EL-19-2424Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date:12/16/2019
Location Address Parcel Number
969 NE 92ND ST, Miami Shores, FL 33138 1132060060031
Contacts
Permit NO.: EL-10-19-2424
Permit Type: Electrical - Residential
Work Classification: Alteration
Permit Status: Approved
Expiration: 06/15/2020
Dwight Bourne Owner
969 NE 92 ST, Miami Shores, FL 331382910
LONGMAN ELECTRIC INC Contractor
MICHAEL LONGMAN
95 NE 166 ST, Miami, FL 33162
Business: 3057581211 longmanelectric@bellsouth.net
Inspection Requests:
Description: NEW BATHROOM ELECTRICAL WORK Valuation: $ 1,000.00 Inspec i n Re
49
TotalSq Feet: 65.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$0.60
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.20
Permit Fee
$50.00
Scanning Fee
$3.00
Technology Fee
$2.50
Work Without Permit 1st Offense
$100.00
Total:
$210.30
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$210.30
Credit Card
12/16/2019 $210.30
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
regul4g, constryrtion7and zoning. Futhermore, I authorize the above named contractor to do the work stated.
Owner / Applicant / Contractor / Agent Date
December 16, 2019 Page 2 of 2
Miami Shores Village RECEIVED
BUILDING
PERMIT APPLICATION
❑BUILDING OLECTRIC
PLUMBING ❑ MECHANICAL
JOB ADDRESS:
Building Department OCT If7 �31
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 201-+
Master Permit No. T c <)4 19 ) 42'R
Sub Permit No. EL' C� q6'
❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
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/ /S�implee Titleholder): Phone#:
Addres�s,:/-/ ( N� ` p ��
City: /V/%�,V/ � 's�/��S State: P 1L_ Zip:
Tenant/Lessee Name:
Email
Phone#:
CONTRACTOR: Company NaJm�e:j,� OWN A41 N �GTP,rG �C' Phone*
Address: C1 �N4 1 {(/((/
City: A M 1 State: P—L— Zip:
Qualifier Name: M " Ze_— LA)Md N Phone#:S ISO �� r
State Certification or Registration #: CC-1 3�%� 3 Certificate of Competency #:
DESIGNER: Architect/Engineer:
Address
City:
State: Zip:
Value of Work for this Permit: $ �r Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace
Description of Work:
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Permit Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $
❑ Demolition
iz. ((::...( A. L_ W O;;? K .
DBPR $
CO/CC $
Notary $
Double Fee $ _
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $ It U . 30
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 low 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
OWNER or AGENT
The foregoing instrument was acknowledged before me this
- day of , 20 by
who is personally known to
me or who has producedas
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
Seal:
Signature
CONTRACTOR
The forgoing instrument was acknowledged beforemethis
//
ld �l day of �� 20 1- \ by
Mom►y►G�V1niW who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Print:
Seal
S
,0+s+'1 °4i Notary Public State of Florida
• Yf%;
Michelle Perez
o� My Commission GG 084089
fExpires04/0=021
APPROVED BY �� 7� ���G� ��� Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)