EL-19-2135Miami Shores Village
10050 2 AveMiami Shores
33138s FL 33138
305-795-2204
Issue Date:
Location Address Parcel Number
126 NE 103RD ST, Miami Shores, FL 33138 1132060131760
Contacts
Permitmo.: EL -09-19-2136
Permit Type: irlectrical - Residential
Work Ciossykation: Alteration
Permit Status: Approved
Expiration: 03/16/2020
Description: INSTALL NEW DISCONNECT BOX FOR AC CHANGE Valuation: $ 300.00 Inspection Reuests:
OUT 305-762x4949
Total Sq Feet: 0.00
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
Payments
Date Paid Amt Paid
Total Fees
$110.30
Credit Card
09/16/2019 $50.00
Credit Card
10/22/2019 $60.30
Amount Due:
$0.00
Building Department Copy
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 constructio"nd zonigq. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Signature: / Applicant / Contractor / Agent Date
October 22, 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
RECEIVED
SEP 1610p
-)'
FBC 2011
BUILDING Master Permit No. Mc — oli —1 r
PERMIT APPLICATION Sub Permit No. �.'� —19 —Z( 3 S
❑BUILDING Q ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 126 NE 103 STREET
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11 -3206-013-1760 Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): MAXI RAYMOND & MARIE D BOURDEAU phone#: 305-244-1626
Address: 126 NE 103 ST
City: MIAMI SHORES State: FLORIDA Zip: 33138
Tenant/Lessee Name: N/A Phone#:
Email: N/A
CONTRACTOR: Company Name: Austin Brite Electric Electrical Service LLC Phone#: 954-931-4641
Address: 3643 NW 21 Ct.
City: CORAL SPRINGS State: FLORIDA Zip: 33071
Qualifier Name: Christopher Austin Phone#: 954-931-4641
State Certification or Registration #: ER13014898 Certificate of Competency #:
DESIGNER: Architect/Engineer: N/A Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 300 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: INSTALL NEW DISCONNECT BOX FOR AC CHANGE OUT
Specify color of color thru tile:
Submittal Fee S Permit Fee $ CCF $ CO/CC $
...� .w .i... - ,. i.in,., :
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
Double Fee $
Bond $
TOTAL FEE NOW DUE $ VV
Bonding Company's Name (if applicable) N/A
Bonding Company's Address
City State _
Mortgage Lender's Name (if applicable) N/A
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 $1500, 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 Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
day of AUGUST 20 19 by
MAXI RAYMOND who is personally known to
me or who has produced
Driver License
identification and who did take an oath.
NOTARY PUBLIC:
Sign: — I d A —,IV :6
Print: ALICIA M BUGBEE
The foregoing instrument was acknowledged before me this
day of AUGUST 20 19 by
Christopher Austin who' personally know to
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign: -2b
Print: ALICIA M BUGBEE
as
Seal: POs .. ALICIA M BUGIEE Seal: o • ALICIA M BUGBEE
•��` NotaryPublic - State of Florid t �a
<s =t/7 Notary Public - State of Florida
Commission p GG 324903 N w
<; GG 324903
d,,: 8: Commission
or .: My Comm. Expires Aar t r 202 3Assr. '48F My Comm. Expires Apr t 1, 2023
Bonded through Natiora, rotar: Assr. y r,
*********** ************************�6ar�de6#gr�P4�91t►Aidi!R*�ii�:�1e0�# ***************
Ajj��j
APPROVED BY ! 7 Plans Examiner Zoning
Structural Review
(Revised02/24/2014)
Clerk
150 AMP
OUTDOOR PANEL
45 AMP FOR AHU
35 AMP FOR CU
20 AMP FOR PUMI
NAME: RAYMOND RESIDENCE
ADDRESS: 126 NE 103 STREET
CITY: MIAMI SHORES
ZIP: 33138
I" CONDUIT
2 #6 THHN 2 #12 THHN
2 #8 THHN 1 #6 GREEN
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3.5 TON
AHU
7 K
CONTRACTOR: AUSTIN BRITE ELECTRICAL SERVICE LLC
ADDRESS: 3643 NW 21 COURT
CITY: CORAL SPRINGS, FL 33071
LICENSE #: ER13014898
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