EL-17-3003Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit NO. EL-12-17-3003
Permit Type: Electrical - Residential
Pen Work Classification: Addition/Alteration
Permit Status: APPROVED
Issue Date: 1/2/2018 1 Expiration: 07/01/2018
Project Address Parcel Number Applicant
10250 NE 2 Avenue 1132060131710
Miami Shores, FL Block: Lot: RACHEL SANON
Owner Information Address Phone Cell
RACHEL SANON 10250 2 Avenue
MIAMI SHORES FL 33138-
10250 2 Avenue
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone
LS CURTIS INC (305)933-0683
of Work: TWO SWITCHES AND TWO LIGHTS
itional Info: TWO SWITCHES AND TWO LIGHTS
,sification: Residential
nning: 1
Fees Due
Amount
CCF
$0.60
DBPR Fee
$2.25
DCA Fee
$2.00
Education Surcharge
$0.20
Notary Fee
$5.00
Permit Fee - Additions/Alterations
$150.00
Scanning Fee
$3.00
Technology Fee
$0.80
Total:
$163.85
Valuation: $ 500.00
Total Scl Feet: 10
Pay Date Pay Type Amt Paid Amt Due
Invoice # EL-12-17-65983
12/26/2017 Credit Card $ 50.00 $ 113.85
01/02/2018 Credit Card $ 113.85 $ 0.00
Avauaoie inspections:
Inspection Type:
Final
Meter Box
Alteration
Relocation
Fire Alarm
Service Change
Review Electrical
rou
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 regulating
construction and zonin4—Futhermore, I authorize the above -named contractor to do the work stated.
January 02, 2018
Auth z IA ure: Own—Omn—I / Applicant / Contractor / Agent
Building Department Copy
January 02, 2018
Miami Shores Village
Building Department
10050 N.L.Znd Av@nu@, Miami 5hgre5, FI®ri4a 33136
Tali (305) 703-2M4 Faxi (305) 73b-6077
INSPECTION LINE PHONE NUMBER, (305) 762.4940
C IV
12 z(o l O
BY
Fat 2014S—
BUILDING Master Permit No.-
, p0)6 - 2,Z'TI_
PERMIT APPLICATION Sub Permit No..e)�i R — 3003
❑BUILDING 'ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBL.IC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: I b % _57`0 Iy - ` &I`P
Citiry: Miami Shores County: Miami Dade Zip; �� L� fQ—
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: _Flood Zone: 13FE: FFE: —
OWNER: Name (Fee Simple Titleholder): ��( �V S i4� Phone##; ' S 2,-943
Address: o-z `o t j %YK —
City: I�,�,�/1 State:— _Zip: ���, —
Tenant/Lessee Name: Phoneh: —
Email:
CONTRACTOR: Company Name: i, � Lit/Ri±)�1,�� 1�Y(� Phone##: �K-�'j GOG
Address: w _!4rl <Q P- ' �� —
City: &&—AAkUA4 State: _Zip: —
Qualifier Name: S rplwi �� Phone#:
State Certification or Registration #: r C7 .� Certificate of Competency #: .
DESIGNER: Architect/Engineer: ! T- (I u I E% Phoneh: —
Address: ��1 S In, t�� j4vC)�' City: State: �LZip:
Value of Work for this Permit: $ 6-00. (9, Square/Linear Footage of Work: _ —
Typ o Glfo?k: ❑ Addition r�..Alter,tion ❑ New ❑ Repair/Replace ❑ Demolition
De iption of Work: 0—
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ 1: �� 4112' CCF $_
Scanning Fee $ Radon Fee $. DBPR $
Technology Fee $ Training/Education Fee $
Structural Reviews $ _
40/CC $ —
Notary $ E x A —
Doublg Fee $
Bond $ —
(Revised02/24/2014)
TOTAL FEE NOW E)UE $
l(3'&,�C->
Bonding Company's Name (if applicable)
Bonding Company's Address _
City ��ate zip
Mortgap Lender's Name (if gppllcabl@)
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 d 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 peimit is issued. In the absence of such posted notice, the
inspection will not b pproved a a reins tion fee will be charged.
Signature Signature
0 or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
day of , 20 by
who is personally known to
me or who has produced j�---1>92-(VE�e— IJQ;1E7NSa'
identification and who did take an oath.
The foregoing instrument was acknowledged before me this
day of 20, by
L�, who is-pers y cnowrl to
me or who has produced -as
identification and who did take an oath.
NOTARY PUB IC:
NOTARY PUBLIC:
j
CASSAWRA NED
, �„u',4,�••
�,•, Notary Pub"c - S'.ate
Sign:
Sign:_
� 6er^ ., sign # FF
Print:
Print:
e;' E�piresJu
Seal r"` 'v „,r�.. Y v y „
Seal:
�nnn„o �!•�!,
oW s� Notary Public State of Florida {
-,india Alvarez {
,y commission FF 156750 (
'
Expires 09/03/2018
APPROVED BY f _ Plans
Examiner
Z(:)ning
Structural Review Clerk
(Revised02/24/2014)