EL-10-19-2303, 249 NW 92nd StMiami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Parcel Number
249 NW 92ND ST, Miami Shores, FL 33150 1131010331170
Contacts
Ins oection Requests:
Description: electric for pool a Valuation: $ 1,500.00
9 €E I'E
Total Sq Feet: 338.00y�;; ;E
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
Payments
Date Paid Amt Paid
Total Fees
$111.10
Credit Card
11/15/2019 $61.10
Credit Card
10/01/2019 $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 tha foregoing information is accurate an h t all work will be done in compli f
nce with all applicable laws
regulating construction and zoning. Futhermore, I authorize the above n ed c M;iF
o the work stated.
1 f % 6al
Authorized Signature: Owner / Applicant / Contractor gent Date 4
November 15, 2019 Page 2 of 2
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 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 oregoing instrumentwasac(k�(n�Qwl dged before me this
day of J \ ' 20 I \ by
who is -personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign: I -- —
Signature
-
CONTRACTOR
The foregoing instrument was acknowledged before this
day of 1 ` 20 by
Tr�l Lac e' Nti�' , who is personally known to
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:�� )
Print: J— v i :� �—Py 6\ r -�w Print:
Seal: #00,44�, Notary Public State of Florida Seal:
Luis Ariel Duarte
My Commission FF 969561
Expires 03IM020
*********** ****************
APPROVED 134 �l�C—�J' Plans Examiner
Structural Review
as
**
Zoning
Clerk
(Revised02/24/2014)
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 FE-] ELECTRIC ❑ ROOFING
RCF�o
FBC 201-4
Master Permit No. to .Ic-,I- Ry 1
T
Sub Permit No. E�- I l� ' �� -6 _3,
❑ REVISION ❑ EXTENSION []RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 249 NW 92 St.
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-3101-033-1170 Is the Building Historically Designated: Yes NO XX
Occupancy Type: SFR Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Fernando Gutierrez Phone#:
Address:249 NW 92 St.
City: Miami Shores State: FL Zip: 33150
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: F. Jimenez Electrical Contractor Phone#: 786-402-2256
Address: 3485 Environ Blvd. #109
City: Lauderhill State: FL Zip: 33319
Qualifier Name:' Re))erarl-6 gQ -�) C4) J1 Phone#: 786-402-2253
State Certification or Registration #: EC13002779 Certificate of Competency #:
DESIGNER: Architect/Engineer: Ken Pfeiffer Phone#: 786-235.2435
Address:8754 NW 206 Ln City: Cutler Bay State: FL Zip: 33186
Value of Work for this Permit: $ l i SA Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration Q New ❑ Repair/Replace ❑ Demolition
Description of Work: Electric for pool
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $_
Structural Reviews $
Permit Fee $
Radon Fee $
Training/Education Fee $
CCF $_
DBPR $
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)