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EL-17-2868Miami Shores Village L PCCEIVED Buildin no artment g V kc 'o t 2017 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 �� Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 fFBC 201" ` l BUILDING Master Permit No. 1�• C `�� PERMIT APPLICATION Sub Permit No. ❑BUILDING 4 ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION RENEWAL ❑PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: City: Miz e Folio/Parcel#: i ' Occupancy Type: _ OWNER: Name e�(Fee am Address: L I9 Cou the Building Historically Designated: Yes NO Load: Construction Type: Flood Zone: BFE: FFE: CA hone#:J7� `>i City: /" I . S6ivk6 State: /' / Zip: Tenant/Lessee Name: 0 w n tr Phone#: Email: CONTRACTOR: Company Name: 1 1��q""� It L v-( C st �w( �� Phone#: Address: 4�0—M /vim f"_0 14 VQ/L tze City: ,IUM��¢r/Ljl Qualifier Name: ne#: State Certification or Registration #: EC A 6P 0 Certificate of Competency #: _ DESIGNER: Architect/Engineer: 0//4 Phone#: Address: City: State:Zip: YtValue of Work for this Permit: $ L�Q� Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: "lo(a4 A rhuv- him'l S Specify color of color thru tile:, Submittal Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ Permit Fee $ CCF $ CO/CC $ Radon Fee $2 ' W D B P R $ 2 25 Notary $ Training/Education Fee $ Double Fee $ Bond $ (Revised02/24/2014) TOTAL FEE NOW DUE $ I (0 • 6S 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 0 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 ex $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien rochure ill a delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notic commencem t m st be po d at the job site for the first inspection which occ s seven (7) days after the building permit ' issue In the sen a of posted notice, the inspection will not be a�ed a/4areinspection fee will be charged. Signature ER or AGENT Signature 61"t e- ��rwAlel, CONTRACTOR The foregoing inkrumepkwas acknowle ged before me this The foregoing instrument was acknowl dged before me this day of 6 20 t / by 3 day of 20 l by lJ1 ifNt IM64rd 5 , who is personally known to who is personally ,knAow�Qto� me or who has produced as me or who has produced identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: Sign *~— Prin. Seal NOTARY PUBLIC: Sign:_ Print: 4; :s: ---- •,�,:i:satc�NA'FFJI9DQ5 Seal: (467 9 CXP1RESi�lay4201S Oi53 Flariditt.7S"v ;0M ************************************************************************************************************ APPROVED BY Plans Examiner Structural Review Zoning ! Clerk (Revised02/24/2014) LIMITED POWER OF ATTORNEY Know All Meat by These Presents, that HB_ Devgtopment Properties. LLLP, a Florida Limited Liability Limited Partnerships ("Property Owner") have made, constituted and appointed, and by these presents does make, constitt#e and appoint Juan Morales lawful attorney for them and in their name, place and stead. Giving and granting unto Juan Morales full power and authority to do and perform all and every act and thing whatsoever regwisite and necessary to be done to +� making and terminating contracts with respect to any and all utilities (including electricity, gas, water, and waste management) for residential real estate owned by Property owner ("Residential Property"); communicating and acting on Property Owner's behalf with respect to all homeowner's association matters relating to atresidential property; y signing Notices of Commencement associated with roof work; li,� filling out, si6ing, and registering documents related to resolution of construction liens; and registering and filing out documents with respect to Residential Property with any and all applicable authorities with jurisdiction over matters affecting the Residential Property; provided, however, that no power is granted hereunder to encumber any Residential Property or take any action that Would be adverse to the interests of the Property Owner or any of its officers, members, or affiliates This limited Power of Attorney will remain in effect until December 31, 2017, unless earlier revoked by Property Owner upon notice. The authority granted to the Attorney -In -Fact by this Limited Power of Attorney is not transferrable to any other party or entity. In Witness Whereof, we have hereunto set our hands and seals on this 19`' day of September 2016. i Signed, sealed and delivered in the presence of: Wetness Sig natute Witness Printed Signature STATE OF FLOOR DA COUNTY OF BROWARD HB Development Properties LLLP a Florida Limited Liability Limited Partnership By: Eagle RHGP, Inc a Florida Corp ton. General Partner v: i, - - --- -------- - iartosz ; .< President The foregoing itistrunient. was acknowledged before me this 19`h Day of September 2016 by Bartosz C zarowski, as manager for iB Development Properties LLLP, a Florida Limited Liability Limited Partnership. He. i. �rsonally know to me or has produced _ as identification. p JULIANA GOMEZ ,' I MY COMMISSI(}N #F14i�saa yf• tea, EXPIRES March 13 20't' i (407) 396.0153 FtwtdatictarpServicexom *Diary Public, State ana county aforesaid -- j a.-i i a n to tiotary Printed Signature Notaries Public Page 1 of I Department Menu Commission Detail Notary ID:1195880 Last Name: GOMEZ First Name: JULIANA Middle Name: Birth Date:8/17/XX Transaction Type: REN Certificate: FF 101644 Status: ACT Issue Date:03/14/14 Expire Date: 03/13/18 Bonding Agency: American Safety Council Mailing Address:1745 sw 108 Terrace Davie, FL 33324-0000 [Department of State][Notary Public Access S sy tem][Email Us] Florida Department of State Division of Corporations P.O. Box 6327 Tallahassee, FL. 32314 Phone (850) 245-6945 http://notaries.dos.state.fl.us/NotldSearch.asp?ID=1 195880 12/5/2017 • • • • • • • • • • RECEIVtL DEC n r, ry,9'7 k00%AliPF j (10 IN, O ' P,>pE kAf 9.75 Q u z � a' ,Si . C�rfi�icd fed �:.LU .. /7" o Looms .ws�aciwt to E a iitAwe evre Z %iib��oi .459sipQ. c� y IMP 5au1r� F/otidU .4r A4,,, -o ' O .yr3 lyiFQ 44.5 Ha��c Pl of yam','--=—:.:N.eIIL" .W � �''� D r�►- .r-...---"" . ICE' 7 4 J L Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit No. EL-12-17-2868 Permit Type: Electrical - Residential Per 1"t Work Classification: Service Change Permit Status: APPROVED Parcel Number Issue Date: 12/12/2017 1 Expiration: 06/10/2018 Applicant 278 NE 103 Street 1132060134860 HB GROWTH PROPERTIES LLLI Miami Shores, FL 33138-2431 Block: Lot: Owner Information Address Phone Cell HB GROWTH PROPERTIES LLLP 17071 W DIXIE Highway NORHT MIAMI BEACH FL 33160- 17071 W DIXIE Highway NORHT MIAMI BEACH FL 33160- Contractor(s) Phone Cell Phone METRO ELECTRIC SERVICE, INC (305)945-1991 (305)945-1991 of Work: RELOCATE FROM OVERHEAD TO UNDERGROU itional Info: RELOCATE FROM OVERHEAD TO UNDERGROU ,sification: Residential nning: 3 Fees Due Amount CCF $1.80 DBPR Fee $2.25 DCA Fee $2.00 Education Surcharge $0.60 Permit Fee -Add itions/Alterations $150.00 Scanning Fee $9.00 Technology Fee $2.40 Total: $168.05 Valuation: $ 2,400.00 Total Sq Feet: 39 Pay Date Pay Type Amt Paid Amt Due Invoice # EL-12-17-65822 12/05/2017 Cash $ 50.00 $ 118.05 12/12/2017 Credit Card $ 118.05 $ 0.00 In consideration of the issuance to me of this permit, I agree pertaining thereto and in strict conformity with the plans, drawin accepting this permit I assume responsibility for all work don required for ELECTRICAL, PLUMBING, MECHANICAL, WIND OWNERS AFFIDAVIT: I certify that all the foregoing i construction and zoning. Futhermore, I authorize the at; Available Inspections: Inspection Type: Review Electrical work covered hereunder in compliance with all ordinances and regulations specifications submitted to the proper authorities of Miami Shores Village. In my agent, servants, or employes. I understand that separate permits are )OFING and SWIMMING POOL work. nd that all work will be done in compliance with all applicable laws regulating do the work stated. December 12, 2017 Authorized Signature: Owner / Building Department Copy Y" December 12, 2017 Agent 1