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ELC-19-1805Miami Shores Village 10050 NE 2 Ave Miami Shores Fl. 33138 305-795-2204 Location Address Issue Date: 09/06/2019 Parcel Number Permit NO.: ELC-08-18-1805 Permit Type: Electrical - Commercial Work Classification: Service Change Permit Status: Approved Expiration: 02/03/2020 Project 180 NE 99 ST, Miami Shores, FL 1132060132230 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 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: NEW SERVICE AT 180 NE 99 ST PUMPS FOR SEWER Valuation: $ 3,800.00 Inspection Requests: _ CONNECTION 305-762-4949 Total Scl Feet: 79.00 Fees Amount Application Fee - Other $50.00 CCF $2.40 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.80 Permit Fee $83.00 Scanning Fee $3.00 Technology Fee $3.33 Total: $146.53 Payments Date Paid Amt Paid Total Fees $146.53 Credit Card 08/06/2019 $146.53 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 construction and zoning. Futhermore, I authorize the above named contractor to do the work staid. Authorized Signature: Owner / Applicant / Contractor / Agent Date August 06, 2019 Page 2 of 2 BUILDING PERMIT APPLICATION ❑BUILDING Q ELECTRIC 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 ❑ ROOFING PLUMBING ❑ MECHANICAL PUBLIC WORKS JOB ADDRESS: 180 NE 99 street FBC 20 Master Permit No. PLC 9-18-2376 Sub Permit No.'F_ Lc - C9 -1 cI - I �OS ❑ REVISION ❑ EXTENSION ❑ RENEWAL CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR 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) 757-9797 Email: orit@elyseeinc.com CONTRACTOR: Company Name: Ballad Electric Inc. Phone#: (754)400-8588 Address: 4725 Monroe Street City: Hollywood State: Florida Zip: 33021 Qualifier Name: Nigel B. Henry Phone#: (813)362-6161 State Certification or Registration M ER13015192 Certificate of Competency #: DESIGNER: Architect/Engineer: Joseph Chan Phone#: 786-488-1000 Address:12000 SW 92 street �� City. Miami State: FL Value of Work for this Permit: $ 34 BIJV' W Square/Linear Footage of Work: Zip: 33186 Type of Work: ❑ Addition ❑ Alteration N New ❑ Repair/Replace ❑ Demolition Description of Work: New service at 180 NE 99 Street, pumps for sewer connection Property is connecting to sewer (PLC 9-18-2376) Specify color f color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Structural Reviews $ Training/Education Fee $ CCF $ CO/CC $ _ DBPR $ Notary $ Double Fee $ _ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address A City State Zip Mortgage Lender's Name (if applicable) I Mortgage Lender's Address City State 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 reinspecti will be charged. Signature Signature OWNER or AGENT CONTRACTOR The fo a oing instrument was acknowledged before me this day of 120 by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: a APPROVED BY The foregoing instrument was acknowledged before me this day f ' 1 20 11 by i- i t t. -nlL w o is personally known to me or who has produced C ( kq 1Ir as m1111111111JJ/it identific tion d w did take an oath. � Y � /�j// OTAR PUBL , �`\`','••' N25.2•� s Sign: / .� w► 0l/l - 40.. • Print: C;�OI r� � s" B � ORITMIMOUN Seal: MY COMMISSION162406 /11111111 Ew'IRES: December 14, 2021 Bonded T1 Plans Examiner Structural Review Zoning Clerk (Revised02/24/2014) 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 FBC 20 BUILDING Master Permit No. PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑ ROOFING Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Phone#: Address: City: State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: .�7 g!; 114 � �(-GLfV"6Ge, 1 -_L � Phone#: Address: %� 251 ' " zC"1VD'e- `4— City: 1�((�/L" C'd ' ' I State: li Zip: ©21 Qualifier Name: �C r ! u G� /-�yi ✓• 2 Phone#: State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: ne#: Address.:, ;.w.,:s:. City: State: Zip: Value of Work.for.this:Permit: $ Square/Linear Footage of Work: Type of Work: ,❑, Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition Description of,Work , Specifyjcolor�bf color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ Radon Fee $ Training/Education Fee $ CCF $ CO/CC $ _ DBPR $ Notary $ Double Fee $ _ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) 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 BUILDING PERMIT APPLICATION ❑BUILDING O ELECTRIC ❑ ROOFING ❑ REVISION [PLUMBING [ MECHANICAL MPUBLICWORKS ❑ CHANGE JOB ADDRESS: 180 NE 99 street CONTRA Folio/Pa rcela:1132060132230 Occupancy Type: Load: OWNER: Name (Fee Simple Titleholder): - Address: 210 Seventy First Streel City, Miami Beach Tenant/Lessee Name: Dr Thrower's Email: orit@el eeinc.com Miami S461es Center Care CONTRACTOR: Comps Name: Ballad Elgctric Inc. Address: 4725 MonrobStreet \ FL City: Hollywood State: Florida Qualifier Name: Nigel B. Hen State Certification or Registration 9: 130151 2 DESIGNER: Architect/Engineer: Joseph &n Address:12000 SW 92 street Value of Work for this Permit: $ f mE Type of Work: ❑ Addition ❑ Alteration © N Description of work: New service at 180 NE 99 Stre , Property is connecting to sewer (PLC 9-18-23 ) Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Trainl /Education Fee S Structural Reviews $ (Ft a v: $e d 02/2»/20I: ) R E C I V E I AUG 0 5 2019 t-Q" FBc zc Cl No. PLC 9-18-2376 Sub Permi o. EXTEN OI ( [ CANCELLA ❑RENEWAL ❑ SHOP DRAWINGS i Hiitorl�lly Designated: Yes NO X Flood Zone: BFE: FFE: 1 P, ,,, ,. 305-864-8885 Zip: 33141 ,(305) 9797' (754)400-8588 Zip: 33021 (813)362-6161 ificaA of Competencya: Phone#: 786-488-1000 . Miami State: FL Zip: 33186 fear Footage of Work: ❑ Repair/Replace ❑ Demolition for sewer connection CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address C;ty State 1 Zia Mortgage Lender's Name (if applicao.e) Mortgage Lender's Address City 5tate Zia Application is hereby made to obtain a permit to do the work and instatiaCons as indicated. I certify that no work or insta,lation has cornmerced prior to the issuance of a perm't and that all work wilt be performed to meet the standards of all laws regulating construction in this jurisciction. I understand that a separate permit most be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC...,. OWNER'S AFFIDAVIT: I certfy that all the foregoing information is accurate and that all work will be done in comol;ance w:th all aoplicable 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 o building permit with or, estimated volue exceeding $2500, the applicant must Promise in good faith that a copy of the notice of commencement and construction lien lac-, brochure will be delivered to the person whose property is subject to attachment. Also, o 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 rernspection fe .ill a charged. / Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument :va acknowledged befo-e me tc;s rq ,'°d�f' °_f '! p 20 , by `:, r` day r�%f� J urn r .20 I �( by ��.(lWM H o is personally knowr to V r1 r 1 J { �tili .I who is personally anown to l � \ I me or v.+C nas produced as me or whoo��has produced 1 ) I iV' t { (601K" as identification and who did take an oath. idenofic8:ion and who did take an oath. ��ti�Y1Pfi(FT� //ij NOTARY PUBLIC: NOTARY PUBLIC: '+�Et ; • ��i Sign: Sign ` \ = ®•� J ac Print i` k 40 Print: I , o g 1 �' 'rY, • p& `\ i cy,� 11 I bk Seal: � ,��`s ORIT Mwom .oMM!.g1m,IMJWA IRES: DBoember 14, 2021 Thru Notary Pu%& 1 t,rns., Plans Examiner Zoning jl. V-41-t" 1,141 _ ( Structural Review Clerk