EL-18-1622Miami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit NO. EL-6-18-1622
Permit Type: Electrical - Residential
Pen
Work Classification: Alteration
Permit Status: APPROVED
Parcel Number
Issue Date: 7/6/2018 1 Expiration: 01/02/2019
Applicant
175 NW 100 Street 1131010230320
CHRISTIAN LANSER
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
CHRISTIAN LANSER 175 NW 100 Street (305)772-4313
MIAMI SHORES FL 33150-
175 NW 100 Street
MIAMI SHORES FL 33150-
Contractor(s) Phone Cell Phone
MAX ELECTRIC CORPORATION (305)498-5422 (786)277-6278
e of Work: ELECTRICAL INTERIOR REMDELING
itional Info: ELECTRICAL INTERIOR REMDELING
>sification: Residential
nning: 1
Fees Due
Amount
CCF
$7.80
DBPR Fee
$6.56
DCA Fee
$4.38
Education Surcharge
$2.60
Penalty Fee
$0.00
Permit Fee - Additions/Alterations
$437.50
Scanning Fee
$3.00
Technology Fee
$10.40
Work without Permit Fee
$0.00
Total:
$472.24
Valuation: $ 12,500.00
Total Sq Feet: 0
Pay Date Pay Type Amt Paid Amt Due
Invoice # EL-6-18-67917
07/06/2018 Credit Card $ 422.24 $ 50.00
06/13/2018 Check #: 4036 $ 50.00 $ 0.00
Available Inspections:
Inspection Type:
Review Electrical
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 A AVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construct' n an Wing Futherm I authorize the abo�vp-named contractortoddo, the work stated.
July 06, 2018
Authorized Sin wrier /—Applicant / Contractor / Agent Date
Building Department Copy
July 06, 2018
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
l�
JUN 3 .018 `
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BUILDING Master Permit No. h c i o " n - ZTd
ZZ.
PERMIT APPLICATION Sub Permit No. �, L 196 -' U Z.
❑BUILDING �ECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: (� S Lo L O O
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: { 1 - 3Q 1 — 023 —0 3 20 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Z�l 25ZIK`P LX-3flyfx�- Phone#: S % '-
Address: �� 1�I I O
City: [Al+lState: f::7L zip•315a
Tenant/Lessee Name: _ Phone#:
Email: S C---A L'P�t4
CONTRACTOR: Company Name:�t"I l'e Phone#:
Address: 34,;, 7-5 S "�Ccc— R
City: Zip: 3 31 SS
Qualifier Name: �: . 'Do CX7 -r—>O i-2 32 Phone#: �4-1 S� 2
State Certification or Registration #: E tk300 -iO4 6 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address City: State: Zip:
J
Value of Work for this Permit: $ Z-, • ou, J Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration 1 ❑ New 2 Repair/Replace ❑ Demolition
Description of Work: -1-►��n(Wo2 Q-F �AVtkl &-o
Specify color of color thru tile:
Submittal Fee $— 50 q,d Permit Fee $ 3r 3!J CCF $ CO/CC $
Scanning Fee $
Radon Fee $ • 3e DBPR $ 6 Notary $
Technology Fee $ Training/Education Fee $
Structural Reviews $
Double Fee
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
4 22.2`1
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 offer 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
�'-�WNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
12 day of Lk-
�� e 201 r� by
C;VI `(4 li) %Q V\ �S-2 (Z . who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
as
The foregoing instrument was acknowledged before me this
12 day o 76 -a re—, .20 1 S by
who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Print:.. �Dl �� ee Print: N It GG 085349
Seal: � uu�,, NEW0. PERU Seal: oP� EXINRE 1y21, 2021
.•� ,y T� �t,.+• Fronded Thru Notary Public Underwriters
*S Notary t ubk • 11tsts of Florida
•= Commission # FF 182380
My Comm. Expires Apr 2, 2019
APPROVED BY /J,/V J / 6 Plans Examiner Zoning
Structural Review Clerk
(R-ISedo2/24/2014)
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