EL-18-3110Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
issue Date:10/17/2018
Parcel Number
Permit NO.. EL-10- 8-3110
Permit Type: Electrical - Residential
Work Classification: Alteration
Permit Status: Approved
Expiration: 04/08/2019
Project
25 NE 108 ST, Miami Shores, FL 33161 1121360110430 <NONE>
Contacts
Owner Applicant
25 NE 108 ST, MIAMI SHORES, FL 33161 25 NE 108 ST, MIAMI SHORES, FL 33161
CAMAGUEY ELECTRICAL SERVICE Contractor
SAMUEL JORGE GONZALEZ
6160 W 26 CT, MIAMI, FL 33016
Business: 3059841036
Description: INTERIOR LIGHTING, SMOKE DETECTORS, Valuation: $ 1,000.00 Inspection Requests:
CARBON MONOXIDE DETECTORS. 305-762-4949
Total Scl Feet: 452.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$0.60
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.20
Permit Fee
$50.00
Technology Fee
$2.50
Total:
$107.30
Building Department Copy
Payments Date Paid
Amt Paid
Total Fees
$107.30
Credit Card 10/17/2018
$57.30
Credit Card 10/09/2018
$50.00
Amount Due:
$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 pnd)zoning. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Signatur-&:`6wner / Applicant / Contractor / Agent Date
October 17, 2018 Page 2 of 2
Miami Shores Village L-
10050l 9 018
Building Department N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
❑BUILDING ELECTRIC ❑ ROOFING
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS
JOB ADDRESS:
;FB�C( 20r1 �1
Master Permit No. I�C�'� 1
Sub Permit No. C L 18
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores County: Miami Dade Zip: 3� 3
Folio/Parcel#: ' t - D ( 3(O - CA I 043O Is the Building Historically Designated: Yes NO
Occupancy Type: G S- Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Title
Ad
City: 1 t'ay -:t ay)nl-e � State: -PI t-xo- Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: ( a*f49e e--f --�e�'y /rC�S Phone#: ir3o 0
Address: ajJJ
City: (�� �Q-�t State: i- (a < t`dZip: 3 3 0
Qualifier Name: SQ A2r u �/ �� `� �tJ o -, Phone#: C�aS� 9gS+r
State Certification or Registration #: Ffi'/3 Y Certificate of Competency #:
DESIGNER: Architect/Engineer:
ne#:
Address: City:
Value of Work for this Permit: $ ODD ' `7fl Square/Linear Footage of Work:
Zip:
Type of Work: JZ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of work:„ ali Ijl^�1 SMo r t CJI 01�� _ 044bix
Specify color of color thru tile:
Submittal Fee $ SQ i Permit Fee $ /jOrOl ®O CCF $
Scanning Fee $ Radon Fee $ CKD DBPR $ 2 CA
Technology Fee $ Training/Education Fee $
Structural Reviews $
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $O
(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 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 20, by
who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of 20 by
Se( u4 V c- ( V a e iho is personally known to
as me or who has produced
identification and wbo did take an oath.
NOTARY
Print:
Seal: Seal: z
o �0
0
STAtE �FQ
as
✓ b
APPROVED BY �G lans Examiner Zoning
Structural Review _ Clerk
(Revised02/24/2014)
*P CAMAGUEV ELECTRICAL SERVICES CORP.
Q n Electrical Contractor
J(305)984-1036
Lic:#ER13014584
Date: a '— T C4/ a dS'
State of:
County of:
a> ' c� �
Before me this day personally appeared Q``'t `' �-1 J t (29 , who being duly
sworn, deposes and says:
That he wi erson working on the project located at
Contractor signature
Sworn to or affirmed and subscribed before me this day of oso6f , 2018
By 439,-rw A T.
Personally know
Or Produced Identification
Type of
VLADIMIR LOP
MY COMMISSION 2036
EXPIRES st 17, 2021
Bonded Thor Notary Public underwriters
Print, Type or Stamp Name of Notary