EL-19-2836Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
1430 NE 102ND ST, Miami Shores, FL 33138
Contacts
[D�
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Issue Date:11/27/2019
Parcel Number
1132050240230
Permit NO.: EL-11-19-2836
Permit Type: Electrical - Residential
Work Classiffcotion: Pool
Permit Status: Approved
Expiration: 05/26/2020
LESZEK WNUK Owner
1430 NE 102 ST, MIAMI SHORES, FL 33138
Home: 954-330-8686
CAMAGUEY ELECTRICAL SERVICE Contractor
SAMUEL JORGE GONZALEZ
6160 W 26 CT, MIAMI, FL 33016
Business: 3059841036
Inspection Requests:
Description: NEW POOL CONSTRUCTION Valuation: $ 0.00 Inspection e
cost included in master Total 5q Feet: 486.00
Fees
Amount
Application Fee - Other
$50.00
DBPR Fee
$2.00
DCA Fee
$2.00
Permit Fee
$50.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$109.50
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$109.50
Credit Card
11/27/2019 $109.50
Amount Due:
$0.00
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. In acMire
permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
permits are reLECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS A FIDANYI certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating co structib ;zoning. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Sig
/ Applicant / Contractor / Agent
Date
November 27, 2019 Page 2 of 2
ENTERED
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
NOV 2 6 2019
By:—AEQ�--
FBC 201-t LAtq
BUILDING Master Permit No. --t6 (--(.
PERMIT APPL CATION Sub Permit No. i-L'1 1-Iq•- 283�
❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 14 ✓D !f,
b
Folio/Parcel#: ll •" si'V5,"DN ^ ()2 3-D Is the Building Historically Designated: Yes NO
Occupancy Type:
OWNER: Name (Fee Siimlpl
U `� Address: �1 `� o c-
City: U�
Tenant/Lessee Name:
Email: QAr-k I-e-u .
Load: C
Titleholder
Vol, 5
�+S
ruction Type: Flood Zone: _
A
State:
Z,
BFE: FFE:
hone#: 45;30$'6`66O
Zip: 33 \346
hone#:
-v
CONTRACTOR: Company Name: A Phone#: W 16VB3,C
Address: 7-�1I G
City: z LC LA State: Zip: <� 3o t,(-
Qualifier Name: 1 C�c`a lRs Phone#:
State Certification or Registration #: �C 0c� Tg Certificate of Competency #:
DESIGNER: Architect/Engineer. o--^%��� Phone#:
Address: T%1 S -5� 2giLi CO-
-�1�d ��y�D1'l) City: �.') State: Zip: 3 ��
Value of Work for this Permit: $ d" Square/Linear Footage of Work:
Type of Work: ❑ Addition (j❑ Alteration❑ New ❑ Repair/Replace ❑Demolition
Description of Work:
LQx'T 4%JUU 19 E,(ok2l P,10 (' 4R-Z' , .
Specify color of color thru tile:'
Submittal Fee $ Permit Fee $' CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $
Structural Reviews $
Training/Education Fee $
Double Fee $
Bond $
(Revised02/24/2014)
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 is ued.-4,n a absence of such posted notice, the
inspection will not be approved and a nsp tion fee will be charged.
Signature Signat
OWNER or GENT CONTRACTOR
The foregoing instrument was acknowledged before me this
2 day f l� 04Qn�I_nl��%.�c , 20 \Z by
L . �' QS2 ` t � Owl, , who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
The foregoing instrument was acknowledgede/befo e this
day of & 20 , by
�Q"� �,C-3�2c>�tL , who is personally known to
me or who has produced VLA lL as
identification and who did take an oath.
NOTARY PUBLIC:
Sig
Sig
Print:
Print:
'or ^oe
Seal: �: ••••.�
ANINELY MAY RAL
Seal:
,*nrru°
ANINELYMAYORAL
R
Commission # GG 242094
3' .••.. ;�,
Commission # GG 242094
Expires November 3, 2022
R
Expires November 3, 2022
Ba M Thru BoW Nolery Berrlm
Bonged Inn Budpel Nolery $eMaa
**********************************************************************************************************
APPROVED BY
I LL Plans Examiner
Zoning
Structural Review Clerk
(Revised02/24/2014)