EL-18-3476Permit mo.: EL -11-18-3476
Miami Shores Village Permit Type: Electrical - Residential
10050 NE 2 Ave
Miami Shores FL 33138 $KWork Classificadon: Addition/Aiteration
305-795-2204 1Permit Status: Approved
Issue Date: 12/07/2018 1 Expiration: 06/05/2019
Location Address Parcel Number
860 NE 98TH ST, Miami Shores, FL 33138 1132060142550
Contacts
NICOLA & GUNTHER MEYER Owner PERFECT CONNECTION ELECTRICAL Contractor
860 NE 98 ST, MIAMI SHORES, FL 33138 SERVICE LLC
Other: 7865546045 JAROD HAIGLER
109 LOCK RD 8, DEERFIELD BEACH, FL 33342
Business: 7543680692 pcesllc@gmail.com
Inspection
Description: INSTALL 4 LIGHTS AND 2 FANS Valuation: $ 1,100.00
on Re uests: Ins
305-eti
4949
Total Sq Feet: 408.00
Fees Amount
Application Fee - Other 50.00
CCF 1.20
Change of Contractor 110.00
DBPR Fee 2.00
DCA Fee 2.00
Education Surcharge 0.40
Permit Fee 50.00
Scanning Fee 9.00
Technology Fee 2.50
Total: 227.10
Building Department Copy
Payments Date Paid Amt Paid
Total Fees 227.10
Check # 11291 03/28/2019 110.00
Credit Card 12/07/2018 67.10
Check # 11250 11/16/2018 50.00
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.
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 construction and zoning. Futhermore, I authorize the above named contractor to do the work stated.
Au)Xzed Signatu : Owner / Applicant / Contractor / Agent Date
March 28, 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 TLECTRIC ROOFING
PLUMBING MECHANICAL PUBLIC WORKS
FBC 20
Master Permit Norb&" %- \\-%-!
Sub Permit No:E\ •-1\^\$
REVISION EXTENSION RENEWAL
EeCHANGE OF CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: L•jc C
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): (2:k Phone#:
Address: g_00 3z
City: H\C.v', crpQ State:l Zip:'J W3oC)
Tenant/Lessee Name: Phone#:
Email:
s j , Address:
n
Cit 1f622,k,State Zip:4 -
Qualifier Name:- -_<Dk C_1L\U\j2_ti.. Phone
State Certification or Registration #: ISO /s 0') Certificate of Competency #:
DESIGNER: Architect/Engineer: hone#:
Address: City: State:
Value of Work for this Permit: $ too Square/Linear Footage of Work:
Type of Work: Addition El Alteration
1
F-1New
n
ElRepair/Replace
IDescriptionofWork: nA2 ! `l obi s an Z : " 2ns
Specify color of color thru the:
Submittal Fee
Scanning Fee $
Technology Fee $
Structural Reviews $
Revised02/24/2014)
Permit Fee $
Radon Fee $
Training/Education Fee $
CCF $_
DBPR $
Zip:
Demolition
CO/CC $
Notary $
Double Fee $ _
Bond $
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 ofa building permit with on 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.
4Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
Z.l day of . 20 kci by 2— day of 20 \g by
GVyL '(`W who is personally known to who is personally known to
me or who has produced asme orew hoiacs produ d as
identification c we id to <p r t f ZA R R 0 identification a
s VILMA PIZARROStateofFlorida -Notary Public ; c ,% NOTARY PUB Commission tt GG 190324 NOTARY PUBLI_State of Florida -Notary Public
N _ Commission # GG 190324
0 1,,. My Commission Expires =.,+ My Commission ExpiresFebruary26, 2022 "`° February 6, 2022
Si S
Pri Print c,
Seal: Seal:
s****•s**s*s sr•s**s***s**s*«sst**sr**•s****ss*ssss#**sss***ss**sssss**ss•suss***s**t****s+e*as*:***s+esss
APPROVED BY Plans Examiner Zoning
Structural Review
Revised02/24/2014)
Clerk
Miamishores Village
BY: Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CHANGE OF CONTRACTOR / ARCHITECT
Permit NPL -l1- A ' aAA
Owner's Name (Fee Simple Title Holder).Q , c- ti Sjg:.r Phone #:
L "IgA ty r ._ State : \ Zip Code:3\'3
Job Address (Of where work is being done): &L Y `ii!ej ---=A
City: Miami Shores State:—Florida Zip Code:
Contractor's Company Name:
Address: nE 1!'
Phone #:
City: f"l w. I State: --"T- l Zip Code:
Qualifier's Name: kQk 4-k"As.4- Lic. Number: t'Cl 393zM =24
Architect/ Engineer of Record Name:
Address:
City:
Describe Work:
State:
Phone #:
Zip Code:
hereby certify that the work has been abandoned and/or the contractor/architect
is unable or unwilling to complete the contract. I hold the Building Official and the
Mi#i Shores harmless of all legal involvement.
Signature YOqASignature/.(
Owner or Agent Contractor or Architect
The foregoing instrument was aknowledged before me
this2 day ofllne ,201Q,br.k-
Who is pprs_ on _ally known to me or who has produced
as indentification.
The foregoing instrument was aknowledged before me
this — fn LIA , 20 kc*tby 5, n
who is ersonall to me or who has produced
Notary P ic: Notary P
Si Sign•
S I: a' V I LM Ah .< .,,,,,,,, _ _ ,„
Tti VILi%ia Fs:
RRO
rs,;RO ,o,PY B,-Sta -
otaryPubii
race of F nrica.w •ar P Commission 0 GG 190324
CO n issi0n y ublic
GG 190324 ; `= My Commission ExpiresYEUfFUPY February 26, 2022SionExpiresmm •Y.
y 26, 2022
indentification.
Miami Shores Village
Building Department
CONTRACTORS' REGISTRATION
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
A. COPY OF QUALIFIER'S STATE LICENCES
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF LIABILITY INSURANCE*
D. COPY OF WORKERS COMPENSATION INSURANCE*
Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER
B. J COPY OF LOCAL BUSINESS TAX RECEIPT
C. _ COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL
CONTRACTOR'S TAX RECEIPT.
D. COPY OF LIABILITY INSURACE*
E. COPY OF WORKERS COMPENSATION INSURANCE*
Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit)
YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW:
Certificate Holder:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
Certificate must specify the description of operations or contractor license number.
BUSINESS NAME- C rnQ c m Q »c0 1 C_
BUSINESS ADDRESS: ICS'\ t c Q ejCITY STATE-- ZIP ]! A
BUSINESS PHONE: FAX NUMBER ( )`
1
CELL PHONE ( ) QUALIFIER'S NAME: X C 4 C>I41 C—
QUALIFIER'S LIC NUMBER: C -:!>c q
SBR RD COL 1 ITY" OC L USi /Ess?AX RECEIPT
315 S. Andrews Ave., Rm. A-100. Ft. Lauderdale, FL 33301-1895-954-:831-4000
VALID OCTOBER 1, 2018 THROUGH SEPTEMBER 30, 2019
DBA: P'Rt( BCT CONNECTION ELECTRICALBusinessName. SERVICE LLC
Owner Name: JW= KWAKZAA MUGLER
Business Location: 109 BOCK Ria APT 8
DEERFIELD BEACH
Business Phone. 800-208-9212
Receipt #ELECT2RICAI %ALARKS>CONTRAC'
business Type: (ELECTRIcu CONTRACTOR )
Business O,pened:03%0712017
State/County/Cert/Reg:ER13 0153os
Exemption Code.
looms Seats Fmptoyees Machines professionals
For Vending BuMness Only
fcnr9inn TVTfR'
Mm"JILCJ LI MOW)AITW. -
Tax UM NSF FeeArrx
uccttEE
Penalty Prior Years cavec:5on Cost Total Paid
27.0 0 0.00 fl.00 0.00 0.00 27.00
THIS RECEIPT 1VIUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
THIS BECOMES .A TAX RECEIPT This tax is levied for the privilege of ruing business within Broward County and is
non4egulatury in nature_ You must meet all County and/or Municipality planning
WHEN VALIDATED and zoning Tequ'rrements. This Business Tax Receipt must be transferred when
the business is sold, business name has changed or you have moved the
business location. This receipt does -rot indicate that ,the business is legal or that
it is in compliance with State Or local laws and regulations.
t1 ailing Address:
PERFECT CONNECTION ELECTRICAL SERV
109 LOCK RD APT 8
DEERFIELD BEACH, FL 33442
n
2018 -20119
Receipt #02C-17-00003922
Paid oa/27/2018 27.00
C KU CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
3122/2019
THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT
AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES
NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms
and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu
of such endorsement(s).
PRODUCER
ARGENIA, LLC.
P.O. BOX 17370
Little Rock, AR 72222
CONTACT NAME
PHONE (AIC No, EM): FAX (AIC No):
EMAIL ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
INSURED
PERFECT CONNECTION ELECTRICAL SERVICE LLC
109 LOCK RD, APT 8
DEERFIELD BEACH, FL 33442
INSURER A: United States Liability Insurance Company 25895
INSUREB B:
INSURER C:
INSURER D:
INSURER E:
INSURER F:
rnvt=anl^_Gc r;=PTIFIrATF NIIMRFR• REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE
ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF
SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR TYPE OF INSURANCE
ADDL
INSR
SUBR
VWD POLICY NUMBER
POLICY EFF
MM/DD/YYYY)
POLICY EXP
MM/DD/YYYY) LIMITS
A
GENERAL LIABILITY
XLCOMMERCIALGENERALLIABILITY
CLAIMS -MADE FX1 OCCUR
C1914571 210712019 2/07/2020
EACH OCCURENCE $1,000,000
S OJ2ENTED
eta occurrence) $100,000
MED EXP (Any one person) $5,000
PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $2,000,000
PRODUCTS-COMP/OPAGG $2,000,000HGENTLAGGREGATELIMITAPPLIESPER.
POLICY PROEl LOC
AUTOMOBILIE LIABILITY
ANY AUTO
AA T8rED kCy6pRULED
HIREDAUTOS
ANIJOTOSNMED
CO eB INDtSINGLE LIMIT $
BODILY INJURY (Per person) $
BODILY INJURY (Per accident $
Peolacddent)
AGE $
UMBRELLA LIAB
EXCESS LIAR
OCCUR
CLAIMS -MADE
EACH OCCURRENCE $
AGGREGATE $
DED RETENTION $
WORKERS COMPENSASION
AND EMPLOYERS' LIABILITY
AAQN
FYGGPEROPRIIEMTBOER/
PARTNER/EXECUTIVE
W(Menoa3ory In NHg EXCLUDED? F d Mscab fl
DESSCR N' bndF vrPERATIONS below
NIA
L, pEF2T IyyCFNYtA 7pRfIS
E.L. EACH ACCIDENT $
E.L. DISEASE -EA EMPLOYEE $
E.L. DISEASE -POLICY LIMIT $
DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (See attecheclAcord 101 foradditional liability limits)
92478- Electrical VWrk-within buildings L-723 02/09 Blanket Additional Insured Endorsement is part ofthis policy.
FR 111-1(:A 1 F HOI 1)FM 1./11VlitLL/i I IUIV
Miami Shores Village Bldg. Dept. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
10050 NE 2nd Ave EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
Miami Shores, FL 33138 POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2010105) Gopyngnt ly2Rs-YUIU AWKU L:UKYVKA I IUIvfAllingni5 reserveu.
The ACORD name and logo are registered marks of ACORD
t%/
J
A " CERTIFICATE OF LIABILITY INSURANCE
DATE(MMIDD/YYYY)
03/27/2019
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCERNTA
All Risk Insurance Group
T
NAME: Lisa Pacillo
PNONE Ed); (561) 395-5220 a/c NII: (561) 447-2250
ADDRess: lisa@allriskinsurancegroup.com101PlazaRealSouth #218
INSURERS AFFORDING COVERAGE NAIC X
INSURERA: Normandy Insurance CompanyBocaRatonFL33432
INSURED INSURER 8:
INSURERC: Perfect Connection Electrical Service, LLC
INSURER D : 109 LOCK ROAD
INSURER E : 8
INSURER F : Deerfield Beach FL 33342
rnvGRACFs rFRTIFICATF NI IMRFR• REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSRLTR TYPE OF INSURANCE
ADDL SUBR
POLICY NUMBER
FOLIC EFF MPnOLILIp EXP LIMITS
AUTHORIZED REPRESENTATIVE
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE 1-1OCCUR
Ci^GT IV v (i(
EACH OCCURRENCE $
DAMAGE TO
PREMISES
EaENTED
occurren $
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY JECTPRO F-1LOC
OTHER:
GENERAL AGGREGATE $
PRODUCTS - COMP/OP AGG $
AUTOMOBILE LIABILITY
ANYAUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
COMBINED SINGLE LIMIT $
Ea accident ._
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PROPERTY DAMAGE $
Per accident
UMBRELLA LIAR
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE $
AGGREGATE $
DED I I RETENTION $
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITYANYPROPRIETOR/PARTNER/EXECUTIVE YIN
OFFICER/MEMBEREXCLUDED? F-1
Mandatory In NH)
Ifyes, describe under
DESCRIPTION OF OPERATIONS below
N/A
I
NHFL0086022019
I
03/21/2019
I
03/21/2020
I
STATUTE ER
E.L. EACH ACCIDENT $ 1,000,000
E.L. DISEASE - EA EMPLOYEE $ 1,000,000
E.L. DISEASE - POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional RemarksSchedule, may be attached If morespaceIs required)
Lic# ER 13015309
I+COTICl/+ATo unr non rAll I ATI[lN
Miami Shores Village Bldg Dept.
19)
10050 NE 2nd Ave SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Miami Shores, FL 33138 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Ci^GT IV v (i(
1988-2015 AGORD GORPORATIUN. All rlgnts reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
CT- B
Construction Trades ualifying Board
BUSINESS CERTIFICATE OF COMPETENCY
17EO00575
PERFECT CONNECTION ELECTRICAL SERVICE LLC
D.B.A.:
JARODHAIGLERK
I is certified under the provisions of Chapter 1 o cif Miami -Dade C dunty,
CERTIFICATE OF COMPETENCY
BPS 'AAC
K2
JAROD HAIGLER
Master Electrician
PERFECT GOtiNECTION ELECTRICAL SERVICE, LLC
CC# 17 -CME -20424-X EXPIRES 08J31/2020
STATE OF FLORIDA DEPARTMENT
Of BUSINE55 AND PROFESSIONAL
REGULATION
ER13015309 iSSUED. 0512li2018
ELECTRICAL CONTRACTOR
HAIGLER. JAROD KWANZAA
PERFECT CONNF-roM, N ELEGTRICAL SERV
viSSgatre
LICENSED 33 R CHAPW489. FLORiDA STATUTES
EXPIRATION DATE: AUGUST31.2020
QUALIFYING TRADE(S)
0001 ELECTRICAL
i.i. D. Gascm, P.E. .. _)r
secrdary ofthe Board wv .rrd*mh d*.w/xaia^r
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
IPF-'' ' Q' UV
Issue Date: 12/07
Location Address Parcel Number
860 NE 98TH ST, Miami Shores, FL 33138 1132060142550
Contacts
Permit ND.: EL -11-18-3476
Permit Type: Electrical - Residential
Work Classification: Addition/Alteration
Permit Status: Approved
8" Expiration: 06/05/2019
NICOLA & GUNTHER MEYER Owner WISDOM ELECTRIC INC Contractor
860 NE 98 ST, MIAMI SHORES, FL 33138 IVAN MARTINEZ
Other: 7865546045 2330 NW 35 ST, MIAMI, FL 33142
Business: 3059151983
Description: INSTALL 4 LIGHTS AND 2 FANS Valuation: $ 1,100.00
Inspection Requests:
305-7ti2-4949
Total Sq Feet: 408.00j
Fees Amount
Application Fee - Other 50.00
CCF 1.20
DBPR Fee 2.00
DCA Fee 2.00
Education Surcharge 0.40
Permit Fee 50.00
Scanning Fee 9.00
Technology Fee 2.50
Total: 117.10
Payments Date Paid Amt Paid
Total Fees 117.10
Credit Card 12/07/2018 67.10
Check # 11250 11/16/2018 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
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 a t all work will be done in compliance with all applicable laws
regulating construction and zoning. Futhermore, I authorize the above named cXtractpf to do the wqO Rat
Authorized Signature: Owner / Applicant / Contractor Date
December 07, 2018 Page 2 of 2
Miami Shores Village RECEiVL L.
Building Department No -j6 2010
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 20L7:3r
BUILDING Master Permit No'` *N&IT s
PERMIT APPLICATION Sub Permit No.fin 11
BUILDING [50LECTRIC ROOFING REVISION EXTENSION RENEWAL
F-1 PLUMBING MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: Strn' L-- Q
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): XS'_ c- HC '— Phone#:
City: HkavyNt
Tenant/Lessee Name:
Email:
one#:
P:
CONTRACTOR: Company Name: '>> p V—Nrx `\C Phone#:
Address:: Z _I y —J zz'
4
City: 1 okay—"-' State:
Qualifier Name: Phone#:
State Certification or Registration #: 1:—:'-_V3C` C Certificate of Competency #: _
DESIGNER: Architect/Engineer:
p:VZ
Address: City: State: Zip:
Value of Work for this Permit: $ \NCY' Square/Linear Footage of Work:
Type of Work: Addition Alteration 6aNew Repair/Replace
Description of Work:
Specify color of color thru tile:
Demolition
Submittal Fee $ Permit Fee $ 140-0,4-0 CCF $ CO/CC $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
Revised02/24/2014)
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ ' f 0
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 A i Q.A Signature /' /`Y –
OWNER or AGE T CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
c\ day of Qom- 120 1J by day of C 20 \Y by
r' Y who is perso y_ aammto '"' d'l , who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Si Si
Pri Print. o c'tyj
Seal:- ; VILMA PIZARRO Seal: PY'' VILMA PIZARRO1> UBiStatsofFlorida -Notary Public I State of Florida -Notary Public
Commission # GG 190324 ' Commission # GG 190324
VIW', My Commission ExpiresMyCommissionExpiresoF«
Febru
APPROVEDPlans Examiner Zoning
Structural Review
Revised02/24/2014)
Clerk