EL-19-2784Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
F�ki')Kva'�
Issue Date. 12/16/2019
Location Address Parcel Number
257 NE 91ST ST, Miami Shores, FL 33138 1132060133450
Contacts
Permit No.: EL-11-19-2784
Permit Type: Electrical - Residential
Work Glassifrcation: Alteration
Permit status: Approved
Expiration: 06/ 15/2020
IARA COLTRO Owner
257 NE 91 ST, MIAMI SHORES, FL 33138
Business: 3055357656
MESA ELECTRIC SYSTEMS CORP Contractor
CARLOS A MESA
11240 SW 48 ST ****
Business: 3052795498
Description: BATH REMODELING (UPSTAIRS KIDS L
j3b5-7624946 Valuation: $ 950.00 Inspection Requests:
Total Sq Feet: 55.00
�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
Credit Card
12/16/2019 $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 that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating construction and wing. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Signature: ObvFie� / / Applicant / Contractor / Agent Date
December 16, 2019 ` 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 ® ELECTRIC ❑ ROOFING
ENTERED
NOV 21 ai9
BY:
(Ot Y 1
FBC 2G10\`-:�
Master Permit No.w,— t'' ZUW9 Sub Permit No. a' (� _ ( q - 2394
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
N�
City: Miami Shores County: f'0krk PWMiami Dade Zip: 3
Folio/Parcel#: It —a 20 G -OQ� - 3 4 M Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): '#7A-Pk 6al,T20 Phone#: -3pS' 3s "iGS(o
Address: 2_S,-1" NE 91 Sfi
City: rGA W. : 0-02Z S State: Fzz)"'o Zip:
Tenant/Lessee Name:
Email
Phone#:
CONTRACTOR: Company Name: i�iz:SA tu S TI& R r Phone#:'�S
Address: :.li (-� "(—
City: State: Zip: 12,1 C, 4
Qualifier Name: CPA o5 �- !Z,� s A Phone#:
State Certification or Registration #: Igo ✓ �� � Certificate of Competency #: _
DESIGNER: Architect/Engineer:
Add
Phone#:
City: State: Zip:
Value of Work for this Permit: $ /off Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace
Description of Work:
❑ Demolition
Specify color of color thru tile:
Submittal Fee $ PerftitY�`ee $'" CCF $ "` "'°" `" " "CO/CC $ '
Scanning Fee $
Technology Fee $.
Structural Reviews $,
Radon Fee $
Training/Education Fee $
DBPR $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
e
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 wi!I 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 40�
OWNER or AGENT
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of Nfl✓cn,2,e,c. 20 tJ by iZ ` day of N 7, , 20 M by
COAM , who is R !Mask , who is personally known to
r"e or who has produced DC41>< CY36' MW' 53" 6-4s"Q me or who has produced -DL* N 2,0-- IJI-bZ-2QG-0 as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: wo
Pri .�
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
Seal:11 :;v:'"'"•. VICfORINOJ,LUCERO Seal:
MY COMMISSION # GG 167510
EXPIRES: APO 8, 2022
ll,-Z�f,��IWB=WThmNO"PubkUndwwftm 11
###########
MY
EXPIRES: •.; 'Ar., 2022
##################
APPROVED BY /� 9CNd/-�� Z Plans Examiner Zoning
Structural Review Clerk
(RevisedO2/24/2014)