EL-05-21-1312Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Parcel Number
41 NW 106TH ST, Miami Shores, FL 33150 1121360060210
Contacts
Jesus Jimenez Owner HENRY RODRIGUEZ ELECTRICAL Contractor
41 106 CONTRACTOR, INC
HENRY RODRYGUEZ
14522 SW 142 PL, MIAMI, FL 33186
Business: 3052187878
National Pool Design Agent
Ernesto Don
2423 SW 147 Ave 212, Miami, FL 33185
ernie@nationalpooldesign.com
'' Inspection Requests:
Description: NEW SWIMMING POOL AND DECK (PAVER ON Valuation: $ 2,400.00 305 762549
I SAND TRAVERTINE)
Total Sq Feet: 500.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$1.80
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.60
Permit Fee
$50.00
Scanning Fee
$12.00
Technology Fee
$2.50
Total:
$120.90
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$120.90
Check # 5955
06/03/2021 $120.90
Amount Due:
$0.00
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 foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating construction and zoning. Futhermore, I authorize the above named contractor to do thejvork stated.
Authorized Signature: Owner / Applicant / Contractor /
Date
June 03, 2021 Page 2 of 2
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
BUILDING
PERMIT APPLICATION
❑BUILDING IFfELECTRIC ❑ ROOFING
FBC 2020
Master Permit No./a)9p' 1 o�y7S
Sub Permit No.UL QS - 21 ^ 13 1 Z
❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: ` / �j w /0 6 S trez f
City: Miami Shores r- County: Miami Dade Zip:
Folio/Parcel#: / % - a / 3 & Q Q 6 Q a Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: P00 / Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): b -Cdyj J/ MP-^e -'2, Phone#: 30&— Cj(A2 _ 0
Address: y / Nlti yi0 G
City: /� lam, shop%j- State: / L Zip: 3g/SD
Tenant/Lessee Name:
Email
e v.3 (G) CL o / . 40M
Phone#:
CONTRACTOR: Company Name: my yD d ✓1 C y1*P- 2-4C jQCt- t Q1ljrA40P'h0o ne#:
Address: J C"/5o1P SV4 iq?- 't'1 ct ce f-tr( 1e
City: I" 1 Cky '1 l State: I I Zip: 3 1 S-c'.
Qualifier Name: 9-2nr-j" '-Roc�rig("e -L Phone#:3�5 a�$'iFf'1 Fi
State Certification or Registration #: EC "Du vats. I' j Certificate of Competency #:
DESIGNER: Architect/Engineer:
hone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 2 ,�( Square/Linear Footage of Work:
Type of Work: El Addition ❑ Alteration u New ❑ Repair/Replace ❑ Demolition
Description of Work:
C/�ctr •'a 1 wo1"c A.i
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $_
Structural Reviews $
(Revised02/24/2014)
Permit Fee $
Radon Fee $
Training/Education Fee $
CCF S
DBPR $
CO/CC $ _
Notary $
Double Fee $ _
Bond $
TOTAL FEE NOW DUE $ _
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
E.
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
inspectionapproved and a reinspection fee will be charged.
Signature '� ~�' Signature %
R r GENT J CON RACTOR
The foregoing instrument was acknowledged before me this
6 day of Xt c.`f 20 1 - / by
0 n-. /A <-�-rl1i'Z, who is personally known to
me or who has produced /PL �- 3-> as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
The foregoing instrumentwasacknowledged before me this
L7 day of 20 by
f-i A i,eV I2O i°J6-70ee' who is rsonally know o
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
](---
Sign:
Print:
Print:
WE
��+
Seal:
Seal:
;�i �e�•,CRISTINA
?:
Notary Public - Sta
;'tiAYou•, CRISTINARODRIGUEZ
Notary Public - State of Florida
r:
DFda
Commission HCommission
X HH 083889
ti.My Comm. Expires Bonded
OF My Comm. Expires May 16, 2025
through National
APPROVED BY
Plans Examiner
Structural Review
Zoning
Clerk
(Revised02/24/2014)
. f
Local Business Tax Receipt
Miami -Dade County, State of Florida
—THIS IS NOT A BILL — DO NOT PAY
5116330
BUSINESS NAME/LOCATION
HENRY RODRIGUEZ
ELECTRICAL CONTRACTOR
14522 SW 142ND PLACE CIR
MIAMI, FL 33186
OWNER
HENRY RODRIGUEZ ELECTRICAL
CONTRACTOR
r/r1 HENRY Pnnpini IF7 nI IAI IFIFR
Worker(s) 1
RECEIPT NO,
RENEWAL
5344379
SEC. TYPE OF BUSINESS
196 ELECTRICAL
CONTRACTOR
EC0002411
EXPIRES
SEPTEMBER 30, 2021
Must be displayed at place of business
Pursuant to County Code
Chapter 8A — Art. 9 & 10
PAYMENT RECEIVED
BY TAX COLLECTOR
82.50 06/02/2021
INT-21-312230
This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license,
permit, or a certification of the holder's qualifications, to do business. Holder must comply with any governmental
or nongovernmental regulatory laws and requirements which apply to the business.
The RECEIPT NO. above must be displayed on all commercial vehicles — Miami —Dade Code Sec Ba-276.
MIAMtDADE For more information, visit www.miamidade.nov/taxcollector