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EL-05-19-1116, 1420 NE 101st StLocation Address Miami Shores Village g Permit Tyke. Electricai - Resrdeh 10050 NE 2 Ave Miami Shores FL 33138 Work Classification I 305-795-2204 Permit 5totus: ApproV Expiration:11/22/2021 Parcel Number 1420 NE 101ST ST, Miami Shores, FL 33138 1132050230050 Contacts MATTHEW ALLEN Owner Van Kirk & Sons Contractor 1420 NE 101 ST, MIAMI SHORES, FL 33138 Denise Okun Other: 3056732847 3144 13 DR, Deerfield Beach, FL 33442 dokun@vankirkpools.com TBM ELECTRICAL Contractor RICHARD ANTHONY MAJDOWSKI Business: 9547411004 _._ _........ -._._ _ _ Inspection Re uests Description: ELECTRICAL HOOK UP FOR FOUNTAIN Valuation: $ 1,500.00 � 305 762 4949. . . . . . . . . . j E Total Sq Feet: 0.00 Fees Amount Application Fee - Other $50.00 CCF $1.20 Change of Contractor $110.00 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: $227.10 Payments Date Paid Amt Paid Total Fees $227.10 Check # 43392 05/16/2019 $50.00 Check # 43464 06/13/2019 $67.10 Check # 44637 09/24/2021 $110.00 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 rtify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regy,[atir�nstructionning. Futhermore, I authorize the above named contractor to do the work stated. re: / Applicant / Contractor / Agent Date September 24, 2021 Page 2 of 2 Miami Shores Village Building Department *4?16��;` y 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 201"1 N BUILDING Master Permit No.? *" ] �--i 01411 PERMIT APPLICATION Sub Permit No. FLOS-19 -111 ❑BUILDING ❑■ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: Al G City: >Miami Shores County: Miami Dade Zip: o3,_4 O Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE: OWNER: Name (Fee Simple Titleholder)Ak�'*' i G/_/�i`fr � r ` / Phone#: Add City Tenant/Lessee Name: Email: Phone#: CONTRACTOR: Company Name: D.A.W. Electric Inc. Phone#: 786-877-3500 Address: 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: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ Ins& '6 a Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration DNew ❑ Repair/Replace ❑ Demolition Description of Work: � <-+r- c "-j C kc-_ 1 ` - 7 r-- -:Fi t , n 4m-- i Specify color of color thru the: Submittal Fee $ Scanning Fee $ Technology Fee $_ Structural Reviews $ (Revised02/24/2014) Permit Fee $ Radon Fee $ Training/Education Fee $ CCF $ DBPR $ CO/CC $ _ Notary $ Double Fee $ _ Bond $ TOTAL FEE NOW DUE $ &9 . ( O 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 reinspection fee will be charged. Signature Signaturc-- OWNER or AGENT The foregoing instrument was acknowledged before me this _ day oof" LC 1��`L20 by f lCL4 Q� j' 12 «X ` rI t who is personally known to me or who has produced�t� I u as identification and ho NOTARY PUBLIC: CONTRACTOR The foregoing instrument was acknowledged before me this �day of a (! 20 ,'by *O(-YYljl 6 wl I(! , who is known to me or who has produced as identification and ho id take an oath. NOTARY PUBLIC: Sign: —� Sign:t --�� Print: 1 Print: ► ) Seal: �—ROB: ,<T dr l� ` ,SY PUpY „ GG 070033 � :� Seal: I R BERTVAN KIRK Ill— — C r�1Y ca�ntiglas)ors June MYco,.rrJ,l;,,, ., _ SSI0N # GG 070�333 � Unaenvrit rs i i?- EXRRES: June 7, 2u21 i- 11COY A J Th u P �, <'.y + ut ;c Undenvri;ers m APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 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 :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 R Inspection Requests: Description: ELECTRICAL HOOK UP FOR FOUNTAIN Valuation: $ 1,500.00 K'2 4949 z 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 Building Department Copy Payments Date Paid Amt Paid Total Fees $117.10 Check # 43392 05/16/2019 $50.00 Check # 43464 06/13/2019 $67.10 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: ify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction z Wing. Futhermore, I authorize the above named contractor to do the work stated. Authorized Sigrfature: Owner F/ Applicant / Contractor / Agent Date June 13, 2019 Page 2 of 2