EL-19-520Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date:
Location Address Parcel Number
29 NE 109TH ST, Miami Shores, FL 33161 1121360040600
Contacts
Permit NO.: EL -03-99-520
Permit Type: Eiectricai - Residential
Work Classif 5catiart: Low Voltage
Permit status: Approved
Expiration: 10/30/2019
Inspection Requests:
Description: ELECTRICAL INSTALLATION FOR CABLE TV AND SIX Valuation: $ 800.00 305-762-4949'
CAMERA CABLE
Total Sq Feet: 593.50
Fees
JACQUELINE GONZALEZ Owner
29 NE 109TH ST, Miami Shores, FL 33161
Mobile: 3052818409
ODETTE ELECTRIC CO Contractor
LUIS M AGUILA
300 W 30 ST; HIALEAH, FL 33012
Business: 7868534177
$50.00
CCF
$0.60
Inspection Requests:
Description: ELECTRICAL INSTALLATION FOR CABLE TV AND SIX Valuation: $ 800.00 305-762-4949'
CAMERA CABLE
Total Sq Feet: 593.50
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
03/11/2019 $50.00
Credit Card
05/03/2019 $60.30
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
regul* g con§truction and zoning. Futhermore, I authorize the above named contractor to do the work stated.
re: Owner / Applicant / Contractor / Agent
Date
03, 2019 Page 2 of 2
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 dELECTRIC ❑ ROOFING
CE ]
R1 20 9
BY: �
FBC 20
Master Permit No. RG I S -1-30) L+
Sub Permit No. -4-3 - 1 q - SZO
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: CSS(, 1 N C( \ 13+-YlGa-t
City: Miami Shores County: Miami Dade zip: 3�
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type
OWNER: Name (Fee Simple Titleholder): 1 I V
Address: 129 I\JE k 0 9 5+ ��
City: 1 rf I Q
State: k
Flood Zone
CIA Zej- 1 ;—r -
BFE: FFE:
Tenant/Lessee Name: Phone#:
Email: 11alMd5fiQ,• S0rf7-q LZ qWt-c-k -c�v✓�
305
3361
CONTRACTOR: Company Name: o e-fle C lia r_4ez. r roo-el-\ r ill C Phone#: 9Y(-fS'3 -
Address: 926 I ' / 3? $ 1- I
ty
City: C -,d Lj State: Zip: 3 c3 /
Qualifier Name: L () ( � A q V 11 Phone#:
State Certification or Registration #: SO- I(— � 0093 a LY -Certificate of Competency #
DESIGNER: Architect/Engineer: Phone#:
Address
City: State:
' gUU
Value of Work for this Permit: $ lX ' Lt' Square/Linear Footage of Work:
Zip:
Type of Work: ❑ Addition F-1Alteration❑ New ❑ Repair/Replace El Demolition
Descripti n of Work: G (c 4--c9cA � ,S --( � — C-1
..A-Lo4-0
I , J i Jr r 'mal . A vA A / A Ll ( �r
Specify color of color thru tile:
Submittal Fee $ ii Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Technology Fee $
Structural Reviews 5
(Revised02/24/2014)
Radon Fee $
Training/Education Fee $
DBPR $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ (00.30
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 no ' commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Iso, a rtified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which ccurs se n (7) d ys after the building permit is issued. in the absence of such posted notice, the
inspection will not b�erove nd a rei spectio fee will be charged. %) /f
Signatu
NE14 or AGENT
The f egoing instrum(eennt was acknowledged bdoregme this
day of , • `ar 20 ! l by
X1Oti'l� uPl�,who is personally known to
me or who has pro uced j( ("1 G(- L f e �� "124 /rZas
identification and who did take an oath.
Signat
The foregoing instrument was acknowledged before me this
SAI -4- day of �t1= �� 20 , by
who is personally known to
me or who has produced a'1 at i 40- as
identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: 4, V 4ej,4, e 10 Sign: An V' ate (�0.4,�
Print: �J r Print: V ,e
Seal:iiia+' JARDIEL ABREU ROMERO Seal: --
ds• JARDtEI ABREU ROMERO
�P,•' '3ts
•'z MY COMMISSION # GG064945 ;¢'=
EXPIRES January 23, 2021 MY COMMISSION # GG064945'
• EXPIRES January 23, 2021
APPROVED BY 3 ljj Plans Examiner Zoning
Structural Review Clerk
(Revised 02/24/2014)