EL-18-940�ewO1S y� Miami Shores Village
r�
10050 N.E. 2nd Avenue NE
a
Miami Shores, FL 33138-0000
h—tea` Phone: (305)795-2204
Permit No. EL-4-18-940
Permit Type: Electrical - Residential
erlill,Work Classification: Pool - Private
Permit States: APPROVED
Issue Date: 5/15/2018 1 Expiration: 1111 V2018
Project Address Parcel Number Applicant
639 NE 97 Street 1132060171880
JUAN DIAZ
Miami Shores, FL 33138-2470 Block: Lot:
Owner Information Address Phone Cell
JENNIFER DIAZ 639 NE 97 ST
MIAMI SHORES FL 33138-2470
Contractor(s) Phone Cell Phone
INDUSTRIAL ELECTRICAL SYSTEM C 305/228-1384
/pe of Work: ELECTRICAL POOUSPA
dditional Info:
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
Valuation: $ 650.00
Total Sq Feet: 0
Available Inspections:
Inspection Type:
Final
Light Niche
Bonding
Review Electrical
Alarms
Pay Date Pay Type Amt Paid Amt Due
Invoice # EL-4-18-67120
05/15/2018 Credit Card $ 262.10 $ 50.00
04/10/2018 Credit Card $ 50.00 $ 0.00
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 zanich Futhermore, I authorize the above -named contractor to do the work stated.
May 15, 2018
Authorized Signa Wre: Owner / Applicant / Contractor / Agent
Building Department Copy
May 15, 2018
1
Miami Shores Village c IVErD
Building Department A 10 2018
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY:
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 201 -9
BUILDING Master Permit No. LJ ✓ 39
PERMIT APP ON Sub Permit No. , -- (Fj - �o
BUILDING 0 ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION RENEWAL
PLUMBING ❑ MECHANICAL PUBLIC WORKS CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 639 NE 97 ST
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): JUAN CARLOS DIAZ Phone#: 305-934-7406
Address: 639 NE 97 ST
City: MIAMI SHORES State: FL Zip: 33138
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:.1y A��'�C�� Phone#: 3/186-57 21
Address: l LISVNLk)
City: �I 11�j State: Zip:33
Qualifier Name: �SiL�Q coe-Jk:,�n Phone#:
State Certification or Registration #: ocl30 0 2 11 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
b
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration FEW New ❑ Repair/Replace ❑ Demolition
Description of work: ELECTRICAL POOL/SPA
Specify color of color tt hru tile:
j
Submittal Fee $ " ) Permit Fee $����� CCF $ CO/CC $
Scanning Fee $ Radon Fee $ 3 _ CA DBPR $ y 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
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 b at the j ite
for the first inspection which occurs seven (7) days after the building permit is issued. In the ab a of such posted Tice, the
inspection will not be approved and a reinspection fee will be charged. =
Signature
—IAOWNER or AGENT <
The foregoing instrument was acknowledged before me this
day of t 1V Y , 20 , by
who is personally known to
me or who has produced CkCy"I�c as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print
Seal
S' ature
CONTRACTOR
The foregoing instrument was acknowledged beforemethis
daayy of, / AN ( 20 �O by
1� TOY C V to, , who is personally known to
me or who has produced ctVL as
identification and who did tak/oath. ''NOTARY PUBLIC:Sign:
Print: Vl2
Seal:
APPROVED BY Zy PTZle Plans Examiner
Structural Review
Zoning
Clerk
(Revised02/24/2014)