EL-19-2896Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
360 NE 91ST ST, Miami Shores, FL 33138
rnntarts
Issue Date: 01/02/2020
Parcel Number
1132060190210
Permit NO.: EL-12-19-2896
Permit Type: Electrical - Residential
Work Classification. Alteration
Permit status: Approved
Expiration: 06/30/2020
SAM RISSMAN Owner METRO ELECTRIC SERVICE INC Contractor
360 NE 91 ST, MIAMI SHORES, FL 33138 SAMUEL AZUZ
Home: 5107172306 sam@sambr.com 15050 NE 20 AVE, Miami, FL 33181
Business: 3059451991 henrygarzon@hotmail.com
Description: REMOVE AND INSTALL KITCHEN CABINETS Valuation: $ 1,100.00 Inspection Requests:
305-762-4949
Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$1.20
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.40
Permit Fee
$50.00
Scanning Fee
$9.00
Technology Fee
$2.50
Total:
$117.10
Payments
Date Paid Amt Paid
Total Fees
$117.10
Credit Card
01/02/2020 $117.10
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 AFFI IT: I certify that all the foregoing information is ac to and that all work will be done in compliance with all applicable laws
rPg}�lating con r . and zoning. I authorize s above n ed tractor to d,5 F e work stated.
�i�_W. _No
Authorized Signature: Owner
/ Applicant / Contractor / Agent
January 02, 2020 Page 2 of 2
Miami Shores Village ENTEREn
g DFr o6 s
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 Tql�-LECTRIC ❑ ROOFING
F-IPLUMBING ❑ MECHANICAL F-�PUBLICWORKS
JOB ADDRESS:
FBC 2gV-7
Master Permit No. T / C ._.-t).._19
V_ 1
❑ REVISION EXTENSION 7RENEWAL
CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City
Miami Shores
County
Miami Dade Zip:
Folio/Parcel#:
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Is the Building Historically Designated: Yes NO
Occupancy Type:
Load:
Construction Type:
Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):
Address: c��l 2
B��ePhonne#�[ n 2
City:' VI& �7�V' f State: L/
Tenant/Lessee Name: Phone#:
Email
CONTRACTOR: Company Name:
Address:
City: qq
Qualifier Name: e
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Ad
Value of Work for this Permit:
Type of Work: ❑ Addition
Description of Work:
0
State:]- L zip:: ,� i `
t ) '-;7 Phone#:
--ti --7�
Certificate of Competency #:
Ayco Q yPhone#:
nn /1 VCity: State: ip:
1) , D Square/Linear Footage of Work:
ration ❑ New ❑ Repair/Replace ❑ emolition
Specify color of c for thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $ _
CCF $_
DBPR $
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
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 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.
1C Signatur� SignatureIce
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
dav of �� 20 l� by _ day of _ , 2 by
1f17who is personally known to ( 1 Z , wh ersonalIy known
me or s pro uce _ as me or who has produced as
identification and who did take an oath. identification and who did tak n oath.
NOTARY PUBLIC: NOTARY PUBLI
.,.
n0.Y PVP��i,'OUBERT PiERPE
Notary Public • Statr of Rnrida
* , : Cortisslon # FF 9;9121
Sign:0;Sign: '��� oFc�Q;•` r�y ornm. Expires ay , 2020
.
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Print: r/i% Print:
Seal: °.5' .. 0IANE SCHWARTZ Seal:
�.v .
5 ko'3'Y P "'c -Sate or Florida
COmmissior: GG 142572 _
My Comm. Expires May 6, 2020
Borded through National NOtaryAssn.
APPROVED BY Plans Plans Examiner Zoning
Structural Review
(Revised02/24/2014)
Clerk