EL-08-20-1677Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Parcel Number
800 NE 95TH ST, Miami Shores, FL 33138 1132060410010
Contacts
Ariadna Cuson Owner G Brickell Electric LLC Applicant
800 NE 95 ST, Miami Shores, FL 33138 Carlos Garcia
RTCFLOWERS@GMAIL.COM 18512 NW 42 CT 18512 NW 42 CT, miami gardens, FL 33055
Iggd44@yahoo.com
G BRICKELL ELECTRIC LLC Contractor
OMAR 1 GALAN
3192 NW 45 ST, MIAMI, FL 33142
Business:3053516954 MENESESASSOCIATES@GMAIL.COM
Mobile: 3052974655
Inspection Requests:
Description: Replace Panel Breakers Valuation: $ 1,200.00 E,-
Total Sq Feet: 0.00
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
$9.00
Technology Fee
$2.50
Total:
$117.10
Payments
Date Paid Amt Paid
Total Fees
$117.10
Credit Card
12/28/2020 $67.10.
Credit Card
10/02/2020 $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 AFFID IT: I ceify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating construction and z ng. ""Futhermore, I authorize the above named contractor to do the work stated.
Authorized Signat4re: Owner / Applicant / Contractor / Agent
December 28,
Date
Page 2 of 2
Miami Shores Village RECEIV.E.)
Building Department OfTI 02 20'0
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 20 t►
BUILDING
Master Pemiit No. FL-Ocf-,-
PERMIT APPLICATION
Sub Permit No.
❑BUILDING j ELECTRIC
❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL
❑PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: Q G A e 1 6- - ' i'
City: Shores
County: Miami Dade Zlo: + a
(Miami
Folio/Parcel#: i 3 Z 0 (00 y( Q 01 O Is the Building Historically Designated: Yes NO
Occupancy Type: Load:
Construction Type: Flood Zone: BFE: FFE:
/ r'
Af 'A A C, U� N � �j
S 0-� / �13 _. 6 7
OWNER: Name (Fee Simple Titleholder):
DO Phone#• I
Address: 9 ny
>_ I
City: im ]A N � � �S
i
State: _ .1� � Zip:
Tenant/Lessee Name: ZJ
Phone#:�,C7 S� �J ��7 " ��j•Jr
Email: AZ'AbN+4 eoSo N (9- � M A Z, A.
CONTRACTOR: Company Name: f + `"� t 1U' i? (+ 1 h `k 0-- Phone#:
Address: i C1 z. A( K° `4 `l t)T
City: i C1 ��1 i State: /-- Zip: 3 % -z-
Qualifier Name: 0-mck j c t v` Phone#.— �4 k q (a 41
State Certification or Registration #: 6t. • i 31 V t� ci 01b Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address Cdy State Zip:
Value of Work for this Permit: $ Square/Linew Footage of Work
Type of Work: ❑ Addition` _ ❑ Alteration i ❑ New (51 Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee S� •_ Permit Fee $ CCF $ CO/cc $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ TrainkWEducation Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ ( O
(Re&ed02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
Zip
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 reinspe ' n fee will be charged.
Signature Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
15 day of �y CA) 4of . 20 W by day of 4 v Gl V bf . 20 Z by
4 r i¢ �yl o, QJ , who is personally known toQ M M G u \E,k,-) , who is personally known to
me or who has produced i-Z-O — 0 00 —4 q— q 4i ' d me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Print: WL0
Seal: o„'r" CARLOS MANU 14;
^'�%Notary Public State
*= Commission # c
My Commis
March
identification and who did take an oath.
NOTARY
Sign:A
Print:
(k,1 C C—
Seal: L
""""� CARLOS MANUEL GARCIA
=ocNry Pie%
s Notary Public -State of Florida
*c Commission # GG 95832.i3
%',o.Fo My Commission Expire
################################################
APPROVED BY `Cd Plans Examiner
Structural Review
wail
Zoning
Clerk
(Revised02/24/2014)