ELC-19-2395Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
IJ�:�"Itnnjiiir
Issue Date:12/17/2019
Location Address Parcel Number
9022 NE STH AVE 1K, Miami Shores, FL 33138 1132060420110
Contacts
Permit NO.: ELC-10-19-2395
Permit Type: Electrical - Commercial
Work Classification: Alteration
Permit Status: Approved
Expiration: 06/15/2020
9022 NE 8 AVE 1 K LLC Owner
501 GRAND CONCOURSE, MIAMI SHORES, 33138
Home: 3059864803
LS CURTIS INC Contractor
LEWIS CURTIS
20341 NE 30 AVE 108, MIAMI , FL 33180
Business: 3059330683
Inspection Requests:
Description: ELECTRICAL IN THE BATHROOM & KITCHEN UP TO Valuation: $ 3,200.00 Inspec i n Re
CO49
DE
Total Sq Feet: 70.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$2.40
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.80
Permit Fee
$50.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$112.70
Payments
Date Paid Amt Paid
Total Fees
$112.70
Check # 2295
12/17/2019 $62.70
Check # 2259
10/09/2019 $50.00
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 nd oning. Futhermore, I authorize the above named contractor to do the work stated.
orized SignaturellCjdmer\ / App iicant / Contractor / Agent
December 17, 2019 Page 2 of 2
Miami Shores Village RECEIVE-0
Building Department
44-
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 lJ/st v
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 2017
BUILDING Master Permit No. CC- (0 - I Cl
PERMIT APPLICATION Sub Permit No.ac- 10— 19- 939S
BUILDING 'ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION RENEWAL
r-jPLUMBING ❑ MECHANICAL EJPUBLICWORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: Q O 7i? �� �L— '�U� 4 U 13 1 % 1— 1,/
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: (' zi�6- 044-2 ` 1 V Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 90 7;1- 1V E � • � f �-L Phone#: 70-1- f!"�
Address: <D-1 -" e,.Vjc
City: /`-f r A±A( S/[�� State: _0:1 Zip:,S, j_1 16S
Tenant/Lessee Name: CY—A Phone#:
Email:
CONTRACTOR: Company Name: ! (2 �� ( ,yI N Ke Phone#: 7
Address: 0 e 22O-**-' � �-� "� � O�
City: ��) C�Nil7 (POA� State: 1 Zip: f
Qualifier Name:
State Certification or Registration #: �j �b Certificate of Competency #:
DESIGNER: Architect/Engineer: N) -Phone#: _
Address: City: State:
Value of Work for this Permit: $ .� n� .O� Square/Linear Footage of Work:
Zip:
!e of W?4TJfi �# y.i 1ffl� ation ❑ New Repair/Replace ❑ Demolition
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Permit 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)
Bonding Company's Name (if applicable) A
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
-
Signature P�11-1 Signature
d1-1OW-WM N PENT
F,� !�-��q�t
The foregoing instrument was acknowledged before me this
day of 0 c-F*J--- — 20 1 "2 by
c,4, c r— C. ,y FFv who i personally know o
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of j 20 / by
/? ,f�2" who is personal y mown
as me or who has produced
identificati
NOTARY P
Sign- Sign:_
Print: Print:
Seal:
LISA CHRISTINA FLORES
Notary Public - State of Florida
*My Comm. xpves in __
Bonded through National Notary Assn.
Seal:
and who did take an oath.
as
�$AlpllA fl6detA
Ngtwy Pubk - 9ta" of FWld&
i N FF 979238
My CoMm. Expires Jul 25, A_N
*****************************************************************
Examiner Zoning
(Revised02/24/2014)
Structural Review Clerk