EL-19-797 (2)Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date: 04/17/2019
Location Address Parcel Number
401 NE 94TH ST, Miami Shores, FL 33138 1132060140480
Contacts
Permit NO.: L-04-19-797
Permit Type: ElectriCal - Residential
Work Classification: Alteration
Permit status: Approved
Expiration: 10/08/2019
Description: INSTALL 2 RECESS LIGHTING Valuation: $ 1,000.00 Inspection Requests:
Total Sq Feet: 0.00
Fees
JACQUELINE BECERRA Owner
401 NE 94 ST, MIAMI SHORES, FL 331382845
CARIBE S ELECTRIC INC =Contractor
HENRY HERNANDEZ
7812 NW 72 AVE, MEDLEY, FL 33166
Business: 7862556212
$50.00
CCF
$0.60
Description: INSTALL 2 RECESS LIGHTING Valuation: $ 1,000.00 Inspection Requests:
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
04/17/2019 $60.30
Credit Card
04/11/2019 $50.00
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.
AFFI AVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
:o ucti nand zoning. thermore, I authorize the above named contractor to do the work stated.
vvn S KA &o
Sig ature:Owner Y Applican / Contractor / Agent Date
April 17, 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 �LECTRIC ❑ ROOFING
FBC 20
Master Permit No. A C. - Q I - jet -(o,,
Sub Permit No. U-04- 11-,� /7
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
r CONTRACTOR DRAWINGS
JOB ADDRESS: 4121 4 e7r r/� 4 Clpr 22
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): Q Ve_ Phone#:
Address: 4%%I OF 4LJ cif
City: �l%/f SOYeS State: /C- L Zip: __33 13
Tenant/Lessee Name: Phone#:
Email:, /�
CONTRACTOR: Company Name: C�i1 h�� / - Y.C� r z a Phone#: MOTS22s`r li
Address: ':? k) aq B0
City: S te:- Zip:
Qualifier Name: 4sm C' Phone#:
State Certification or Registration #: 1 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ I L700 •chi Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ Newu Repair/Replace El Demolition
Description of Work: �' % 7j
Specify color of color thru tile:
Submittal Fee $ So Qi Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
CCF
DBPR $
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ (nC1
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 inspects hich o rs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will n e app oveo,arjd a reinspection fee will be charged.
Signatu
OWNER or AGENT
ngin ru t was, acknowledged befora this
da o rr [.20_11T , by
Ali( s Ato who is personal) known to
m� a or who has produced
identification and who did take an oath. ( .
Signature
CONTRACTOR
The foregoing instrumen was acknowledged before me this
day of 20 141 by
gh who ' rsonally k'nown t
me or who has produced as
identification and who did take an oath.
NOTARY
YACELIS ROQUE
Sign:
;.:
Print: '•— _s; EXPIRES: August 7, 2021
RprfPublic `Mte of Florida Seal:
.Commission # GG 231002
Comm. Expires Oct 16, 2022
.hrough National Notary Assn.
r,+ . ————— — — — — ——
APPROVED Plans Examiner Zoning
Structural Review
(Revised02/24/2014)
Clerk
T
..