EL-19-336 (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 [ �KLECTRIC ❑ ROOFING
RECEIVED
FEB 187
BY:
FBC 201-1 ik�
Master Permit No. ,,A_-0Z— I q--33 So
Sub Permit No.
❑ REVISION ❑ EXTENSION [:]RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: I-1 tia \clw
City: Miami Shores County: Miami Dade Zip: 3313g
Folio/Parcel#: ��' 213� ' � — vZQP0 Is the Building Historically Designated: Yes NO D(,,
Occupancy Type: Load
OWNER: Name (Fee Simple Titleholde
Address
Construction Type: Flood Zone:
n
BFE: FFE:
e#:
City: 1`I ��11►� ►�V��� State: Zip: 33\l31 �
Tenant/Lessee Name: Phone#:305345 v(�
202
Email
CONTRACTOR: Company Name:
n\' �nOnN�eilpC�J� �1��G�� �`% C��Phone#: 305` "I�.JLJ— 60�
Address: J ` r�f r�����,,��210 1V� 1�,
City:`\ L%uVUC>+ State:— Zip: 3'3O2U
Qualifier Name:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
7— Phone#:
:ertificate of Competency #: _
Phone#:
Address: City:
Value of Work for this Permit: $ alczo Square/Linear Footage of Work:
Type of Work: ❑ Addition ff Alteraatioonn El New ElRepair/R,epplaacce,
Description of Work: jq��, 1 t�LJIJLJ 22— r-Lu
Specify color of color thru tile:
Submittal Fee $ •� Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $
Structural Reviews $
Training/Education Fee $
CCF $,
DBPR $
Zip:
❑ Demolition
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ .
(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
WE
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 on 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 rei4specAn fee willlb� charged.
Signature
The foregoing insIrw"Ient was acknowledged before Is
_ day
of
20 by
who is personally known to
me or who has produced
identification and who did take n o th.
NOTARY PUBLIC:
Sign:
Print:
Seal: ��' Caf:.; 'ava;:.3c . or F!rxiaa
Care uo
y � � My Co .miss;nn FF 245758
�z, �x�}ir3: nrn0!i�i1P
APPROVED BY 3111
C!�
ZX
LSD
as
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
q day of �4-,�__p--`(__1U--� 20 lG by
(72M .WZ Who is personally known to
me or who has produced Dl.-- • as
identification and who did take a h.
NOTARY PUBLIC:
Sign:
Print:
Seal: tpovN
Notary ublic State of
Carlo Cavallo
My Commission FF 24
a
Expires 06/30/2019
*************************************************************
Plans Examiner % 4-7 Zoning
Ire
Structural Review
Clerk
(Revised02/24/2014)
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
17 NE 106TH ST, Miami Shores, FL 33138
Contacts
JUAN & MARIA SANCHEZ Owner
Other:3053450202
@ ITI. U� E
Issue Date: 04/02/2019
Parcel Number
1121360060260
Permit NO.: EL-02-19-336
Permit Type: Electrical - Residential
Work Classification: Generator
Permit Status: Approved
Expiration: 09/30/2019
CONKRETA BUILDERS ELECTRIC LLC Contractor
JOHNNY GONZALEZ
3800 terrace, hollywood, FL 33020
Business: 3059005055 CARLO@ CON KRETACONSTRUCTION.CO
Mobile: 9548220032 M
Home: 9548220032
Other: 9548220032
Inspection Requests:
Description: INSTALL NEW 22 KW GENERATOR Val=$4,000-00305-762-4949
Tot
Fees
Amount
Application Fee - Other
$50.00
CCF
$2.40
DBPR Fee
$2.10
DCA Fee
$2'00
Education Surcharge
$0.80
Permit Fee
$90.00
Planning and Zoning Review Fee
$35.00
Scanning Fee
$3'00
Technology Fee
$3.50
Total:
$188.80
Payments
Date Paid Amt Paid
Total Fees
$188.80
Credit Card
02/13/2019 $50.00
Credit Card
04/02/2019 $138.80
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 that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulat rN construction and zoning. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Signature: Owner
/ Applicant / Contractor ! Agent
Date
Page 2 of 2
April 02, 2019