DS-19-915Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Permit NO.: DS-04-19-915
Permit Type: Driveways/Sidewalks/Slabs
V@Imht Work Classifrcatfon: New
Issue Date:
Location Address Parcel Number
1020 NE 93RD ST, Miami Shores, FL 33138 11320501SO140
Contacts
Permit Status: Approved
Expiration: 12/11/2019
J LANE MIDDLETON Owner ALL QUALITY ELECTRICAL SERVICES, INC Contractor
1020 NE 93 ST, MIAMI, FL 331382939 SAMUEL LIGHTBOURNE
14500 NW 16 CT, MIAMI, FL 33167
Business: 3059687832
Description: GENERATOR Valuation: $ 800.00 Ins ection Requests:
1305-762-049
Tot alSq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$0.60
Concrete/asphalt/pavers, slabs, dways,
$50.00
swalks
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.20
Planning and Zoning Review Fee
$35.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$145.30
Payments
Date Paid Amt Paid
Total Fees
$145.30
Credit Card
06/14/2019 $145.30
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
regulating construction and zoning. Futhermore, I authorize the above r
and that all tork w II be done in compliance with all applicable laws
tractor to do t e w k statari.
Authorized Signature: Owner / Applicant / Contractor / Agent Date
June 14, 2019 Page 2 of 2
Miami Shores Village RECEIVED
Building Department APR 25 2019
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
��F^^BC ton
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No1)S CH-iol -Cl : S
(rUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
��ll J CONTRACTOR DRAWINGS
JOB ADDRESS: /V 7 C)
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: //- J 2(� j -0 %S — 6 / V-0 Is the Building Historically Designated: Yes NO
Occupancy Type: ,) Q r Load: Construction Type: "S Flood Zone: ky BFE: FFE:
OWNER: Name (Fee Simple Titleholder): ! ! Phone#: 3o! cl, ,FY-
Address: 1620 iW5 S
City: "to M
Tenant/Lessee Name:
Email
CON"
Addr
City:
Quall
State
DESK
State: /-' 1. Zip: 3 9 1 3 v
Phone#:
hone#: 3&5- 26 / MY
5 1.6
hone#: ),0
hone#:
Address: City: State:
Value of Work for this Permit: $ Square Linear Footage of Work: 41
Type of Work: ElAddition ElAlteration New ❑ Repair/Replace
Description of Work:
i>®
Specify color of col r ru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
Zip:
S0 FF
❑ Demolition
t • a ... ,4GA ��r
DBPR $
Double Fee $
Bond $ TOTAL FEE NOW DUE $ I q ! 33
,Bonding Company's Name (if applicable)
.1
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.
�QJ&oSignature 6LLSignature
[� OWNER or AGENT CONTRACTOR
L— _ ..r
The foregoing instrumen was acknowledged before me this
/g;2�L day of 20 / 9 by
hT "t- %�d G , who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
as
The foregWg instrument w s acknowledged before me this
ay of j 20, by
L� who is ersonally known o
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: /"t ! Sign:_
Print: ^'/ �m `� Print:
Seal:
E;+P
'�or a'
******** ***s
APPROVED BY
(Revised02/24/2014)
K.
Seal: _'• : v: _ Commission # FF 933693
NAOIAM. RAMOS
%; `o`c My Comm. Expires Nov 4, 2019
, r� p�.
Notary Public • State of Florida ° Bonded through National Notary Assn.
Commission # GG 241067
Assn. I (�I
4 Plans Examiner Zoning
Structural Review
Clerk