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EL-3-18-554, 478 NE 92nd St�yH°RES L,� Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Fes` fi10R1DA Phone: (305)795-2204 Permit NO. EL-3-18-554 Permit Type: Electrical - Residential Permit Worts Classification: Low Voltage Pen -nit Status: APPROVED Issue Date: 8/23/2018 ] Expiration: 02/1912019 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- Contractors) Phone Cell Phone BULLARD ELECTRICAL INC (786)487-9505 ype of Work: NEW TWO STORY ADDITION FOR MASTER S dditional Info: NEW TWO STORY ADDITION FOR MASTER S lassification: Residential canning: 1 Fees Due Amount CCF $1.20 DBPR Fee $2.25 DCA Fee $2.00 Education Surcharge $0.40 Permit Fee - Additions/Alterations $150.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $160.45 r Valuation: $ 1,500.00 Total Scl Feet: 0 Pay Date Pay Type Amt Paid Annt Due Invoice # EL-3-18-66664 03/05/2018 Credit Card S 50.00 $ 110.45 08/23/2018 Credit Card $ 110.45 $ 0.00 Available Inspections: Inspection Type: Review Electrical 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 VIT: I certify that all the foregoing information i accurate and that all work will be done in compliance with all applicable laws regulating construction and oning. Futhermore, I horize the above nam c ntractor to do the work stated. Lk--r, August 23, 2018 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy August 23, 2018 1 Miami Shores Village Building Department MAR 0 5 2016 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 df INSPECTION LINE PHONE NUMBER: (305) 762-4949 S fi T BUILDING PERMIT APPLICATION ❑BUILDING [S2/ELECTRIC ROOFING F-IPLUMBING ❑ MECHANICAL DPUBLICWORKS JOB ADDRESS: F0C 20IKA Master Permit No.� Sub Permit No.h 1 J J REVISION ❑ EXTENSION RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS 7i Folio/Parcel#: (� ' (� UV'2iy Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): -(y CKI (\ ( Phone#:'!5 Address: mot 111I 5 1 V°Ci'I L-`'4S City: A) —ShC l--S State: fi Tenant/Lessee Name: Email: cons 0-) M"CLYI--t A2,. CONTRACTOR: Company Name:V�rd 1L Address: L"-� a2 - &W M City: i State: Qualifier Name: i State Certification or Registration #: DESIGNER: Architect/Engineer: Address: Value of Work for this Permit: $ Eo- J Type of Work: Addition ❑ Alteration Description of Work: _ N•1 S4-0Y Specify color of color thru tile: Submittal Fee $ Scanning Fee $ Technology Fee $i Structural Reviews $. J)CO Phone#: Phone#.- - ` qV 7 Zip: "�v) I y t _ Phone#q& • `727 p c-- Certificate of Competency #: L6( ObCD(D© Phone#: City: State: Zip: Square/Linear Footage of Work: Repair/Replace l 03A K40,4i Permit Fee $n�CCF $ Radon Fee $ n DBPR $ _ Training/Education Fee $ ❑ Demolition Rix) CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ I 10 (Revised02/24/2014) 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 Zi 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 reinspecti�fe will be charged. Signature / / Signature_ G OWNER rAGENT CONTRACTOR ThZ6regoinggnstru nt was ackno ged before me this The foregoing instrument was acknowledged before me this day of r (l _by day of 20, by -is personally nown to is personally known to me or who has pr ced as me or who has pro �didtjke identification an wh did take an oath. identification a whan oath. NQTARY PUBLIC; J / i /'N OTARY PUB C: Sign: Print Print: Seal: r°A;R=P.Br% LORETTA COMES Seal: * MY COMMISSION 0 FF 954664 i°`P,�-�P ;�% LORETTA COMES EXPIRES: Match 21, 202o MY COMMISSION 0 FF 954664 Al"L"v Bonded Thru Budget Notary Servka Q EXPIRES: March21,2020 ****************************************************************oFF1 APPROVED BY d� `�� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)