EL-05-19-1112, 1420 NE 101st StMiami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
s ri r
Permit r us Wttd
€
Expiration: 08/19/2020
Location Address Parcel Number
1420 NE 101ST ST, Miami Shores, FL 33138 1132050230050
Contacts
MATTHEW ALLENOwner RCI ELECTRIC INC Contractor
1420 NE 101 ST, MIAMI SHORES, FL 33138 HOWARD DENVER HAMILTON
Other:3056732847
Business: 5617478150
Inspection Requests
[ Description: ELECTRICAL HOOK UP FOR POOL, SPA, 5TON Valuation: $ 1,000.00
I{ HEATER, ALARMS a h
Total Sq Feet: 0.00 ;E
Fees
Amount
Application Fee - Other
$50.00
CCF
$0.60
Change of Contractor
$110.00
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.20
Permit Fee
$50.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$220.30
Building Department Copy
Payments
Date Paid
Amt Paid
Total Fees
$220.30
Check# 110068
08/01/2019
$60.30
Check # 43392
05/16/2019
$50.00
Check# 121266
11/10/2020
$110.00
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 1 Contractor / Agent Date
November 10, 2020 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 0 ELECTRIC ❑ ROOFING
FBC 20
Master Permit No. [0-)1j1P-oS - � � _ 1 � � S
Sub Permit Noll- 01-3 -. 101 - I I I a
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: h-0-0
City: Miami Shores T� County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): kt.allap'LAj i6A I cjf) Phone#: �_ S (413 Al
Address: ILAI�Lo �j t�_ ( 0 1 'f
City: V I(.(,,l' ', &\L S State: t' Zip:? ( �
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name: K, -A
Phone#:
Address: { S /"�� � 1 UAl 1AA:4 "UY- -r)
City: YV\(?>o \ b91C�'nS State: Zip: l-(l
Qualifier Name." LA)(iiEd �- � 12 k VtcpY1 Phone#:
State Certification or Registration #: � C1 =71O D (Q LA ( Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ I r J CAD Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Permit Fee $ CCF $_
Radon Fee $ DBPR $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CO/CC $ -
Notary $,
Double Fee $ _
Bond $
TOTAL FEE NOW DUE $ _
(Revised02/24/2014)
Bonding Company's Name (if applicable) N/A
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 reinspectro will be charged.
Signature Signature
WNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
0 day of I v JVP ?tom 20 ZO by
CIT�A C',�a>�i AlWo its personally known to
me or who has produced L L L as
identification and who did take an oath.
NOTARY PUBLIC:
The foregoing instrument was acknowledged before me this
day of , 20 by
�A5 16 , who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign: Sign:_
Print: Print:
Seal: ..,.r.,
SELENA ARANDA
MY COMMISSION # GG 971705
49" EXPIRES: March 22, 2024
* * * * * * i �►':�ei;;t�{t�e * �Ilikfh'Ii�iiij M�b'l(�e'`e'�S*
APPROVED BY
LYNN BELLIZZI
Seal: MY COMMISSION 4 GG242424
EXPIRES: July 26, 2022
as
********************************************************************
Plans Examiner
Zoning
(Revised02/24/2014)
Structural Review Clerk
r ,
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CHANGE OF CONTRACTOR / ARCHITECT
Permit N.
-05 - / q - i I
Owner's Name (Fee Simple Title Holder): W%(�&Vjk) j t(1f,rj Phone #:
Owner's Address: K4'c-�kD t U IOV`i"' '&1-YY P A
City:t- o-m l Ste(-zL,3 State : e7lZip Code:3-:�t �,S
Job Address (Of where work is being done):1'
City: Miami Shores
Contractor's Company
1 t-)A `--v VA
State: —Florida Zip Code:
Phone #: 01s-I-Slz� LiLAO-,-;z
Address: l�-A -t �UU l -5rrl Df't V'-'-
City: C( (-?�. �-f%�_ - _- State: f--L Zip I
Qualifier's Name: Ewe.'Eon I-i,- IL— Lic. Number:
Architect/ Engineer of Record Name:
Address:
City:
State:
L-E a
CPC o�s9s�
Phone #:
Zip Code: _
Describe Work: OA/)/-A ( f , 6_1 e Lli- i Cn (`br47 Y, C :k� r
P 01 Cp s L,!�770CY-\
I hereby certify that the work has been abandoned and/or the contractor/architect
is unable or unwilling to complete the contract. I hold the Building Official and the
Miami S ores harmless of all legal in vemen .
Signature �' Signature
Owner or Agent Contractor o Architect
The foregoing instrument was aknowledged before me The for oing instrument was aknowledged before me
this'�) ( day of ,2¢�,by this day of G _. 2ti by �� dr1 C t f
Who is personally kirtow�n�to/me or who has produced
,z /�/ /� (ilfll��/1/fs as indentification.
No;tt Public:
Sig
Seal:
YEE
ate of Florida
amberlain
HH 011108
024
who is personally known to me or who has produced
as indentification.
Nota Public:
Sign:
Seal.
Notary State ofFlorida
Samanthatha Chamberlain
My Commission HH 011108
a� Expires 06/16/2024
4 Van Kirk
& SONS
POOLS & SPAS
D.A.W. Electric, Inc.
Derrick Williams
20200 NW 2nd Ave Ste 301
Miami Gardens, FL 33169-2562
November 5, 2020
I, Van Kirk & Sons, do hereby request D.A.W. Electric, Inc. License number EC-1300054, who is my
electrical subcontractor be removed as the electrical subcontractor for permit # EL-05-19-1116 property
located at 1420 NE 101 Street and be replaced by RCI Electric Inc., License number EC 13002641
�/
Contractor's Signature Date
/Z
STATE OF FLORIDA, COUNTY OFZE�.\�? _ _ .
firmed and subscribed befQre me this _5,:Df) _day of WaZ&,nq b6- 0by
o is personallyknower _,(_Sj-jh _ to me or who has produced
(type of ID) identification.
A , Signature of Notary Public State of Florida
,51:n n 'Xiin Ca LkLn iV\,V-4e- d OA 4, _ Print, Type or Stamp Name of Notary
NMry FubW 15left d Flondo
Samantha Chamberlain
(SEAL) My Commosson HH Oil 106
E5vrei;0611612024
=-Wro% A ^
Van Kirk & Sons, Inc, Pools & Spas
14 4 SW I 3 t Drive 1 Deetfield Beach, F1 133442
Ph, 1-800-741-3911 1 Fax 954-341-8950
vvwvv,VanKii kPools.com
www facebook w,,v,.,, ffickt Com/vankirkpools lavdo;w piij1(-,rest cwn/vankifkpools
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address Parcel Number
1420 NE 101ST ST, Miami Shores, FL 33138 1132050230050
����•ro���o��� s000�oo������ �a��o����0000000���o��oo
:ontacts
MATTHEW ALLEN Owner DAW ELECTRIC INC Contractor
1420 NE 101 ST, MIAMI SHORES, FL 33138 DERRICK ANTHONY WILLIAMS
Other: 3056732847 20421 NW 22ND AVE, MIAMI , FL 33056
Business: 7868773500
i Inspection Requests:
Description: ELECTRICAL HOOK UP FOR POOL, SPA, 5TON Valuation: $ 1,000.00
305:7
HEATER, ALARMS .
i Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$0.60
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.20
Permit Fee
$50.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$110.30
Payments Date Paid
Amt Paid
Total Fees
$110.30
Check # 110068 08/01/2019
$60.30
Check # 43392 05/16/2019
$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 rk will be done in compliance with all applicable laws
regulating construction and zoning. Futhermore, I authorize the above na 7
ntractor to d ,the work stated. /
Authorized Signature: Owner
/ Applicant / Contractor / Agent
Date
August 01, 2019 Page 2 of 2
M
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
F-JBUILDING ❑■ ELECTRIC ❑ ROOFING
Y 1� 6 2019
):
FBC 20
Master Permit No.
Sub Permit No.t,l -- C��`' l ' l z
❑ REVISION ❑ EXTENSION RENEWAL
PLUMBING MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: I j.V N ' - /d I S4-7-e-'Cr
City: MiamiShoresCounty: Miami Dade zip: 3 3 / 37
Folio/Parcel#: %1—3o?u9-0
� " 1 " ®S Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction T Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):ems G//�kew-� Phone#.
Address: %oo /V,�- /d% Sew f�
City: rft/kjrn /
Tenant/Lessee Name:
Email:
State:
CONTRACTOR: Company Name: D.A.W. Electric Inc.
Address: 20421 NW 22th Ave.
p: 33 (3' `
hone#:
Phone#: 786-877-3500
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: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 0 - 0Square/Linear Footage of Work:
Type of Work:
Description of Work:
Specify color of color thru tile:
Submittal Fee $ % C'1)1 Permit Fee $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $.
CCF $ CO/CC $
DBPR $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
I '/ u
(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
Zip
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 and a reinspection fee will be charged.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of Ma A" ,— 20 ; by
120 .I'l � Onwho is personally known to
me or who has produced �NW� L ��U ` as
identification and who did take an oath.
NOTARY PUBLIC:
Signature_
CONTRACTOR
The foregoing instrument was acknowledged before me this
d✓av 1of Q 2 1 G by
UI( 1-� W f I �IQ� o is personally kynnn to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign: Sign:ROEERT
Print: >�: ""°P`� = c � <i 7G 070333 Print: - — 1
hoc „�in�S' iUne 7.20 VAN KiKK Ill
t nr �n
as
Seal: E;,, "'" Seal ��
8erd�d hru Wotay E' c. �'Jr d rwntcr _ MY COMM itv # GG 070333
EXPIREi ne7,2 I
"t Bonded I hru Not
'
******************* * ***********[*1*1***
*****APPROVED BY l �Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)