EL-18-3105Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date:12/OS/2018
Location Address Parcel Number
1090 NE 104TH ST, Miami Shores, FL 33138 1122320290190
Contacts
Permit No.: EL-10-18-3105
Permit Type::: Electrical - Residential
Work Classification: Pool
Permit status: Approved
Expiration: 04/08/2019
ERIKA BATEY Owner
1090 104
DAW ELECTRIC INC Contractor
DERRICK ANTHONY WILLIAMS
20421 NW 22ND AVE, MIAMI , FL 33056
Business: 7868773500
Description: ELECTRICAL HOOK UP FOR POOL, SPA, 5 TON Valuation: $ 1,500.00 Inspection Requests:
HEATER, ALARMS 305-162-4949
Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$1.20
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.40
Permit Fee
$50.00
Scanning Fee
$9.00
Technology Fee
$2.50
Total:
$117.10
Payments Date Paid
Amt Paid
Total Fees
$117.10
Check # 43042 12/05/2018
$67.10
Check # 42919 10/09/2018
$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
regulatingseAtruction and zonj�jg Futhermore, I authorize the above named contractor to do the work stated.
Aut'Wed Signatur . Owner / Applicant / Contractor / Agent Date
December 05, 2018 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 Q ELECTRIC ❑ ROOFING
RE+C'�`�YrF�D
C 4 2018
BY:— _,P'
FBC 20
Master Permit No. b P? I S -31o4
Sub Permit No. �-_L la - 3 105,
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
�ii CONTRACTOR DRAWINGS
JOB ADDRESS: I
I b `1 �*
City: Miami Shores ^ County' Miami Dade Zip'
Folio/Parcel#: 0 a�3� 0 c�i� IDI-1-0 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: ByFE: FFE:
OWNER: Name (Fee Simple Titleholder): k1(,bj r Melle+T -rlZs�- �I (k ne#f
Address: ilia tib Q f f 6 LA %oak`
City: iA I A" S h0NQ State: —Zip:
Tenant/Lessee Name:
Email:
Phone#:
CONTRACTOR: Company Name: D.A.W. Electric Inc. Phone#: 786-877-3500
nrlrlrar- 20421 NW 22th Ave.
City: Miami State: Florida Zip: 33056
Qualifier Name: Derrick Williams Phone#: 786-877-3500
State Certification or Registration #^: EC-13005443 Certificate of Competency #:
DESIGNER: Architect/Engineer: 1-)8 (kOJ � + � So � � Phone#: Q �� 9 S_-9 �1`�
Address: �7 ci U N 1 CA. City: (0 1 State: Fl Zip:
Value of Work for this Permit: $ Sy Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration New ❑ Re it/Re ce ❑ Demolitions /
Description of Work: C. �"'� v
Specify color bf r6ldf thru tUe
Submittal Fee $ S Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Technology Fee $_
Structural Reviews $
Radon Fee $
Training/Education Fee $
DBPR $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
N/A
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
Zi
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 Gen 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
OWNER or AGE
The foregoing instrument was acknowledged before me this
I7 day of _5 20 Imby
who is personally known to
me or who has produced 1724as
identification and who did take an oath.
NOTARY PUBLIC:
Signature
0�zd
CONTRACTOR
The foregoing nS'LruRient was acknowledged before me this
day of 20, by
p Q a-ILH 1A)A.1d r0(, , who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
as
Sig ...
— Sign:
I
'*:
COMMISSION F 97
d Y\ I ,
Prin :
20
Print:
s'y
Bdd Thru Noary Pubic Und awdtars
Seal:
VAN KIRK11
MCOMMSION # GG 070833
e8=W
EXPIRES: June 7,2021
####################
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dROBERT
11vu Notary Pubic UrM mOln
#############
APPROVED B
d6'
Plans Examiner
Zoning
Structural Review Clerk
(Revised02/24/2014)