EL-19-1765Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
PGIAJ111-111-�
Issue Date: 08/02/2019
Parcel Number
1158 NE 99 5T, Miami Shores, FL 33138 1132050180130
Contacts
Permit NO.: L-07-19-1765
Permit Type: Electrical - Residential
Work Classification: Alteration
PermitStotus: Approved
Expiration: 01/29/2020
SUSAN PINNAS Owner SUSAN PINNAS Applicant
1158 NE 99 ST, MIAMI SHORES, FL 331382641 1158 NE 99 ST, MIAMI SHORES, FL 331382641
AV ELECTRICAL SERVICE INC Contractor
FELIX NEGRIN
Business: 3052187347
Description: ELECTRICAL RENOVATION Valuation: $ 12,000.00 Inspection Requests:
f55-112-4949
Total Sq Feet: 695.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$7.20
DBPR Fee
$6.30
DCA Fee
$4.20
Education Surcharge
$2.40
Permit Fee
$370.00
Scanning Fee
$3.00
Technology Fee
$10.50
Total:
$453.60
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$453.60
Credit Card
08/02/2019 $453.60
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.
Authorized Signature: Owner / Applicant / Contractor / Agent Date
August 02, 2019 Page 2 of 2
'�J� ,X
>/_�w
BUILDING
PERMIT APPLICATION
Miami Shores Village REcr, IED
Building Department o ass
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 BY'
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20
Master Permit No. — 2"
Sub Permit No.
❑ BUILDING Uf ELECTRIC ❑ ROOFING
❑PLUMBING [:]MECHANICAL [:]PUBLICWORKS
JOB ADDRESS: 1 \ 5-51" �_L 1E ITT r t
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: \1 — 31 04;6�_ a -I P— b ( 3 0 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 5�� 1' ( /4 N Af Phone#:
Address: h&_+� Z) (�C, .1;1
City: tJXAA'1V'L J(w'" State: Zip:
Tenant/Lessee Name:
hone#:
Email:
�f �- _ Z
CONTRACTOR: Company Name: � V Fk (,. 15211 S• Cap- Phone#: 50 5— 21A — I W7
Addrenss/:: 11-f lV 1 I f �), Ky' 1 L JCkf VL
City: IIWI State:
Qualifier Name: —i 7<,UX A . M<q-f ► i\
State Certification or Registration #:
DESIGNER: Architect/Engineer:
hone#:
Certificate of Competency #: _
Phone#:
Address: City: State:
Value of Work for this Permit: $'®y CEO • 6Q) Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace
Description of Work: Sue (-.2 9_'LC-h 1. R� as L) LIZ. "-t
Specify color of color thru tile;
Submittal Fee $ Permit Fee $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
p: �31�S9
Zip:
❑ Demolition
CCF $ CO/CC $
DBPR $
Notary $
Double Fee $
Structural Reviews $,
(Revised02/24/2014)
Bond $
TOTAL FEE NOW DUE $ S 3 - 66
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
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 a d reinspection fee will be charged.
SignatureN Signature
OWNER or AGENT NTRACTOR
The foregoing instrument as a cnowledged before me this The foregoing instrumentwasacknowledged before me this
day of 20 ��, by day of 2012 by
who is personally known toX NtP4r� /1 , who is ersonally I wn to
me or who has produced - - ash me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC:
Sign:
- Print:
NOTARY PUBLIC:
ISB Sign:_
# GO 103959
ii gn9i Print: C
`4,Rf (iiiw Banded Thru Notary Public Underwrbrs a . �bWdO Zd FAM6
Seal: Seal: +r
otlOdam YeN2�
************************************************************************************************************
APPROVED BY 3�,7rco� 1/%� Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)