EL-19-2631Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Fit �-j 0 rr`U
Issue Date:11/15/2019
Parcel Number
10658 NE 11TH AVE, Miami Shores, FL 33138 1122320280680
Contacts
Permit NO.. EL-1 1 -19-2631
Permit Type: Electrical - Residential
Work Classification: Alteration
Permit Status: Approved
Expiration: 05/13/2020
GREGORY CABANA Owner EDD HELMS ELECTRIC Contractor
10658 NE 11 AVE, MIAMI SHORES, FL 33138 JOSEPH KELLY
Home: 3054919001 17850 NE 5 AVE, MIAMI, FL 33162
Business: 3056532520
Description: ELECTRICAL TO INSTALL NEW MINI SPLIT AND Valuation: $ 2,535.00 Ins ection Requests:
REMOVE TWO SUPPLY DUCTS FEEDING MASTER BEDROOM. 305 762 4949
Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$1.80
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.60
Permit Fee
$50.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$111.90
Payments
Date Paid Amt Paid
Total Fees
$111.90
Check # 6708
11/04/2019 $50.00
Check # 6709
11/15/2019 $61.90
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 constructio Adszoning. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Signature: Owner / Applicant / Contractor / Agent Date
November 15, 2019 Page 2 of 2
BUILDING
PERMIT APPLICATION
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
A
V 0 ff 2019
BY:
FBC 20
Master Permit No. M ` II- I�_2'[30
Sub Permit No. EL-11— 19—Z b 3 1
❑ REVISION ❑ EXTENSION [—]RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [] CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 10658 NE 11th Avenue
City: Miami Shores County: Miami Dade Zip: 33138
Folio/Parcel#: 11-2232-028-0680 Is the Building Historically Designated: Yes —NO X
Occupancy Type: _____ Load: Construction Type: --Flood Zone: BFE: _____ FFE:
OWNER: Name (Fee Simple Titleholder): Greg Cabana Phone#:
Address: 10658 NE 11th Avenue
City: Miami Shores, State: Fl. Zip: 33138
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: Edd Helms Electric Phone#: 800-329-2520
Address: 740 International Parkway
City: Sunrise state: Florida Zip: 33325
Qualifier Name: Joseph Kelly Phone#: 800-329-2520
State Certification or Registration #: EC13001830 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ $ 2,535.00 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ® New ❑ Repair/Replace ❑ Demolition
Description of Work:
install new mini split and remove two supply ducts feeding master bedroom
Specify color of color thru tile:
Submittal Fee $� Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE
(Revised02/24/2014)
Bonding Company's Name (if applicable) N/A
Bonding Company's Address
City State _
Mortgage Lender's Name (if applicable) N/A
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 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 reinspects oo fee will be charged.
Signatu
OWNER or AGENT
The,ffoorregoin&4 strument wa acknowledged before me this
day of 0`�"'L�z-;' 20 by
7 L��"�" r" c gfa�(J R w personally know to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sigr
Prir
Signature
_ Wi�,-Wv
CONTRA TOR
The foregoing instrument was acknowledged before me this
day of D ' =—, by
�d9,,o ho is personally known to
me or who has produced _ as
identification and who did take an oath.
NOTARY PUBLIC:
Sign
Prini
Seal
APPROVED BY "`� f by Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)