EL-19-419Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Issue Date: 02/27/2019
Parcel Number
148 NW 96 ST, Miami Shores, FL 33150 1131010240290
Contacts
Permit -NO.: L-02-19-419
Permit Type: i3eetrital - Residential
Mork Classification: Temp for Test
Permit Status: Awroved
Expiration: 08/26/2019
OCA CORP TRS Owner OCA CORP TRS Applicant
148 NW 96 ST, MIAMI SHORES, FL 33150 148 NW 96 ST, MIAMI SHORES, FL 33150
AAA ON TIME ELECTRIC INC Contractor
ROBERT KATZMAN
Business: 7862951748
Inspection Requests:
Description: POWER RELEASE (TO RESTORE POWER) Valuation: $ 1,000.00 305-762-49+49
TotalSq Feet: 928.00
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!
02/27/2019 $60.30
Credit Card
02/25/2019 $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 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 zoning. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Signature: Owner
/ Applicant / Contractor
/ Agent
Date
February 27, 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 tRELECTRIC ❑ ROOFING
VED
FqB 2 N 2019
IM
FBC 202211 hh
Master Permit No. "
Sub Permit No. U-- ®- 1C
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑ PLUMBING ❑ MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR
DRAWINGS
(�,
JOB ADDRESS: Iu- I 1 IV Wl _ 1 6
City: Miami Shores
County:
Miami Dade
Zip:
Folio/Parcel#:
Is the Building Historically Designated: Yes NO
Occupancy Type: Load:
Construction Type:
Flood Zone:
BFE: FIFE:
OWNER: Name(FeeSimple Titleholder):
"�
�\kPhone#:
'ij
Address: ' � C7 � � � �
�+'
City: Nkiam
State: T"(D1" jo' Zip: 33 1 S b
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: _0 M 0 r) t(— Phone#: / 96 V�r) 7 Y�
Address: 0_0 /UW .100 4i-31
City: miytml State: Zip: 3D /sy
Qualifier Name: LAZ4�a Phone#: 744 115-/7y�
State Certification or Registration #: i�C/ ly o t g�1 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address:
City: State: Zip:
Value of Work for this Permit: $ /n b D Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace
Description of Work:
WI
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $
Technology Fee
Structural Reviews $,
Radon Fee $
Training/Education Fee $
W
CCF $
❑ Demolition
CO/CC $
DBPR $ Notary
Double Fee $
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $ 6-0 • ��
. r.
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 $1500, 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.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged beforemethis
'2 3 day of `�b ,20 I by
LS641. t 14 .�N� �i�� , who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Signature J',7(1-,'f
Or
CONTRACTOR
The foregoing instrument was acknowledged before me this
3 day of A41 20 (� by
JL+Z^y% who is personally known to
as me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC: / tiar' THOMAS J ASTA
Notary Public - State of Florida
Commission N GC, 291685
':. My Comm. Expires May 4, 2023
Sien: �r Bonded through National Notary Assn.
Print: 7-4 Print:
e�i ThGMAS : aSTA
Seal: Y'; Notary Public - State of Florida Seal:
Commission Y GG 291685
orf My Comm. Expires May 4, 2023
Bonded through National Notary Assn.
Nota-.. :f Florida
C- .,1695
My C;. = ,., as Nay' 4, 2023
Bcrded:r-.;-,,- Nc::cnalNotaryAssn.
*********************s******s*******s*s***s*ss*s***s****************************************************
APPROVED BY Z)741 1 1 1 l Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)