EL-19-2974Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
82 NW 100TH TER, Miami Shores, FL 33150
Cnntaets
Permit o.: EL-12-19-2974
Permit Type: Electrical - Residential
Work Classification: Addition/Alteration
Permit Status: Approved
Issue Date:12/23/2019 Expirafion: 06/22/2020
Parcel Number
1131010180360
ASS[ SILES Owner
82 100 TER
SOUTH DOM ELECTRIC INC Contractor
JOSE MATOS
5860 NW 192 ST, MIAMI, FL 33015
Business: 3056265904
Description: ELECTRICAL WIRING Valuation: $ 8,800.00 Inspection Requests:
r-1-162-4949
Total Sq Feet: 913.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$5.40
DBPR Fee
$4.62
DCA Fee
$3.08
Education Surcharge
$1.80
Permit Fee
$258.00
Scanning Fee
$3.00
Technology Fee
$7.70
Total:
$333.60
Payments
Date Paid Amt Paid
Total Fees
$333.60
Credit Card
12/18/2019 $50.00
Credit Card
12/23/2019 $283.60
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 cent' that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating construction anq Futhermore, I authorize the above named contractor to do the work stated.
Owner / Applicant / Contractor / Agent
Date
December 23, 2019 Page 2 of 2
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 [� ELECTRIC ❑ ROOFING
C
DEC 18
M.
FBC 20
Master Permit No. R C- /7
Sub Permit No. EL I Z-1 1 -ZT74
REVISION EXTENSION RENEWAL
PLUMBING MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION Ej SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: OZ 1,�Z� `D1�9 `o /L/` 2
City Miami Shores County Miami Dade Zia: J 3�
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
City: Ur/f amp QC�I�� State: rL- Zip:
Tenant/Lessee Name:
Email
CONTRACTOR: Company Name: _S ()��/C� C Phone#:
Address:
City: n A % State: `I Zip:
Qualifier Name: / v l L Phone#:
State Certification or Registration #: ;L 13 ` � / Certificate of Competency #: _
DESIGNER: Architect/Engineer:
F(9i- OP 5 �-
State• Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: (�L Addition Alteration ❑ New ❑ Repair/Replace
Descrintion of Work:
Specify color of color thru tile:
Submittal Fee $ 0 ICI Permit Fee $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $,
DBPR $
❑ Demolition
CO/CC $
Notary $
Double Fee $
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $
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. 1 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
:0;0 r AGENT
The foregoing instrument was acknowledged beforemethis
1* day of , 20 1 1 by
AC-
1 S , who is personally known to
me or who has prodkced ^ as
and who d%I take an oath.
r
Signature A & e -
CONTRACTOR
The foregoing instrument was acknowledged before me this
1� daay,of-bCO—+- ri LC-2- . 20 16 . by
wFio is personally known to
me or who has producedV- WA QQ LA-N-t4� as
identification and who did take an oath.
OTA Y PU LIC: `\`����y-�DY'PRlEr0,/XV*, NOTARY
�::a•�•SSONF. i
A VOGH25,�0%per;,•
Sign: — • • • ' * Egn:_
Print: = 0 V -a,3)rint: --, 1 hrDtP f--UV av
e '
Seal: �i��9 �.iic u�dg • ������� Seal: �;, : i:• SINDIA ALVAREZ
�80 1, SIN \�\\` EXPIRESISSeptember ION#GG ?20223
:',•,' °fir gated Tlw Pbterl+ PuW� Unctavtam
l
APPROVED BY Ins Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)