EL-18-3003Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Issue Date:10125/2018
Parcel Number
77 NE 106TH ST, Miami Shores, FL 33138 1121360060310
Contacts
Permit NO.: EL-10-18-3003
Permit Type: Electrical - Residential
Work Classification: Alteration
Permit Status: Approved
Expiration: 04/01/2019
TANIA GALLONI GALLONI Owner
Mobile: 5617038657
Other: 3057261627
TEAC ELECTRIC Contractor
CARLOS MARTINEZ
1900 NW 16 TERR, MIAMI, FL 33125
Home: 7864262094
Inspection Requests:
Description: ADDING INTERCONNECTED SMOKE DETECOS 2 GFI Valuation: $ 650.00 Inspec i 4949
1 LIGHT FIXTURES
Total Sq Feet: 120.00 —j I
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
Total:
$110.30
Payments Date Paid
Amt Paid
Total Fees
$110.30
Check # 3962 10/25/2018
$110.30
Amount Due:
$0.00
Building Department Copy
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 th all the foregoing
regulating construction and zoning. ,thermore, I authoi
all work will be done in compliance with all applicable laws
�tqe work stated.
Authorized Signature: Owner / Applicant / Contractor / Agent
Date
October 25, 2018 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
BUILDING
PERMIT APPLICATION
❑BUILDING IR ELECTRIC ❑ ROOFING
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS
FBC 20
Master Permit No. 2a% -4-8
Sub Permit No. v
❑ REVISION ❑ EXTENSION [—]RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
b
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: \\ — % �31vo — D Is the Building Historically Designated: Yes NO
Occupancy Type: S Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):
Aririracc• 5'') l\)E. C) Q'�!�
k1`
hone#:
City: M1 State: Zip: �53I J'6
Tenant/Lessee Name: Phone#:
Email: V I `M 0— ;;1 ::�v6 - 28 " --Yon 14
CONTRACTOR: Company Name: -�G e-C�Y; L Phone#:Tf(D
Address: 1!ju / lV V f �1ear
City: /�1 r .�J� i State:
Qualifier Name: La.,r(o.(M
State Certification or Registration #: 54,
DESIGNER: Architect/Engineer:
j
Zip: 331 I-A!Y"
hone#: 746-N2 6 - °L tJ I y
Certificate of Competency #:
one#:
Address: City: State: Zip:
Value of Work for this Permit: $ �!�) , 6 0 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ �/Repair/Replace El Demolition
Description of Work: �D�Nc^ `�Le lY1�E ��l�b SMO KLA 1E k.C-A1 n S Tt
7! , . ' 4 i f
Specify color of color thi'u, tile:.
Submittal Fee $ _ Permit Fee $-I�.�e ^D CCF $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
DBPR $
CO/CC $ r
Notary $.
Double Fee $
Structural Reviews $
(Revised02/24/2014)
Bond $
TOTAL FEE NOW DUE $ 1/0 ' 30
Bonding Company's Name (if applicable)
t
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
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
�,5 dayof by
L 20,
Pr Gt Al C3t\T11 who is personally known to
me or who has produced tr—leJ?—adJ I as
identification and who did take an oath. 165�-n54,-
NOTARY PUBLIC:
Signature -
//z
CONTRACTOR
The foregoing instrument was acknowledged before a this
5 day of 20 L,, by
G /,,r rho is personally kno�wnn,to
me or who has produced iF UI 1(1 L- In &&as
identification and who did take an oath.
NOTARY PUBLIC:
1 Sign: Sign. I �- A& wr "'
Print: r Print: LCl
Seal:::►;�, CECIIAARNfTAHO YWOOD Seal: ...........CECILAARNITAH�N�'A01]
z+: MY COMMISSION # GG 111439 MY COMMISMON4 Gq 111439
�•: :or EXPIRES: August 12, 2021
•''';;off ��� BondedTTwNotaryPuDricUndmvnite�s :,., a° EXPIRES: ,i12,2CZf
• Sonded TnN,Wary ilKttndaPvdiers
APPROVED BY 90 t-7 l e Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)