EL-18-1185Peet No. EL-5-18-1186
sHO1 s o� Miami Shores Village Permit Type: Electrical - Residential
10050 N.E. 2nd Avenue NW Work Classification:: LOW Voltage
Miami Shores, FL 33138-0000 Pwr
Z.;�r` Phone: (305)795-2204 Permit Status: APPROVED
�ioRivA Expiration:11/1212018
Issue gate: 3/16120'f $
Project Address Parcel Number Applicant
43 NW 110 Street 1121360030610
Miami Shores, FL 33168-4318 Block: Lot: INTER MALL INC
Owner Information Address Phone Cell
INTER MALL INC 8260 SW 2 Street (786)231-7789
MIAMI FL 33144-
8260 SW 2 Street
MIAMI FL 33144-
Contractor(s) Phone Cell Phone
CPS ELECTRIC, INC. 305-607-8221
of Work: LOW VOLTAGE (4 TVs and 3 PHONES)
itional Info: LOW VOLTAGE (4 TVs and 3 PHONES)
;sification: Residential
nning: 1
Fees Due
Amount
CCF
$0.60
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.20
Permit Fee - Additions/Alterations
$100.00
Scanning Fee
$3.00
Technology Fee
$0.80
Total:
$108.60
Valuation: $ 300.00
Total Sq Feet: 0
Pay Date Pay Type Amt Paid Amt Due
Invoice # EL-5-18-67409
05/04/2018 Credit Card
05/16/2018 Credit Card
$ 50.00 $ 68.60
$ 58.60 $ 0.00
Available Inspections:
Inspection Type:
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 AFFIDAVI 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 g. Futhermore, I authorriize the above-na7 c ntr for to do the work stated.
�Lf91.1 [_P_1 n 1 P. J L a�417 May 16, 2018
Authorized Signatbje: Owner / Applicant / Contractor I/ Agent Date
Building Department Copy
May 16, 2018 1
00 w
BUILDING
PERMIT APPLICATION
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
F-IBUILDING Q ELECTRIC ❑ ROOFING
Pilo
-
Y 0 20;
BY:
FBC 2014 5�
Master Permit No. RC 3-17-723
Sub Permit No. a l8 — it 8�
❑ REVISION ❑ EXTENSION RENEWAL
F-IPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 43 NW 110 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): Intel" Mall Phone#:
Address:8260 SW 2 ST
City: Miami State: FL Zip: 33144
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: CPS Electric Inc. Phone#: 305-962-9742
Address: 1600 NW 28 ST
City: Miami State: FL Zip: 33155
Qualifier Name: Angel Romero Phone#: 305-962-9742
State Certification or Registration #: EC13005401 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 300.00 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑■ Alteration ❑ New ❑ Repair/Replace
Description of Work: LOW Voltage( 4 TVs and 3 Phones)
Specify color of color thru the:
Submittal Fee $ Permit Fee $ /00%4W
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $
DBPR $
❑ Demolition
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
G
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
Zip
City State 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 inspec ion which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will no approved and a reinspection fee will be charged.
0
The foregoing instrumen was Acknowledged before me this
lWmay of 20by
1 44-0-1tiP_ , who is personally known to
me or who has produced F C - as
identification and who did take an oath.
�-
Signature4�/14�
CONTRACTOR
The foregoing instrument was acknowledged before me this
d 20� by
¢ Y) -e who is personally known to
me or who has produced, as
identification and who did n oath.
NOTARY PUBLIC:
Seal:
# FF981623
APPROVED BY AA l8 Plans Examiner Zoning
Structural Review
(Revised02/24/2014)
Clerk