ELC-05-20-988, 196 NW 95th Stcv� %%-- 5 VZ,(, I -L-'zi,
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
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PERMIT APPLICATION
❑ BUILDING ELECTRIC ❑ ROOFING
FBC 209 ks
Master Permit No.l`L
Sub Permit No. LL
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION []SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
1 ! 6 fit/ af/
(? S
City:
Miami Shores
County:
Miami Dade
Zip:
Folio/Parcel#:
Is the Building Historically
Designated: Yes NO X
Occupancy Type:
Load:
Construction Type':
Flood Zone:
BFE: FFE:
OWNER: Name (Fee Simple Titleholder):
/%
JI rt,°y V,1.4 e ! "l, B
�,o %�
WHone#: -30!5 ' ;.-V Q+
Address:
City: zj'Av:'t r ��OtrG�nS
Tenant/Lessee Name: G/- / !/a
State:: /�Yff
Ct
Zip: -J �l
Phone#: o� — Z �✓ /" 7z��
V"/ 3/ le'l
Email:
CONTRACTOR: Company Name
Address: 11�a �/0�
City: /7'!it-l%�'aGYd
Qualifier Name:, 6e
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Address:
1- /4
Phone#:
zip: 3
Phone#:
Certificate of Competency #: �300�ZDZ
/Z� Phone#: ^d/P
/ e ?d /0 City: X64 W1 ! State: /"� Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration XNew ❑ Repair/Replace ❑ Demolition
Specff y color of color thru tile:
Submittal Fee $
Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews S
(Revised02/24/2014)
CCF $
CO/CC $
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
�1nl.s�
}
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
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 0-JyLJ
OWNERorAGENT
Theforegoinginstrument was acknowledged before me this
l Y day of All 020 ZO by
who is Trsonaily known to
me or who has produced ~"""'� as
identification and who did take an oath.
NOTARY PUBLIC:
Print:
Seal: o'rV °us4 Notary Public Slate of Florida
} ^ Sydney Herrera
My Commission GG 343073
?oino Expires 10104/2023
Signature '
CONTRACTOR
The foregoing instrument was acknowledged before me this
lel day of Alt 20 by
17Uot CJG'F'` kf' f , who is kr5onall n to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Print:
Seal: ,,isy ^ Notary Public State of Florida
+ Sydney Herrera
o My Commission GG 343073
Expires 10/ 0023
ici Rod°
APPROVED BY �Examiner
Structural Review
Zoning
Clerk
(Revisedo2/24/2014)
.SH°zlip Journal Post Listing
Sort By Eery
F�ORIDp'
Department
Number
Journal Type Sub Ledger G/L Date Description
Source Reference Reclassification Journal Type
13.0500- Finance,Finance 2020-00001745
JE GL 05/26/2020 ELC-05-20-988
GIL Date
GIL Account Number
Account Description Description
Source Debit Amount
Credit Amount
05/26/2020
001.24.0400.00_322-000
Building Permits Building Permits ELC-05-20-988
.00
50.00
05/26/2020
001_208-300
Due to Other Governmental Units ELC-05-20-988
.00
2.00
DBPR Surcharge
05/26/2020
001_208-200
Due to Other Governmental Units ELC-05-20-988
.00
2.00
DCA Surcharge
05/26/2020
001.24.0400.00_322-000
Building Permits Building Permits ELC-05-20-988
.00
50.00
05/26/2020
161.24.0400.45_322-110
Building Permits Scanning Fees ELC-05-20-988
.00
3.00
05/26/2020
161.24.0400.46_322-120
Building Permits Technology Fees ELC-05-20-988
.00
2.50
05/26/2020
163.21.0900.92.521_64-000
Machinery and Equipment Machinery ELC-05-20-988
109.50
.00
and Equipment
05/26/2020
801_204-001
Equity in Pooled Cash General Fund ELC-05-20-988
.00
104.00
Due To/Due From: 001 - General Fund
05/26/2020
801_204-161
Equity in Pooled Cash Special Purpose ELC-05-20-988
.00
5.50
Due To/Due From: 161 - Special Purpose Revenue
05/26/2020
801_204-163
Equity in Pooled Cash Forfeiture ELC-05-20-988
109.50
.00
Due To/Due From: 163 - Police Forfeiture
05/26/2020
001_104-801
Equity in Pooled Cash Pooled Cash ELC-05-20-988
104.00
.00
Due To/Due From: 801 - Pooled Cash
05/26/2020
163_104-801
Equity in Pooled Cash Pooled Cash ELC-05-20-988
.00
109.50
Due To/Due From: 801 - Pooled Cash
05/26/2020
161_104-801
Equity in Pooled Cash Pooled Cash ELC-05-20-988
5.50
.00
Due To/Due From: 801 - Pooled Cash
Number of Entries: 13 $328.50
$328.50
Run by Holly Hugdahl on 08/19/2020 12:06:00 PM Page 1 of 1
BILLING CONTACT
HUMBERTO ORTIZ
AUM CONSTRUCTION INC.
278 ATLANTIC AVE
SUNNY ISLES, FL 33160
MIAMI SHORES VILLAGE
MIAMI SHORES VILLAGE
10050 NE 2 AVE
MIAMI SHORES, FL 331382304
OR
Ml
yFN7E5�IN 50
ova
INVOICE NUMBER
INVOICE DATE
INVOICE DUE DATE
INVOICE STATUS
INVOICE DESCRIPTION
INV-00007490
05/26/2020
05/26/2020
Invoiced, Past Due
NONE
REFERENCE NUMBER
FEE NAME
TOTAL
ELC-05-20-988
Application Fee - Other
$50.00
DBPR Fee
$2.00
DCA Fee
$2.00
Permit Fee
$50.00
Scanning Fee
$3.00
Technology Fee
$2.50
9990 Ne 2Nd Ave Miami Shores, FL 33138 SUB TOTAL
$109.50
REMITTANCE INFORMATION
Miami Shores Village
Building Department
10050 NE 2 Ave
Miami Shores FL 33138
Payments
TOTAL I— $109.50
Date Pay Type Check Number Amount Paid Change I
Total Paid: III
Total Due:
August 18, 2020 10050 NE 2 Ave Miami Shores FL 33138 Page 1 of 1