EL-19-792Location Address
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date: 04/ 11/2019
Parcel Number
1296 NE 99TH ST, Miami Shores, FL 33138 1132050090140
Contacts
Permit NO.: EL4M-"-792
Permit Type: Electrical - Res identlal
Work Classification: Service Change
Permit Status: Approved
Expiration: 10/08/2019
Description: ELECTRICAL PERMIT FOR SERVICE REPAIR Valuation: $ 200.00 365-762-4949 Inspection Requests:
Total Sq Feet: 0.00
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Fees
FILPO PROPERTIES LLC Owner
1296 NE 27 ST 2904, MIAMI, FL 33137
Other: 9147140878
DAW ELECTRIC INC Contractor
DERRICK ANTHONY WILLIAMS
20421 NW 22ND AVE, MIAMI, FL 33056
Business: 7868773500
$50.00
CCF
$0.60
Description: ELECTRICAL PERMIT FOR SERVICE REPAIR Valuation: $ 200.00 365-762-4949 Inspection Requests:
Total Sq Feet: 0.00
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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
04/11/2019 $110.30
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.
AFFIDAVIT:i that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
construction a d o in Futhermore, I authorize the above named contractor to do the work stated.
witw� J 4 -l( -t9
Authorized Signature: Owner ) Applicant / Contractor / Agent
Date
April 11, 2019 Page 2 of 2
g�CEI ��-
Miami Shores Village ; DR 11
Building Department BY:
10050 N,E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20
BUILDING Master Permit No. U-01
PERMIT APPLICATION Sub Permit No.
❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP
,�/ CONTRACTOR DRAWINGS
JOB ADDRESS: 2 9 /f/ S 54,
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load
OWNER: Name (Fee Simple Titlehold
Ad
Tena
Email
CONTRACTOR: Company Name:
Address: '2 C) Z o O !'/%LCA •'Z ;4 C1Zs—
Construction Type: Flood Zone
BFE: FIFE:
�.ihone#:R I 1 4 'O8l�
Phone#: Cs— '77
G
City: gZi�(...tCVV1, • State:
Zip:
Qualifier Name:, a-rAV4c ( W,
Phone#: % k/ 7% 35,cs
State Certification or Registration #: �:� I o Ca343
Certificate of Competency #:
DESIGNER: Architect/Engineer:
Phone#:
Address: _ '`%.:.
City: State: Zip:
Value of W' -0, kdor tfill s'Permit: $ =�V Square/tihearFootage`,of•VI(otk:
ype:of Work: Q ,.A;ddifion ❑ Alteration ❑ Ne
Repair�Replac�. El Demolition
Description.?of Uilork: ` `(V �`
A�tC/1
Specify�co/or of color thru tile:
Submittal Fee $ I Permit Fee $
CCF $ CO/CC $
Scanning Fee $ Radon Fee $
DBPR $ Notary $
Technology Fee $ Training/Education Fee $
Double Fee $
Structural Reviews $
Bond $
TOTAL FEE NOW DUE $ Iy V
(Revised02/24/2014)
T
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. . ` Y
"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 rlpt be approved and a reinspection fee will be charged. ,
/�
O'n
Signature CASignature (�%1��L-� !T az
OWNER or AGENT
The foregoing instrum �twas acknowledged before me this
day c (� I 20 I by
Monica G who is p rsonally known to
me or v(he�has p. 4uced t1µ9 y' I t^ `� I�S'Q as
The foregoing instru
1i� ,�n
day of_
me or
produced
CONTRACTOR
was acknowledged before me this
?r; I , 20 19 by
N' who is p�sonally known to
]
�J 1 W Y 1 C.S. e
.� N as
identifi ationd who id take an`��t�Q1N ��� //��i, identi ication a w o d -d take an oa�``�y1�r Y PRI,
r` •......
NOTAR PUBLI •l ��i� N TA Y PUBLIC. N2b,
••.
24
Sign: �d • — Sign: U 00287288
Print: Cll
_6 : 6' � Print: L-AA11RJN.
Seal: ,/���i/i.,•�!�bric```��� Seal: ,sure
1`\��
/ '�L1C•SZP � /
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)