EL-3-18-552, 478 NE 92nd StFc0 1oA
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit NO. EL-3-18-552
Permit Type: Electrical - Residential
Per it Worts Classification: Addition/Alteration
Permit Status: APPROVED
Issue Date: 8/23/2018 1 Expiration: 2/19/201
Project Address Parcel Number Applicant
478 NE 92 Street 1132060140020
Miami Shores, FL Block: Lot: THOMAS ROGER & CHRISTINA
Owner Information Address Phone Cell
THOMAS ROGER & CHRISTINA WHITE 478 NE 92 Street (305)546-1030 (305)439-2855
MIAMI SHORES FL 33138-
478 NE 92 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone
BULLARD ELECTRICAL INC (786)487-9505
Type of Work: NEW TWO STORY ADDITION FOR MASTER S
Additional Info: NEW TWO STORY ADDITION FOR MASTER S
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
$16.20
$13.86
$9.24
$5.40
$924, 00
$3 00
$21.60
$993.30
Valuation: $ 26,400.00
Total Sq Feet: 0
Pay Date Pay Type Amt Paid Amt Due
Invoice # EL-3-18-66662
08/23/2018 Credit Card S 943.30 $ 50.00
03/05/2018 Credit Card $ 50.00 $ 0.00
Available Insoections:
Inspection Type:
Final
Meter Box
Alteration
Relocation
Fire Alarm
Service Change
Review Electrical
W. W.
Underground
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 AFF AVI . I certify that all the foregoing information is accurate nd that all work will be done in compliance with all applicable laws regulating
construction d zonin Futhermore, I thorize the above -named contracto t d the work state
, ` C6, August 23, 2018
Authorized Signature: Owner / Applicant / Contractor / Agent Date
Building Department Copy
August 23, 2018 1
Miami Shores Village otoi 9 o oeN
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 ST
BUILDING
PERMIT APPLICATION
BUILDING Q ELECTRIC ROOFING
Master Permit No. aG F-4 —1 S Q 9
Sub Permit No. i� 1 j g ` l�S 2 .
❑ REVISION ❑ EXTENSION RENEWAL
PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR
DRAWINGS
/ {
JOB ADDRESS:
City: Miami Shores
County:
Miami Dade Zip
5I 3O
Folio/Parcel#: .I I 7 ` Q
0
Is the Building Historically Designated: Yes
NO
Occupancy Type:
Load:
Construction Type:
Flood Zone: BFE:
FFE:
OWNER: Name (Fee Simple Titleho
Addr
City
Tenant/LesseeeNaame:
Email: hQi%c-
CONTRACTOR: Company Name:
Address:
City:
Qualifier Name: V`.S((/ 1(1(,e 1
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Phone#:-3()5'54 to' iIC3D
ne#:
mre. A a QO\/
liard
I -e_r
Zip: 35) ? Phone#:-7q( 7?r% • q,/jwam
Certificate of Competency #: q -fC-OCDC�n 1
Phone#:
Address: /r City: State: Zip:
Value of Work for this Permit: $ W n O Square/Linear Footage of Work:
Type of Work: Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Specify color of color thru the:
Submittal Fee S
Scanning Fee $ _
Technology Fee $,
Structural Reviews $
Permit Fee f'1O CCF $ CO/CC $ _
Radon Fee $ �] DBPR $ 13 ' U� Notary $
—Train ing/Education Fee $ Double Fee $ _
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $ "t 3 • 3 ll
! ; 3 30
( U53 • -}-5
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 reinsg fdn fee will be charged.
Signature
AGENT
The foregoing instru
—) � -- day of_
me or who has produced
Signature
CONTRACTOR
was acknowledged before me this
identification aqd who did take an oath. identification and -who did take an oath.
NOTARY PUBLIC: i ^ NOTARY PU
Sign: / / Sign: II , `� `!. k
e
Print: Print:
LORETTA CO LORE A COMES
Seal: �MY COMMISSION 0 FF 95M Seal: MY COMMISSION 4 FF 9W64
EXPIRES: March 21, 2020 EXPIRES: March 21,2020
fBonded ThryBudget Notary Services
v
F�v��oFl
##########################################################################################################
APPROVED BY l Z 14J�dZC4 Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)