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ELC-19-1186Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 rf ly"� !-A-WXC Issue Date: 08/06/2019 Permit NO.: ELC-03-19-1186 Permit Type: Electrical - Commercial Work Classification: Alteration Permit Status: Approved Expiration: 02/03/2020 Location Address Parcel Number Project 9806 NE 2 AVE, Miami Shores, FL 1132060132241 NE 2 AVE SEWER CONNECTION Contacts MIAMI SHORES CENTER LLC Owner MIAMI SHORES CENTER LLC Applicant 20171 ST 309, MIAMI BEACH, FL 33141 20171 ST 309, MIAMI BEACH, FL 33141 Mobile:7862368569 GRIT@ELYSEElNC.COM Mobile:7862368569 ORIT@ELYSEEINC.COM Other:3058648885 Other:3058648885 BALLAD ELECTRIC INC Contractor HENRY NIGEL Business: 7544008588 BALLADELECTRIC@YAHOO.COM Mobile: 8133626161 ti Description: CONNECT TO SEWER LINES. Valuation: $ 600.00 nests: Ins 305-ection Requests: TotalSq Feet: 75.00 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 Building Department Copy Payments Date Paid Amt Paid Total Fees $110.30 Credit Card 08/06/2019 $60.30 Credit Card 05/23/2019 $50.00 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 construction and zoning. Futhermore, I authorize the above named contractor to do the work stated. r Authorized Signature: Owner / Applicant / Contractor / Agent 0 Date August 06, 2019 Page 2 of 2 gECEIVF Miami Shores Village MA 23 2019 Building Department BY: 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 (� FBC 20 BUILDING Master Permit No. PLC 9-18-2374 PERMIT APPLICATION Sub Permit No.u_`os - 19 — ❑BUILDING ❑■ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING [—]MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 9806 NE 2nd Ave City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:1132060132241 Is the Building Historically Designated: Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Miami Shores Center LLC Phone#. 305-864-8885 Address:210 Seventy First Street city: Miami Beach State: FL Zip: 33141 Tenant/Lessee Name: Miami Theater Center Phone#:a305) 751-955Q Email: orit@elyseeinc.com CONTRACTOR: Company Name: 12>Q j� cj e tt eC V t C, i ✓l C Phone#: Address: 4� 27 ► ` to'Iyo'e' 7 f City: Lief y i Qualifier Name: F(i Zip: `3 Zi 0 L ( one#: p �State Certification or Registration #: Certificate of Competency #: / f 0 O05 Z.0 DESIGNER: Architect/Engineer: Joseph Chan Phone#: 786-488-1000 Address:12000 SW 92 street City: Miami State: FL Zip: 33186 Value of Work for this Permit: $ (Oco ' tO Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of work: Electrical connection from building to pump station, Property is connecting to sewer (PLC 9-18-2374) Specify color of color thru tile: Submittal Fee $ ��` Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ CCF $ CO/CC $ DBPR $ Notary Double Fee $ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) -W Bonding Company's Name (if applicable) na Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address na 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. Signature Signature / ;4 OWNER or AGENT CONTRACTOR The foregoing instru ent was 1 cnowledged before a this iy f 2`O,e� by who is personall�kn.w o me or who has produced as identification and who did take an oath. Signt Print: Seal: **************** The foregoing instru enUL K-wh ledged before me this day of 20 is by is personally known to me or who has produced T��-h U6L ucaj 5 as NOTARY Print: STACY OSKOLSKI Seal: Notary Public -State of Florida Commission Y GG 071356 My Comm. Expires Apr 11, 2021 d who did take an oath. MY COMMISSION # GG 238273 EXPIRES: September 3, 2022 For F4°`' Bonded Thru Notary Public Underwriters s****s**s*ssssss*s*s*ssss*sssssss*ss*ssssss*ssss**sssss*** APPROVED BNJ Plans Examiner Zoning Structural Review Clerk (Revisedo2/24/2014)