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ELC-19-1187Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 180 NE 99 ST, Miami Shores, FL Contacts Issue Date: 08/06/2019 Parcel Number 1132060132230 Permit NO.. ELC-03-19-1187 Permit Type: Electrical - Commercial Work Classification: Alteration Permit status: Approved Expiration: 02/03/2020 Project NE 2 AVE SEWER CONNECTION 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 ORIT@ELYSEEINC.COM Mobile:7862368569 ORIT@ELYSEEINC.COM Other:3058648885 Other:3058648885 BALLAD ELECTRIC INC Contractor HENRY NIGEL Business: 7544008588 BALLADELECTRIC@YAHOO.COM Mobile: 8133626161 Description: CONNECT TO SEWER LINES. Valuation: $ 600.00 Inspection Requests: 305-762-4949 TotalSq Feet: 79.00 .==i � 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 rimed contractor to do the work stated. Authorized Signature: Owner / Applicant / Contractor / August 06, 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 MAY 2 3 2p19 BY: � `U" „". FBC 20 BUILDING Master Permit No. PLC 9-18-2376 PERMIT APPLICATION Sub Permit No .-;E3-� `65—I q - I I BUILDING ❑■ ELECTRIC ❑ ROOFING REVISION EXTENSION RENEWAL PLUMBING ❑ MECHANICAL QPUBLIC WORKS CHANGE OF CANCELLATION SHOP CONTRACTOR JOB ADDRESS: 180 NE 99 street DRAWINGS City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:1132060132230 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: Dr Thrower's Skin Care Phone#:F(305) 757-97971 Email: orit@elyseeinc.com CONTRACTOR: Company Names: �Ct A �1 Q GTI/I G J ✓1 C_ Phone#: F) 33G1z-6N Address: �797 I ► l D ✓ o-e_ l City: Qualifier Name: 7-- 6- Zip: 5 -17 d 2- I n e#: State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: Joseph Chan Phone.: 786-488-1000 Address:12000 SW 92 street //,,,,�� city; Miami State Value of Work for this Permit: $ & 6U yy `Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace Description of Work: Electrical Connection from building to pump station, Property is connecting to sewer (PLC 9-18-2376) Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ Radon Fee $ Training/Education Fee $ CCF DBPR $ FL Zip; 33186 ❑ Demolition CO/CC $ Notary $ Double Fee $ Bond $ 2 _ TOTAL FEE NOW DUE $ �. J (Revised02/24/2014) 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 on estimated value exceeding $1500, 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 OWNER orAGEN CONTRACTOR The foregoing me or who has produced did take dA oath acknowledged before me this 4J 20 1 I by Iwho is personally known to me or who has produced' i, ONS as identification 4n2f,who did take an oath. NOTARY Sign: / Sign: V— Print: 5 Print: ,"t01141 Q Seal: ;.•�;Jd' STACYOSKOLSKI Notary Public Seal: Yo ;• SINDIA ALVAREZ - State of Florida .: Commission a GG071356 ,�°` i. ♦: = MY COMMISSION # GG 238273 3, 2022 My Comm. Expires Apr 11, 2021 ''Oci` :• a; EXPIRES: September ssssssssssssssssssssss t h On sssllrw>A•ss4ger641k`>�0�ill�9iai{'"s ssssssssssssssssss ���o'F��P< ss Thru Notary Public Underwriters �I`Ul! `Plans APPROVED BY Examiner Zoning s Structural Review Clerk (Revised02/24/2014)