EL-19-923Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date:
Location Address Parcel Number
10504 NW 2ND AVE, Miami Shores, FL 33150 1121360020010
Contacts
Permit NO.: L-04-19-923
Permit Type: 8ectriCal - Residential
Work Classification: Service Change
Permit Status: Approved
Expiration: 10/23/2019
NORMA CHACON Owner METRO ELECTRIC SERVICE, INC Contractor
10504 NW 2 AVE, MIAMI SHORES, FL 33150 OMAR R HERNANDEZ
Other: 7862522232 15050 NE 20th Ave, North Miami, FL 33181
Business: 3059451991
Other:3059451991
R
Description: UPGRADE SERVICE ENTRANCE 125 TO 200 AMP Valuation: $ 1,700.00 Requests:
Inspect - Inspection R
TotalSq Feet: 150.00
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
$3.00
Technology Fee
$2.50
Total:
$111.10
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$111.10
Cash
04/26/2019 $50.00
Credit Card
05/03/2019 $61.10
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
regu ing construction and �Oning. Futhermore, I authorize the above named contractor to do the work stated.
/i C
rized Signature: OAne-r / Applicant / Contractor / Agent
May 03, 2019
Date
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 X ELECTRIC ❑ ROOFING
C I)
APR 6 2
BY:
FBC 20
Master Permit No. I� — d
Sub Permit No. J
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: / 05-0q lvw 2 A_ve,'
City: Miami Shores County: Miami Dade Zip: 3 % -s'o
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):A✓O- P WA -I✓ h A- e-C))y Phone#: � � ' ZSZ - Z.Z j Z
Address: 0 15 d q ry-C" 2-'t ye--
City: /2/,1 4 V1 " S /) 0 KG State: -- t/ �-
Tenant/Lessee Name:
Email
Zip:
a
�8G - Zs z 2 z 3 z
CONTRACTOR: Company Name: 6 EC7 /'ic -��4i%&rzj Phone#:
Address: /yf W 4-10 6396 u.
City: Mt *- State: A, Zip: /' �S
Qualifier Name: &&/ Phone#06 31-34
State Certification or Registration #:`� d Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New E4 Repair/Replace' ❑ Demolition
Description of Work: UT—�, rQ G(e - l ' C z- Ci /✓ah N C4:5�
y 2577- 12Q _ A14n
Specify color of color thru tile:
Submittal Fee $ I Permit Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Radon Fee $
Training/Education Fee $
CCF $ CO/CC $
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ Ey
(Revised02/24/2014)
f
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 ap ant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be deliver to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commence s osted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. I en uch posted notice, the
inspection will not be approved and a reinspection fee will be charged.
r
Signature .
t OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of5' , 20 & by
me or who has produced
identification and whd did take an oath.
NOTARY PUBLIC:
Sign:
Signature o /
CONTRACTOR
J
The foregoing instrument was acknowledged before me this
=--t — day of 11✓,,� �- 20 / by
~oic w- K! who is personally known to
as me or who has produced
identification and who did
NOTARY PUBLIC:
Sign:
Print: Print:
�1 Jorge Rousseau ate of Florida
Seal: P.41,
+'' j`yCommission GG 193011 Seal:
�tNn4�. • Expires 05/04/2022
Notary
as
an oath.
c StateAo
n sioa GG
*******************************************************************************************************
APPROVED BY (� Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)