EL-19-1702Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Issue Date: 08/05/2019
Parcel Number
1080 NE 104TH ST, Miami Shores, FL 33138 1122320290200
Contacts
Permit NO.: F.-07-15-1702
Permit Type: Efeetrical - Residential
Work Classification: Alteration
Permit Status: Applied
Expiration: 02/03 /2020
SHORES 104 LLC Owner METPLANET ELECTRICAL Contractor
JEAN LESLIE TELEFORT
Business: 3057788787 REMY@QUILLIOT.COM 6231 GRANT CT, HOLLYWOOD, FL 33024
Business: 7542141695 JEANLTELFORT@AOL.COM
Description: COMPLETE REWIRING SMOKE DETECTOR 250 Valuation: $ 14,500.00 Inspection Reuests:
782 494
AMPS, NEWW ELECTRICAL SERVICE ACCORDINGLYTO THE
MASTER PLAN. Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$9.00
DBPR Fee
$7.61
DCA Fee
$5.08
Education Surcharge
$3.00
Permit Fee
$457.50
Scanning Fee
$3.00
Technology Fee
$12.69
Total:
$547.88
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$547.88
Credit Card
08/05/2019 $547.88
Amount Due:
$0.00
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 co��n and zoning. Futhermore, I authorize the above named contractor to do the work stated.
Owner / Applicant / Contractor / Agent Date
August 05, 2019 Page 2 of 2
RECEIVED
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 Do ELECTRIC ❑ ROOFING
16
FBC 20 11
Master Permit NW -0 3 - t I - 531
Sub Permit N(8 0 1q-.1
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING [:]MECHANICAL [:]PUBLICWORKS MCHANGEOF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: c I"
City: Miami Shores County: Miami Dade Zip: l
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone:
OWNER: Name (Fee Simple Titleholder): /14_J
Address: 7
t` C+ tom,,
City: tll A& J r o State:
Email: I nW'UUI'L-�F? I rok-4
CONTRACTOR: Company Name:
Address: t:;> Z _
BFE: FFE:
Phone#: 7� 0/ W t 4 cj
City: State: i'C, Zip:
Qualifier Name: Phone#:
State Certification or Registration(►#: L� l W j 3 ` C� � Certificate of Competency M
&D-r-F
DESIGNER: Architect/Engineer: VvC. ,iV V_4u- A�, �Gt`�tc1 � Phone#: UO Li�j
�L—
Address: GI Oi? �i dU tS oi&-f pN City: �(M!N i (S State: Zip: 3.3 W4-i
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration �❑ New ❑ Rep air/Replace El Demolition
Description of Work:
Specify color of color thru tile:,
Submittal Fee $
Scanning Fee $
Technology Fee $,
Structural Reviews $
Permit Fee $
Radon Fee $
Training/Education Fee $
CCF $ CO/CC $
DBPR $
Notary $
Double Fee $
Bond $
2
(Revised02/24/2014)
TOTAL FEE NOW DUE $
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 on 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 inspe on which occurs seven (7) days after the building permit is issued. obse�e of such posted notice, the
inspection will not approved and a reinspection fee will be charged.
f
Si ure Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
�2 cday of /dot/' 20 / by
who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY
Sign:_
Print:
Seal:
CONTRACTOR
The fore ing instrument was acknowledged before me this
-111 day of 20 15. , by
T� / P who is personally known to
me or who has produced A/%reg %rzelt-e— as
identU:)
oath.
NOTSign:
Print
Seal:
•..
loyEMMAA.ORJUEIA
Ems`- Notary Public state of Florida
CCroo^mmisssi�onnN G(G�[26838]6OF fV
2
k##### ##iii`K'* ••##ii if�ii3R'�K#iiii��li+��## ######i###########�I
/ APPROVED BY '' �TL , h L�Ge� T Plans Examiner
Structural Review
EMMA A. ORJUELA
Notary Public • State of Florida
Commission N GG 268386
Zoning
Clerk
(Revised02/24/2014)