EL-19-1222Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
ftm 1� I A� Ec
Issue Date: 07/24/2019
Location Address Parcel Number
1421 NE 104TH ST, Miami Shores, FL 33138 1122320320060
Contacts
Permit NO.: EL-06-19-1222
Permit Type: Electrical - Residential
Work Classification: Pool
Permit Status: Approved
Expiration: 01/20/2020
Henry Dow Owner
1421 104
INDUSTRIAL ELECTRICAL SYSTEM CORP Contractor
NESTOR I CORVEA
10257 NW 9 ST 205, MIAMI, FL 33172
Description: ELECTRICAL POOL Valuation: $ 650.00 inspection Requests:
TotalSq Feet: 465.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$0.60
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.20
Permit Fee
$250.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$310.30
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$310.30
Check # 9014
07/24/2019 $260.30
Credit Card
05/29/2019 $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.
Authorized Signature: Owner / Applicant / Contractor /
July 24, 2019
Date
Page 2 of 2
MIC111 ii ai iul CJ V IIId6C T-+ CEIVED
Building Department M Y 2 2019
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 By
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20 I9-
BUILDING Master Permit No-Ryp 6s 1c
PERMIT APPLICATION Sub Permit No. -05- I q `1222-
❑BUILDING JVIELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [-]RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP
CONTRACTOR
JOB ADDRESS: Iwo I l r , of ✓ T
DRAWINGS
City: Miami Shores County: Miami Dade Zip: 33 1 3
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): kf—AN ► i3s— Phone#:
Address: 14 21 MIC /yU
City: MI2m1 e,\&Y-0S State: I Zip: 33 1 3
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: J►'�Cll)J'fY��� -E IeC- yll C3 NSI EN Phone#:
Address: 14 M t'.W 04 '�I) -�kj 1 T C 2 06r7 v
City: rAt2"M ( State: i Zip:
Qualifier Name: O can ia cop Je 5�71 Phone#:
State Certification or Registration #: C 0 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ &SO Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration YNew ❑ Repair/Replace ❑ Demolition
Description of Work:
C2 poyl�
Specify color of color thru tile:
Submittal Fee $ �� '� Permit Fee $ !�700,1 me-' CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUES L 6O , 3 O
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 �/" \ ! \ Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
'lq1 'q— day of l—� 20 by
who is personally known to
me or who has produced Ll ('JL'Vi Jam- as
identification and who did take an oath.
J4,S '01
NOTARY PUBLIC: PC3 GG&o°1
rG t1 ,1p'L
Sign:
Print:
Seal:
CONTRACTOR
The foregoing instrument was acknowledged before me this
2j1 day ofcy� 20 r / , by
' ` e— up— CUAVC't , who is personally known to
me or who has produced aaow as
identification and who did take an oath.
NOT
Sign
Print
Seal
APPROVED B �%Utv < Plans Examiner Zoning
Structural Review Clerk