EL-19-781Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date: 04/16/2019
Location Address Parcel Number
90 NE 91ST ST, Miami Shores, FL 33138 1131010200010
Contacts
Permit NO.: EL-04-19-781
Permit Type: Electrical - Residential
Work Classification: Alteration
Permit Status: Approved
Expiration: 10/08/2019
STEPHEN PELLICCIA Owner F JIMENEZ ELECTRICAL CONTRACTOR, INC Contractor
90 NE 91 ST, MIAMI SHORES, FL 33138 FRANCISCO JIMENEZ
12401 WEST OKEECHOBEE RD 419, HIALEAH GARDERNS, FL 33018
Business: 3055565759
Inspection Description: UPGRADE SERVICE OVERHEAD Valuation: $ 1,800.00 Inspection Requests:
4949
Total Sq Feet: 650.00
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
$12.00
Technology Fee
$2.50
Total:
$120.10
Payments
Date Paid Amt Paid
Total Fees
$120.10
Credit Card
04/16/2019 $70.10
Credit Card
04/11/2019 $50.00
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 EL CTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNER�FF certify that all the fore ng information is accurate and that all work will be done in compliance with all applicable laws
regulati g n d zoning. Futhermore auth rize the above rAmed contractor to do the work stated.
Authorized Sig�nre:,bwner / Applicant // Contractor / Agent Date
April 16, 2019 / Page 2 of 2
\0\
BUILDING
PERMIT APPLICATION
RECEIVED
Building Department
ppR 11 2019
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 2011
Master Permit No. a jWN-i�-y"�� �
Sub Permit No. t _ l " [ b
Miami Shores Village
❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [-]RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 90 NE 91 Street
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): Stephen Pelliccia Phone#: 603 505 1957
Address: 90 NE 91 Street _
City: Miami Shores State: Florida _Zip: 33138
Tenant/Lessee Name: Phonett:
Email: pelliccias@gtlaw.com T /,,
CONTRACTOR: Company Name: ' ���i`i�Z G L-C C / - C 01V 7 Phonett: �Z4 '2 �3 Z/�D
Address: 7 / O SS 7
City: I- F �/ I n�^� State: f�L Zip: 3 3 9_ ']7 /
Qualifier Name: F/`-�-iNG�S�Q t^�Z Phonett: 2-3 -7 4/�7
State Certification or Registration #: �G ` 1000 / 7,/C44 ertificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ / oy ' Square/Linear Footage of Work:
Type of Work: ❑ Addition El Alteration ElNew Re air/Replace ❑ Demolition
Description of Work: v� !�au a
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $ 1
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
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 issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
9
Signaturez
Signature
z,L�
OWNER or AGENT ONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrum nt was acknowledged before me this
+� day of /1a✓r ( 20 by day of 20� by
C r who is" sonally known to OIda INM �T,'\' rho is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
NAOMISAKATA
My Comm. Expires Nov 18, 2019
Bonded #M0 Natio iai Notary Assn.
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
E C,PEREZ
* C m fon G 231918
Sign:
Print: �lfaPFBonded Thru Budget Notary Senrloes
Seal:
as
:**•****r***s�*****r* *r*►*::ri*�:rr***r�*r****r*��******+r*:*********rr*r***********�***rr*r****rrs*r***r*r
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
APR 112019
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