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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)