EL-18-2480Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Parcel Number
465 NE 96 ST, Miami Shores, FL 1132060170120
Contacts
JOSEFINA GEREZ Owner JOSEFINA GEREZ Applicant
465 NE 96 ST, MIAMI SHORES, FL 33138 465 NE 96 ST, MIAMI SHORES, FL 33138
INDUSTRIAL ELECTRICAL SYSTEM CORP Contractor
NESTOR I CORVEA
10257 NW 9 ST 205, MIAMI, FL 33172
Description: ELECTRICITY FOR NEW POOL Valuation: $ 650.00 Inspection Requests:
305-7652.4949
Total Sq Feet: 0.00
Fees
Amount
CCF
$0.60
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.20
Permit Fee - Additions/Alterations
$100.00
Scanning Fee
$3.00
Technology Fee
$0.80
Total:
$108.60
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$108.60
Credit Card
09/18/2018 $50.00
Credit Card
11/01/2018 $58.60
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. Futherpore, I authorize the above named cor,,tractor to do the work stated.
Authorized Signature: Owner
/ Applicant / Contractor / Agent
Date
November 01, 2018 Page 2 of 2
Miami Shores Village
Building Department SEP 8 z 18
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 20 (7 6
BUILDING Master Permit No. bP? IS - 2-`-78
PERMIT APPLICATION Sub Permit No. �1 1 °c0, —2!tg j
❑BUILDING Sb ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
�j
JOB ADDRESS: I(�
City: Miami Shores County: Miami Dade zip: 3
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): �� , JIOI &V Q � Phone#:
Address: � � le
6 PQ- l S "t' +�
City: 1�' R-1i SV?(� I� S State:
( c—
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: -'iryciV 'e2k-Cia' &aY' 24 1 Phone#: 3/cam
Address: I gOSD t-W '2j4 `J� -5L.A- E5 Z® (O
o , -1
City: �(�1c State: Zip: 33( !J
Qualifier Name: Ozslo12 cb-\XAI- Phone#:
State Certification or Registration #: EC, -J®®)JSZ Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: �(� City: State: Zip:
Value of Work for this Permit: $ 1) Gso Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration 2Q New ❑ Repair/Replace ❑ Demolition
Description of Work: e C n 1 l`-1 J i V Q" Poo(
Specify color of color thru tile:
Submittal Fee $ ' Permit Fee $ WgPle®
Scanning Fee $
Technology Fee
Structural Reviews $
Radon Fee $
Training/Education Fee $
CCF $ CO/CC $
DBPR $
Notary
Double Fee $
Bond $
TOTAL FEE NOW DUE $ e19 , 00
(Rev1sed02/24/2014)
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 G Signature Up J
OWNE or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
dayof 20 15 by
�r�#ZIr1� CIIEZ , who is personally known to
me or who has produced b Cs:n S as
identification and who did take an oath. \
NOTARY PUBLIC: 6Jp.O�Op01
Sien
The foregoing instrument was acknowledged before me this
``99 1-1 day of � P , 20 1 ? by
Ivqnv- CCXV Q --, who is personally known to
me or who has produced ^ as
NOTARY PUBLIC:
Sign:
v
Print: -iARK Print:
Seal: =�: �:= Seal:
h.
6JP o90�01
APPROVED BY !�'C% d Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)