EL-19-2540Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
N"n' 1TI-fl flit
Issue Date:11/06/2019
Location Address Parcel Number
17 NE 107TH ST, Miami Shores, FL 33161 1121360070340
Contacts
Permit NO.: EL-10-19-2540
Permit Type: Electrical - Residential
Work Clossificotion: Alteration
Permit Stotus: Approved
Expiration: 05/04/2020
HOWARD HENRIQUES Owner M & C ELECTRICAL INC Contractor
17 NE 107 ST, MIAMI, FL 33161 ROBERTO RODRIGUEZ
henriques3h@gmail.com 9250 FONTAINEBLEAU BLVD APT 205, MIAMI, FL 33172
Business: 7866832536 mycelectricalinc@gmail.com
Description: REMOVE, REPLACE AND REPAIR ELECTRICAL AS Valuation: $ 1,800.00 Inspection Requests:
305-62-4949
NEEDED
CTRI
Total Sq Feet: 0.00
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
Total:
$111.10
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$111.10
Credit Card
11/06/2019 $111.10
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
regulatt>i Tm7sEwction and zoning. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Signature: Owner
/ Applicant / Contractor / Agent
Date
November 06, 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
FBC 20 CI
BUILDING Master Permit No. /�Y (,u7^,//
PERMIT APPLICATION Sub Permit No.ID.% (U" (6- '?_r', �0
❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
/ ) / CONTRACTOR DRAWINGS
JOB ADDRESS:
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): rrlJ e&t Phone#:
Address: ( 7 AA L� i O7
City: M tf�ql. g kjnt:C� State: �%- zip: 931 A l
Tenant/Lessee Name: Phone#:
Email
CONTRACTOR: Company Name: AIVV—/
Address: ` 1?
City:
Qualifier Name: L
3 -2 536
Fz__ _Zip: 2 �% Z
State Certification or Registration #: /Z 25 S Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Add
_286- 6R3 --0 5.36
State: Zip:
Value of Work for this Permit: $ ( i513D ' Square/LinearrFF,000ttage of Work:
Type of Work: ❑ Addition ❑ Alteration ElN New _ Repair/Replace
Description of Work:
•
❑ Demolition
Specify co/ofiY,of ib.t liru1��'ile:`' `' � J
WAX
X
m
Submittal Fee $ :..,."Y • - +-�!Permit.Fee$ -. b CCF $ �. CO/CC $ JC/
Scanning Fee $ nn Radon Fee $ U O DBPR $ Notary $
Technology Fee $ Training/Education Fee $�_ Double Fee $ ,�j
Structural Reviews $ Bond $ o
TOTAL FEE NOW DUE $ III. I
(Revised02/24/2014)
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
Zi
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 —44
OWNER or AGENT
CONTRACTOR
The folegoing instrument was acknowledged before me this The foregoing instrument wa a knowledged before me this
day of DC.-i0%j2% 20 1 by Ar-/y day of 4eY Z� 20 /1 by
Cbw 7 H t&LL who is personally known to 1e4'- "ho is p rsonally kn n to
me or who has produced t.ChS� as me or who has produced -� s �� �k l �'� as
identification and who did take an oath.
Sign:_
Print:
Seal: ""sk a-,
�
r
RAPHAELA ST. AUDE
` `
Notary Public - State of Florida
Comms�sioo # GG 051820
6JLLFFl
My Comm. Expires Nov 30, 2020
APPROVED BY
f%z!
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: IZZO,2"
Seal: .I LEONARDOFEUU i
MY COMMISSION ill GO 3012M
EXPIRES: Aprl 22, 2023
••�: or M1°`''�• W.,W Diu
fiu Notary Mk UrWOmbm
################# #############
lans Examiner Zoning
(Revised02/24/2014)
Structural Review Clerk