EL-17-2058`yeortEs Miami Shores Village
10050 N.E. 2nd Avenue NE
I�- Miami Shores, FL 33138-0000
aFs Phone: (305)795-2204
CORio
Pennir No. EL-8-17- 05
Permit Type: Electrical - Residential
erit Work Classification. Low Voltage
Permit Status: APPROVED
Issue Date: 8/2112017 1 Expiration: 02/18/2018
Project Address Parcel Number Applicant
1037 NE 91 Terrace 1132050010050
Miami Shores, FL Block: Lot: ALISON HARKE
Owner Information Address Phone Cell
ALISON HARKE 1037 NE 91 TERR
MIAMI SHORES FL 33138-3401
Contractor(s) Phone Cell Phone
SAME & Q ELECTRIC INC (305)219-0427
Type of Work: 8 EXITING OUTLETS OF LOW VOLTAGE
Additional Info:
Classification: Residential
Scanning: 3
Fees Due
Amount
CCF
$0.60
DBPR Fee
$2.25
DCA Fee
$2.25
Education Surcharge
$0.20
Permit Fee - Additions/Alterations
$150.00
Scanning Fee
$9.00
Technology Fee
$0.80
Total:
$165.10
Valuation: $ 500.00
Total Sq Feet: 0
Pay Date Pay Type Amt Paid Amt Due
Invoice # EL-8-17-64869
08/15/2017 Cash $ 50.00 $ 115.10
08/21/2017 Credit Card $ 115.10 $ 0.00
Available Inspections:
Inspection Type:
Rough
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 zoning. Futhermore, I authorize the above-nard contractor to do the work stated.
August 21, 2017
Authorized Signature: Owner / Applicant
Building Department Copy
August 21, 2017
/ Agent
Miami Shores Village
Building Department
10050 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 P ELECTRIC ❑ ROOFING
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS
JOB ADDRESS: / D 3
RECEIVED-
AUG 15 70V
FBC 2oFt�
Master Permit No. _ l T? 8
Sub Permit No.FLO S8�
❑ REVISION ❑ EXTENSION [:]RENEWAL
CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: // Z 2 JI D �.3 OZ 10 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): A /1 fo h ✓6iP. Phone#:
Address: � o 2 �- /0'T i
City: /--1 1^4'44 ; -S`,_C---ef State: Irz Zip:
Tenant/Lessee Name:
Email
hone#:
CONTRACTOR: Company Name: ��' '� �� L Phone#:
Address: S 31 S 2N �.- s +
City: C,4D C�-A� ��OAC"�� Stater Zip: 33 l -7 4
Qualifier Name: � `S G,� Q. n S 1 Phone#: -:� D(�- 2401 O T�
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address
State: Zip:
Value of Work for this Permit: $ 5�Do' v Square/Linear Footage of Work:
Type of Work: ❑ Addition n, Alteration ❑ New ❑ Repair/Replace
Description of Work:
U 1) L -)4 €- � -tl .
Specify color of color thru tile:
Submittal Fee $ 5Q'Do Permit Fee $ CCF $
Scanning Fee $
Technology Fee $
Radon Fee $
Training/Education Fee $
DBPR $
❑ Demolition
CO/CC $
Notary $
Double Fee $
Structural Reviews $
(Revised02/24/2014)
Bond $
TOTAL FEE NOW DUE $ l
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 a&
OWN&O AGENT
The foregoing instrument was acknowledged before me this
day of 20 / 7 by
Qf who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
as
Signature
CONTRACTOR
The fore oing instrum t was acknowledged before me this
day o 20 by
personally known to
me or who has produced as
identification and who di ce a
NOTARY PUBLIC:
Sign:
Pri t:d ��� Print:
:✓i� �� ry Pubft Stew of FIo11da
Seal: :� 'S°:: SANDI PENA Seal: nayBazain
My CommisWoe GG 131S64
_ MY COMMISSION #FF163783 NOV Exam 081061MI
oFnd;•' EXPIRES September 28. 201 a
(407) 398-0153 Flon
APPROVED BY �(ro,�iClG i l� Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)