EL-18-1240�sNO1iF; y�
Miami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
++�f—
Phone: (305)795-2204
FCORIOp'
Permit No. EL-5-18-1240
Permit Type: Electrical - Residential
'Perli'll Work Classification: Addition/Alteration
Permit Status: APPROVED
Issue gate:6/11/2018 1 Expiration:11/07/2018
Project Address Parcel Number Applicant
141 NW 101 Street 1131010220170
Miami Shores, FL 33150- Block: Lot: COLBY NEUMANN
Owner Information Address Phone Cell
COLBY NEUMANN 141 NW 101 Street (786)210-9004
MIAMI SHORES FL 33150-
141 NW 101 Street
MIAMI SHORES FL 33150-
Contractor(s) Phone Cell Phone
HOME OWNER
Type of Work: ELECTRICAL WORK FOR KITCHEN & BATH
Additional Info: ELECTRICAL WORK FOR KITCHEN & BATH
-lassification: Residential
Scanning: 1
Fees Due
Amount
CCF
$1.20
DBPR Fee
$2.25
DCA Fee
$2.00
Education Surcharge
$0.40
Notary Fee
$5.00
Permit Fee -Additions/Alterations
$150.00
Scanning Fee
$3.00
Technology Fee
$1.60
Total:
$165.45
Valuation: $ 1,800.00
Total Sq Feet: 0
Pay Date Pay Type Amt Paid Amt Due
Invoice # EL-5-18-67487
05/11/2018 Credit Card
05/09/2018 Credit Card
$ 115.45 $ 50.00
$ 50.00 $ 0.00
Avaname ins
Inspection Type:
Final
Meter Box
Fire Alarm
Service Change
W. W.
Underground
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 AF
construction a
that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
lore, I authoriz the bove-named contractor to do the work stated.
NUN N ym\ay\y 1 May 11, 2018
Authorized Signature: Owner / Applicant / Contractor / Agent Date
Building Department Copy
May 11, 2018
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
i
MA 0 9 2018
FBC 201" 6t4%
BUILDING Master Permit No. I K J q 0
PERMIT APPLICATION Sub Permit No. EL- S' 125 , IZ.40
❑BUILDING a,, LECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [-]RENEWAL
❑ PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
n� �f�� ` i1 r p CONTRACTOR DRAWINGS
JOB ADDRESS: ' ' v • ' ` v I Si 1 -t t�
i 5 0
Folio/Parcel#: (� I 0 I - V 0 1 1- 0 Is the Building Historically Designated: Yes NO
Occupancy Type: i (�' Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): C,� I � 1 lUr 1 r , Phone#: CJ 21 I U U
Address:: � l `1' NW 101 2 f
City: WWI Q� i C V l ky � 3 State: B/ Zip: v13 31 J D A
Tenant/Lessee Name: S �I vvl Nt1 `G ri n Phone#:
Email: �� � • N� �l MR N rl 0►'y*l
CONTRACTOR: Company Name: Phone#:
Address:
City:
Qualifier Name:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Certificate of Competency #:
one#:
Zip:
Address: (�i l City: State:
Value of Work for this Permit: $ I b U Square/Linear Footage of Work:
Zip:
Type of Work: ❑ Addition 0 Alteration
�/�� ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:1
Specify color of color thru tile:
Submittal Fee $ O►1 Permit Fee $ f -4'), DD
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)
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.
4ASignature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
Cit* day of 20 $, by
Fft1�O - \- &UMMINV1who is personally known to
me or lo has produced riV-QY UC%X1-!4 as
identifica on a w o did take
NOTARY UBLIC:
Sign:
Print: U Ot
Seal:
YANADY PRIETO
MY COMMISSION # FF 214031
-,.p
EXPiRES: March 25, 2019
;, 4.
Bonded Thrc Notary Put' c Underwriters
The foregoing instrument was acknowledged before me this
day of , 20 , by
, who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
APPROVED BY �L 7 �iS� i��i Plans Examiner
Structural Review
as
Zoning
Clerk
(Revised02/24/2014)