EL-20-556Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
FD Q
Location Address Parcel Number
142 NW 111TH ST, Miami Shores, FL 33168 1121360030440
Contacts
Permit NO.: EL-03-20-556
Permit Type: Electrical -Residential
Work Ciassfiiation: Alteration
Permit Status: Approved
Expiration: 09/21/2020
MEDEROS INVESTMENTS L.L.C. Owner BUILDING SERVICE TEKS LLC Contractor
13873 SW 41 TER, MIAMI, FL 33175 JESUS CARMENATE
Business: 7863381385 promax4@yahoo.com 5323 MILLENNIA LAKES BLVD 300, ORLANDO, FL 32839
Description: RESIDENCE RENOVATION AND LEGALIZATION TO Valuation: $ 1,500.00 Inspection Requests:
COMPLY WITH NOV-11-19-28121,305-762-4949
Total Sq Feet: 1,070.00
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
$3.00
Technology Fee
$2.50
Work Without Permit Fee
$100.00
Total:
$211.10
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$211.10
Credit Card
03/24/2020 $211.10
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 namedpc r ractor to do the work stated.
Authorized Signature: Owner / Applicant / Contractor / Agent / I Date
March 24, 2020 Page 2 of 2
Miami Shores Village
ENTMRED
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
MAR 19 2020
BY:
FBC 20
BUILDING Master Permit No. WC-- 0Z^7-0 -
PERMIT APPLICATION Sub Permit No. E L- OS" 2-0 '�S 5�0
❑BUILDING CdELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
11{2 Atu/ 111
Folio/Parcel#: tt -ysc - 003- 0qq D Is the Building Historically Designated: Yes NO
Occupancy Type:V1,5 Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): In P.
Address: / 3 S 7 3 S tom! `"l ( -�.er.
L(-L PhoneA 72RG )13 R ' 13 SS
City: State: FL► Zip: 33 tf 7.S
Tenant/Lessee Name: N A Phone#:
Email
CONTRACTOR: Company Name:! till A r':
Address:5 --Lcl� Lm
City: State: 1
Qualifier Name:
State Certification or Registration #: Gaza=--
DESIGNER: Architect/Engineer:
Zip:
one#cfo!!)
Certificate of Competency #:
one#:
Address: City: State: Zip:
Value of Work for this Permit: $ , S C) U Square/Linear Footage of Work: , O o 0
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: fi.ln0 vek/1'o#%_S'
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
CCF $ CO/CC $
DBPR $ Notary $
Double Fee $ ( C�
Structural Reviews $
(Revised02/24/2014)
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 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.
A/V�
Signature Signatur
WNER or AGENT CONTRACTOR
The foregoing instrumenj was acknowledged before me this
�11_ day of J '20 2-0 by
ttV/IUL' i a / ie,9S • , who is personally known to
me or who has produced �L 2) L as
identification and who did take an oath.
NOTARY PUBLIC:
i
Sign:
Print:
�z L Inim
The`f6regoing instrument was acknowledged before me this
day of �V d% 20 �, by
�Ptbs Cirv4-y,4 (, who is personally known to
me or who has produced ( Vk',vers 1,IC.Ph,�_- as
identification and who did take an oath.
NOTARY PUBLIC:
Print:
Ai Le de Ia Yncera Garcia
Seal:
NOTARY PUBLIC Seal:
'1►"' "�,•.,
g; r
��••
DAVID GARCIA
Notary Public - State of Florida
-+STATE OF FLORIDA
:''
Commission p GG 250693
Comm# GG057433
My Comm. Expires Aug 20, 2022
APPROVED BY
4�K&Y9,E20 Plans Examiner
Zoning
Structural Review Clerk
(Revised02/24/2014)