is subject to rescission and
nancellation and electric power can be cut off at the discretion of the building official and will be disconcerted of
ie building concerned is occupied before final inspections are approved and/or obtained a Certificate of
Occupancy or Completion. Note: Failure to comply with the provisions of this affidavit will result in your
being unable to obtain future Temporary for Test permits.
I, .'14 J (Oa.,l?_ c,Z , being first duly sworn, depose and say that I am the owner of the
above described property, and that I agree that the structure covered in this agreement shall not be occupied
until the building contractor has obtained approval of final inspections and/or obtained a Certificate of
Occupancy of Completion. Note: Failure to comply with the provisions of1his affidavit will result in your
being unable to obtain future T A A I K. GONZALEZ
MY COMMISSION # GG 044602 rc
Signature of Owner P EXPIRES: November 2, 2020 Signature o Notary
Fo R• Bonded Thru Notary Public Underwriters
being duly sworn, epose an
the above -described property and ons as
•SM•Y Pu'•,
if tem y serviceis connected.MAHARAI K. GONZALEZ
�, t_ MY COMMISSION # GG 044602
'd: EXPIRES: November2, 2020
SI nat re of Electrical Contractor °°F °' BOndedThruNota
g _ ry Public Underwriters
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
AFFIDAVIT FOR 30 DAY TEMPORARY -ELECTRIC SERVICE
NOTE: ELECTRIC SERVICE WILL BE DISCONNECTED "WITHOUT NOTICE" UPON 30 DAY
TERMINATION UNLESS APPLICATION IS RENEWED.
It is understood that the temporary -electrical approval by the Miami Shores Village, Building Department given
in connection with the building being constructed under:
Building Permit N:
At Address: —L
For Owners:
that I am the Electrical Contractor for
, xktirAy'vill not create a safety hazard
ignature bf Notary
I, C "!� !�� u ( , being first duly sworn, depose and say that I am the Building Contractor
of the abov descri ed property and that I will not permit occupancy of this building until final inspections have
been called for by the contractors and sub -contractors concerned and final approval by the inspection division
obtained and that I have the authority insofar as the owner of saidproperty is concerned to prohibit occupancy
until sut,tnjfinal inspections are optained an ..... ,• R.1 or Completion is issued.
Notary Public — State of Florida
I.,
Commission # GG 171862
aaemm. res Jan 2
es Jan 2es Jan
aoa6ignature of ldng Con ctor Bonded Nryu of Notary
Signature of Inspector
Signature of Notary