EL-19-201Location Address
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue
Parcel Number
10007 NE 4 AVE, Miami Shores, FL 1132060170490
Contacts
Permit NO.: EL -01-19-201
Permit Type: Electrkal - Residential
Work Classification: Temp for Test
Permit Status: Approved
Expiration: 07/29/2019
JOHN & CRISTINA BUTLER Owner JOHN & CRISTINA BUTLER Applicant
500 NE 102 ST, MIAMI SHORES, FL 33138 500 NE 102 ST, MIAMI SHORES, FL 33138
KELLY BENSON ELECTRIC INC Contractor
KELLY PATRICK BENSON
PO BOX 223425, HOLLYWOOD, FL 33022
Business: 9549215400
Description: TEMP FOR TEST ELECTRICAL Valuation: $
350Inspection
Requests:
00
305-762-4949
Total Sq Feet: 2,700.00
Fees Amount
Application Fee - Other 50.00
CCF 0.60
DBPR Fee 2.00
DCA Fee 2.00
Education Surcharge 0.20
Notary Fee 5.00
Permit Fee 50.00
Scanning Fee 3.00
Technology Fee 2.50
Total: 115.30
Payments Date Paid Amt Paid
Total Fees 115.30
Credit Card 01/30/2019 $65.30
Credit Card 01/28/2019 $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.
OW E AFFI T: certify th t all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regul tin const coon d zonin thermore, I authorize the above named contractor to do the work stated.
Authorized Signature: Owner / Applicant / Contractor / Agent Date
January 30, 2019 Page 2 of 2
W\ V Miami Shores Village RECEIVED
Building Department JAN 2 s 201
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
IF BC 201
BUILDING master Permit No. %1G -I7- 7,
PERMIT APPLICATION Sub Permit No.
BUILDING ELECTRIC ROOFING REVISION EXTENSION REN-
7,01L
F-] PLUMBING MECHANICAL PUBLIC WORKS CHANGE OF [—]CANCELLATION [:] SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: IUD 0 7 A e cl!Ave
City: Miami Shores County: Miami Dade Zip: L3 1136
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder)/:' 1 "LI ,Z v (S 1 Phone#:
4 —
I
Address: N U G
City:
Tenant/Lessee Name:
f^
Email: 6 l 1(A.+i_e 10
Name:
Address: f v DDS- fsv.7
State: Zip: -53 ( 3 5'
hone#: /01q1q
Phone#: q' / - qyy"
City: r7ZjVAj State: Zip:
e
Qualifier Name: Phone#: )37 `' ,qV qvt Y
State Certification or Registration #: Gy 13 Certificate of Competency #:
DESIGNER:. Architect/Engineer: Phone#:
Address: City: State
29ValueofWorkforthisPermit: $__ `t ri 16t Square/Linear Footage of Work:
Type of Work: Addition Alteration LJ NewF-1 Repair/Replace
Description of Work: !%
Oo
s /" r. -ax, & ' i*0*0 /V c---
Zip:
Demolition
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanninj Fee $
Technology Fee $_
Structural Reviews $
Revised02/24/2014)
Radon Fee $
Training/Education Fee $
DBPR $ Notary $
Double Fee $
Bond $
f
TOTAL FEE NOW DUE $ '
Bonding Company's Name (if applicable)
Bonding Company's Addres
City State
Mortgage Lendftr's Name (if applicable)
tender's Address
State
Zip
Zi
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. 5,,ILI
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 n e approved and reinspection fee will be charged.
h
r
o i
F
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument.was acknowledged before me this The!foregoing inastrument.was acknowledged before'me this
a,
dray of C 20, by
I—
day pf , l t 20 ` by
Ct'5 nGC.0 who is p lly known to 1 I hVil I no n to
me or who has produced as me or who has produced( l 1 as
identification and who did take an oath.
NOTARa'C PU BLI C:
P
Notary Public - State of FlorAfas
Seal: ; Commission M GG 104296
My Comm. Expires May 14, 2021
Honded througl National Notary Assn.
identification ad who did.take an oath.
NOTAR)t,P
4
4 ,
Sign:
n Print.
Seal:
MAHARAI K. GONZALEZ
EXPIRES: November 2, 2020
Bonded Thru Notary Public Underwriters
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
Revised02/24/2014)