EL-8-16-2179, 141 NW 96th StMiami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit No. EL-8-16-2179
Permit Type: Electrical - Residential
Permit Work Classification: Pool - Private
Permit Status: APPROVED
Issue Date: 10/11/2016 I Expiration: 04/09/2017
Project Address Parcel Number
141 NW 96 Street 1131010250110
Miami Shores, FL 33150- Block: Lot:
Owner Information Address Phone
PETER GOLDSMITH 141 NW 96 Street
MIAMI SHORES FL 33150-
141 NW 96 Street
MIAMI SHORES FL 33150-
Contractor(s) Phone Cell Phone
INDUSTRIAL ELECTRICAL SYSTEM C 305/228-1384
Type of Work: ELECTRICAL WORK FOR NEW POOL.
4dditional Info:
classification: Residential
Scanning: 1
Fees Due
Amount
CCF
$0.60
DBPR Fee
$4.50
DCA Fee
$4.50
Education Surcharge
$0 20
Permit Fee - Additions/Alterations
$300.00
Scanning Fee
$3.00
Technology Fee
$0.80
Total:
$313.60
Applicant
PETER GOLDSMITH
Cell
Valuation: $ 1,000.00
Total Sq Feet: 0
Pay Date Pay Type Amt Paid Annt Due
Invoice # EL-8-16-60850
08/03/2016 Check #: 7464 $ 50.00 $ 263.60
10/11/2016 Credit Card $ 263.60 $ 0.00
Available Inspections:
Inspection Type:
Final
Light Niche
Bonding
Review Electrical
Alarms
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 the foregoiing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I auth4frizglft, above -named contractor to do the work stated.
October 11, 2016
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
October 11, 2016
1
Miami Shores Village
BUILDING
PERMIT APPLICATION
Building Department AUG o 3 2016
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY:
Tel: (305) 795-2204 Fax: (305) 756-8972 y
INSPECTION LINE PHONE NUMBER: (305) 762-4949 5
FBC 2014
Master Permit No. VE`
Sub Permit No. F.�
❑BUILDING ® ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
PLUMBING F-1 MECHANICAL MPUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION 0 SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: / T / w(o -2 0 S -/
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: lilf-3J D / i!� a SD// 0 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titlehol
Address: 'Ifi'/ /%W %&
City:State: /*_2� Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:
Address: /O ADC
City: State: /4�_ Zip:
Qualifier Name: /i%5-4/2 77 Phone#: _
State Certification or Registration #: i 30_ D �/ Z-1 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
33
Address: City: State: Zip:
Value of Work for this Permit: $ io �d ` Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ �' r®� ° -1-" 0 CCF $ V d (0 CO/CC $
,l
Scanning Fee $ Radon Fee $ y ' 0 DBPR $ `I ' 0!70 Notary $_
Technology Fee $ Training/Education Fee $ 2 Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ 2C�z 3e �0 d
(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
Zip
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 days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved re spection fee i be charged.
Signature Signature
NER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
%%�� day of 20 l6 by day of 20 by
9 e 505/yr%11/ , who is personally known to �B/L/l�Pe; who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC*-n'
NOTARY PUBLIC:
'tOE SALGW I,(,
P "��`el' ZOE SALGUEIRO
Notary Public - State of Fla1ida Py P'�Sign: commission # FF 245464 => Notary Public State of Florida
Sign:
Comm. Expires u print: �g oiy Comm. Expires Jun 30, 2019
Print: .F National Notary Assn. 3� Print:
„
Seal: Seal:
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APPROVED BY �/Z �.Q� Plans Examiner Zoning
Structural Review Clerk
(Revis c!02/24/2014)