EL-19-495Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date:
Location Address Parcel Number
1037 NE 91 TER, Miami Shores, FL 1132050010050
Contacts
Permit NO.: EL-03-19-496
Permit Type: Electrical - Residential
Work Ciassffication: Temp for Test
Permit status: Aoved
Expiration: 09/16/2019
ALISON HARKE Owner ALISON HARKE Applicant
1037 NE 91 TERR, MIAMI SHORES, FL 331383401 1037 NE 91 TERR, MIAMI SHORES, FL 331383401
SAME & Q ELECTRIC INC Contractor
MANUEL E QUESADA
5310 SW 7 ST, CORAL GABLES, FL 33134
Business: 3052190427
Description: TEMP FOR TEST 30 DAY Valuation: $ 100.00 Inspection Requests:
305-762-4949
Total Sq Feet: 1,300.00
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
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$110.30
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$110.30
Credit Card
03/18/2019 $60.30
Credit Card
03/06/2019 $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 and zoning. Futhermore, I aut0orke t)pe abAve named contractor to do the work stated.
Authorized Signature: Owner
/ Applicant / Contractor /
Agent
Date
March 18, 2019 Page 2 of 2
Miami Shores Village
RECEIVED Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 MAR 06 M
\Y/ Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20 1—1 O
BUILDING Master Permit No. PC — (ov
PERMIT APPLICATION Sub Permit No.;E�%�3'�cj
❑ BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑ PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
A �] S� fyrare
��� N
JOB ADDRESS: _ ) `
City: Miami Shores County:
Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction
Flood Zone: BFE: FFE:
nTTyp�e:: �
OWNER: Name (Fee Simple Titleholder):�ks-mt,1 V��`—C,
g
Phone#: ��IVJ S . Si U
Address`: Igr Q'gA GL
�► '�- _�r� (
City: M �� �`'W+ l�J State:
Zip:
Tenant/Lessee Name:
Phone#:
Email:
CONTRACTOR: Company Name: &.VO'e, 4— (�- � 1 IQ�JA�
i
C '�C Phone#:
Address: 6D S`j )13er CA— !10l
s.
City: State:
Zip:
,,,PPC5-Q� JI
A it
O//W'4'9
Qualifier Name: N
Phone#:
State Certification or Registration #: tC 4' I3 O O 4 1 It
Certificate of Competency #:
DESIGNER: Architect/Engineer:
Phone#:
Address:
City: State: Zip:
Value of Work for this Permit: $ Square/Linear
Footage of Work:
Type of Work: ❑ Addition ❑ Iteration ❑ New
❑ Repair/Replace ❑ Demolition
Description of Work: 5�
Specify color of color thru tile:
Submittal Fee $ S`� Permit Fee $
l
CCF $ CO/CC $
Scanning Fee $ Radon Fee $
DBPR $ 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 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 :7 — - / V — Signature
OWNER or AGENT
The foregoing instrument wasacknowledgedbefore me this
—1�dayof t"'�L-1 20 by
CT`�SJrI�►/�L who is personally own to
me or who has produced as
identification and o,d� x ke an oathURORADILLON
'; Notary Public - State of Florida
NOTARY PUBLIC: • ; Commission It GG 88902
My Comm. Expires Jul 25, 2021
Banded through National Notary Assn.
Sign: 1
Print: ail/D(a �ItI u \
Seal:
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of MD✓ L 11 , 20 " by
AA v C1 b-J CZ act U who i�personally� to
me or who has produced as
identification and who ii4J,, ,,atn oat=AURORADILLONILLONNtate of Florida+4 ;,` NOTARY PUBLIC: �. IGG88902Mes Ju125, 2021Boional Notary Assn.
Sign:
Print: ✓�% UaIIL,I �,�
Seal:
********************* ************************************************************************************
APPROVED BY 3 g (� Plans Examiner Zoning
Structural Review Clerk
(Revise d02/24/2014)
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: � — � " l �' �� Electrical Permit N:
At Address: %n3 NE � C Miami Shores, FL 3,3 1 '5J
For Owners: f i� G . r' and is being given only for
construction purpose or for testing the following equipment in said
structure:cal 2U P/Q n,f
The owner does herby agree to assume fhe 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
r:ancellation 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.
G , 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 pied
until the building contractor has obtained approval of final inspections aigne
ep�Xpitq:Jtr6�30ortRil
cc ncy of Comp tion. Note: Failure to comply with the provisio it i your
bei n ble to ain future Temporary for Test permits. My Comm. Expires Jul25,2021
Bonded through National Notary Assn,
igna , re of w Y Notary
I, Ni Rtiv�L - &LCFSG-A , being duly sworn, depose and say th ; arn� ,,e . ec I K4ki1i rJAssn.
r
the Wove-deibed property and that the electrical installations as now a stf nc*ter e�tsleand
if toice is connected. o •; Commission#GG8890
"' My Comm. Expires Jul 25, 2
Bonded through National Notary
Signat a of Electrical Contractor Sign o r
1, LC4\A �. being first duly sworn, depose and say that I am the Building Contractor
of the above described property and that I will not permit occupancy of this buildi '1
been called for by th contractors and sub -contractors concerned and final appr hee,awpgB,�by,p
obtained and that I h the authority insofar as the owner of said property is cc gg�uctcy
until such fi are obtained and/or a Certificate of Occupancy or Cc `1F z
gnature o Idinc� Contractor Signature of Notary
Signature of I ctor Signature of Notary