EL-18-677 (2)r,�
Miami Shores Village
�sKO1S
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
FCORiDp'
Permit NO. EL-3-18-677
Permit Type: Electrical - Residential
Per It Work Classification: Addition/Alteration
Permit Status: APPROVED
Issue Date: 4/26/2018 1 Expiration: 10/23/2018
Project Address Parcel Number Applicant
126 NE 107 Street 1121360070220
ILEANA ESTHER FAJARDO
Miami Shores, FL 33161-7032 Block: Lot:
Owner Information Address Phone Cell
ILEANA ESTHER FAJARDO 126 NE 107 Street
MIAMI SHORES FL 33161-
126 NE 107 Street
MIAMI SHORES FL 33161-
Contractor(s) Phone Cell Phone
LS CURTIS INC (305)933-0683
Type of Work: ONE DEDICATED 20 AMPS FOR THE WASHE
Additional Info: ONE DEDICATED 20 AMPS FOR THE WASHE
Classification: Residential
Scanning: 1
Fees Due
Amount
CCF
$0.60
DBPR Fee
$2.25
DCA Fee
$2.00
Education Surcharge
$0.20
Notary Fee
$5.00
Permit Fee - Additions/Alterations
$150.00
Scanning Fee
$3.00
Technology Fee
$0.80
Total:
$163.85
Valuation: $ 750.00
Total Sq Feet: 0
Available Inspections:
Inspection Type:
Final
Meter Box
Alteration
Relocation
Fire Alarm
Service Change
Review Electrical
Underground
W. W.
Pay Date Pay Type Amt Paid Amt Due
Invoice # EL-3-18-66804
04/26/2018 Check #: 697 $ 163.85 $ 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 authorize the above-naKmdzyffteactor to do the work stated.
.April 26, 2018
Authorized Signature: Owner / Applicant I-. Contrgbtrdr / Agent
Building Department Copy
April 26, 2018 1
RECEIVED
Miami Shores Village 14AR 14 1018
Building Department ci�4_1
10050 N.E.2nd Avenue Miami Shores Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 cp
FBC 20 �_'
BUILDING Master Permit No. �?_C_
PERMIT APPLICATION Sub Permit Nocf ,j
❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ PLUMBING ❑ MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: X <? & a
City: Miami Shores County: Miami Dade Zi :
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name Fee Simple Titleholder): //v/ r L /IJ� (Phone#:
Address: /) � . /� % n
City: )� /�y7 - �p Sl/V�f State: L Zip:
Tenant/Lessee Name: Al n— Phone#:
Email:
CONTRACTOR: Company Name: G Gl &)fz V L` S I Vt C_ Phone#:gcank�t;q
Address: 00aAl #J ��G`�'I'` &2e 100
City: =Ayen l�� State: E—Q-1 Zip:
Qualifier Name: (,(AAA 5-, 8 k=Ad 6C.4�S. Phone#:
State Certification or Registration #: 66000:22( 75 Certificate of Competency #:
DESIGNER: Architect/Engine,_err: Y.� eiy -. "., �„J'� /� Phone#:,� l m��g
"A' ,.i {'*. I. �A-A' �s _ c79 City: �`f. � Q. State: _ Zipi�o�
Address
Value of Work for this Permit: $
Square/Linear Footage of Work:
Type of Work: ❑ Addition tAlteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: Qn �^ l'.� i� � �(� 74-1 &tAC6 6 AA /'
c�n--
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Permit Fee $
Radon Fee $
Training/Education Fee $
CCF $ CO/CC $
DBPR $
Notary
Double Fee $
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 O&Qpproved and a reinspection fee will be charged.
Sign
OWNER or
The foregoing instrument was acknowledged before me this
day of 1/ 20 by
Cl r o is personally known to
� �
me or who has produced 4!22!! r� as
identification and who did take an oath.
NOTARY
Print:
Seal:
=U< Y: W, q
EXPIRES: November 2, 2020
Bonded Thru Notary Public Underwriters
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of 20 /, by
me or who has produced
identification and who di
NOTARY PUBLIC:
CASSANDRA NEBBIA
h' Notary Public - S!ate of Florida
. • Commission # FF 979238
My Comm. Expires Jul 25, 2020
•�'° Bonded through National Notary Assn.
************************************************************************************************************
APPROVED BY Plans Examiner
Structural Review
Zoning
Clerk
(Revised02/24/2014)