EL-18-2396Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date:
Location Address Parcel Number
1421 NE 104 ST, Miami Shores, FL 33138-2663 1122320320060
Contacts
Permit NO.: EL -9-18-2396
Permit Type: Electrical - Residential
Work Ctassiffcation: Alteration
Permit staters: Approved
Expiration: 03/11/2019
HENRY DOW Owner HENRY DOW Applicant
1421 NE 104 ST, MIAMI SHORES, FL 33138 1421 NE 104 ST, MIAMI SHORES, FL 33138
Other: 3056612533 Other: 3056612533
INDUSTRIAL ELECTRICAL SYSTEM CORP Contractor
NESTOR I CORVEA
10257 NW 9 ST 205, MIAMI, FL 33172
Description: REPLACE HIGH HATS AS PER PLANS, NEW WIRING Valuation: $ 8,500.00
Inspection Requests:
305-762-4949ANDOUTLETSINNEWPARTITIONSASPERPLANS.
Total Sq Feet: 0.00
Fees Amount
CCF 5.40
DBPR Fee 4.46
DCA Fee 2.98
Education Surcharge 1.80
Permit Fee - Additions/Alterations 297.50
Scanning Fee 3.00
Technology Fee 7.20
Total: 322.34
Payments Date Paid Amt Paid
Total Fees 322.34
Credit Card 10/29/2018 272.34
Credit Card 09/10/2018 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
permipgre required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWN R AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regul ting onstruction and zoning. Futhermore, I authorize the above named contractor to do the work stated.
re: Owner / Applicant / Contractor / Agent Date
October 29, 2018 Page 2 of 2
0
Miami Shores
VillagegDepartmentDBY: Buildin
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 --
INSPECTION LINE PHONE NUMBER: (305) 762-4949 C
FBC 20 1
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.
BUILDING ELECTRIC ROOFING REVISION EXTENSION RENEWAL
PLUMBING MECHANICAL PUBLIC WORKS [:]CHANGE OF CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: - l w t," U
City: Miami Shores County:—t—'", Miami Dade Zip: 3; 3
ti
Folio/Parcel#: I I ` 113 -ZJ OD 2 d 00 60 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): I Q,l—f Dui Phone#:_ ` 5 `1 2.
1b
10
Address: ` W C 1 s.
City: M ( r a-
Tenant/Lessee Name:
Email: 'A 'u
State: eL' Zip: 33 1 3 3
Phone#:
CONTRACTOR: Company Name: $ - r.,\ C r Lc 1 > `f S +5 rPPhone#: 3c ->S —3
Address: 0:5p V*' S. Sv1 `)-06
City: /^ti-,—,, State: l L Zip: 331-33
Qualifier Name: %U Sfc,- to, Phone#: 30.5` M—e " `4 4 ?
State Certification or Registration #: '5 C Certificate of Competency #:
DESIGNER: Architect/Engineer:
Add
Phone#:
State: Zip:
Value of Work for this Permit: $ Square/linear--F--,00//t''age of Work:
Type of Work: F-1Addition [:1 Alteration ID New DI Repair/Replace Demolition
Description of Work: Yi 2 y" S Pyr' P\o"5 , WLw W`^ wq \ L) -A
C -s nor
Specify color of color thru tile:
p
Submittal Fee $ • J Permit Fee $ X G r 5 o CCF $
Scanning Fee $
Technology Fee
Structural Reviews $
Revised02/24/2014)
Radon Fee $
Training/Education Fee $
DBPR $
CO/CC $
Notary $
Double Fee $
Bond $
2
TOTAL FEE NOW DUE $
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature 9 L,---,7 6 Signature a"ej'o a 2-• ""
OWNER or AGENT
The foregoing instrument was acknowledged before me this
0 day of Sff 20 10 by
i' cA!'l D j who • personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
CONTRACTOR
The foregoing instrument was acknowledged before me this
7TH day of SEPTEMBER 20 18 by
NESTOR I CORVEA who is personally known to
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign: IC("Y' rty v1 Sign:
Print: Mo M ny Print: '! C/ 5
Seal: Seal:
Marta Marin
j*__ COMMISSION # FF182845
rr**** •' * t x>t t k r*
e
Qe1*$
e*:s*******s*:*******ss*:***:**s:*r**
Ig °
AARoNNOTARY.COM
APPROVED BY /0 5,r --s`' / Plans Examiner
Structural Review
Revised02/24/2014)
7
as
FRANCISCO P. N10RALE6
Notary Public — State c' Florida
Commissior. GG 158509
My Comm. Expires Nov 17 2021
Bonded :hrouoh Na:icna Vci,,; Assr..
Zoning
Clerk
RICK SCOTT, GOVERNOR JONATHAN ZACHEM, SECRETARY
o bIa
r
Cp ..
VWMS
STATE OF FLORIDA
DEPARTMENT OF BUSINESS-,A N -P..; . OFESSIONAL REGULATION
ELECTRICA t,C.^ CN NG BOARD
THE ELECTRIC LJO&IU-R,CTO t Ei E1N'IS C YLEI19 UNDER THE
PROVI IO.N . C °'.'A1TER8FL= 'RI 3STATUTES
El
fit U_ RI XE-L C-T '4 -S S° E S RP
yTE0%
ANS • r 331$3 ;44
0 T82LfCNSEIUh/IBEW-W 0_j
q EXPIRATION TE_t U.GbIl -T-43 -1, 2020
Always verify licenses online at MyFloridaLicense.com R
Ell a
Do not alter this document in any form.
This is your license. It is unlawful for anyone other -than the licensee to use this document.