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EL-11-19-2839, 1298 NE 95th StMiami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 1298 NE 95TH ST, Miami Shores, FL 33138 1132060144030 Contacts Andrea Suarez Owner YURI MORALEZ Owner 1298 NE 95 ST, MIAMI SHORES, FL 33138 302 NE 92ND ST, Miami Shores, FL 33138 Home: 3057903849 yurimorales@gmail.com LONGMAN ELECTRIC INC Contractor MICHAEL LONGMAN 95 NE 166 ST, Miami, FL 33162 Business: 3057581211 longmanelectric@bellsouth.net Description: TEMPORARY POWER POLE Valuation: $ 1,500.00 Inspection Re nests: - Total Sq Feet: 3,200.00�� 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 Credit Card 12/02/2019 $61.10 Credit Card 11/26/2019 $50.00 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 AFFIDAy1T: I certifyt all the foregoing information is accurate and that all work will be done in compliance with all applicable laws requladnqlconstruclion and zon' q. Ruthermore, I authorize the above named contractor to do the work stated. Signature: Owner/ / Applicant / Contractor ! Agent Date December 02, 2019 Page 2 of 2 Miami Shores Village -P'1ECE1VF-D Building Department 2Q' 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 201�� BUILDING Master Permit No. PERMIT APP CATION Sub Permit No.- l �G "2©Yl ❑ BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [—]RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS Q a JOB ADDRESS: v r� Z City: Miami Shores County: Miami Dade Zip: 33/ 3 Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FF°-E::C� \ 1 OWNER: Name (Fee Simple Titleholder): I o 0 1 �I DQ t� L /� / t Phone#: �(i 5% ! o— 3 � Address: 3 o 2-- Ax City: /A ( R/4 ( S LIM C!3 State: r & Zip: _-33 I Tenant/Lessee Name: Phone#: Email: U v z i Get /Lcolti CONTRACTOR: Company Nam !4'% e: �0,0 go /e!G 95 N Address: � /" S Phone#: ga—j City: "';Ko State: Zip: Qualifier Name: _101w4ael Phone#:T ^!� State Certification or Registration #: G/ kP�71 _;E� Certificate of Competency #: DESIGNER: Architect/Engineer: A �� Phone#: Address: City: State: Zip: Value of Work for this Permit: $ i /f� Square/Linear Footage of Work: Type of Work: ❑ Addition ❑A,lltteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: ? Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ CCF $ CO/CC $ d DB'PR$-" Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ 1CO1 (Revised02/24/2014) r 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 applicant must promise in good faith that a copy of the notice of commencement and construction lien low 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 L' Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The fore oing instrument was acknowledged before me this 2\SN day of NWCW)�' ( 20 1 � by %\ MOr OA e,S who is personally known to me or who has produced _'FL Dr\Ui�,( t (P-,1Sf° as identification and who did take an oath. NOTARY PUBLIC: -- Sig . c Print: Seal: _ _ ------ KEVIN LAIPCIGIER ' Notary Public - State of Florida +• ° Commission # GG 364682 •` **NIA`mifii'f."tafc rtft"Mt'KZN5 APPROVED BY 'ty/* d y of /UI dP f7Gff" 20 �� by a� who is personally known to me or who has produced as identification and who did take an oath. NOTARY Print: ✓ off► " Notary Public State of Florid, Seal: _ F Michelle Perez "S �� My Commission GG 084089 'for fe Expires 04/08/2021 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)