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EL-09-22-2301 (2)Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 9509 N MIAMI AVE, Miami Shores, FL 33150 Contacts Permit NO.: EL-09-22-2301 Permit Type: Electrical - Residential Work Classification: Temp for Construction Permit Status: Approved Issue Date: 09/14/2022 1 Expiration:03/14/2023 Parcel Number 1132060130670 MARIA T BERGUA SANCHEZ DEL CORRAL Owner Maria Bergua Applicant 10603 NE 30 PL, MIAMI SHORES, FL 331382103 9509 N Miami ave, Miami shores, 33150 Other: 3058126015 Mobile: 3058126015 mariabergua@hotmaii.com ELECTRIC INC Contractor OLEY JACKSON SMITH 2629 SW 31 CT, MIAMI, FL 33133 Mobile: 3054768080 Description: TEMP POWER FOR CONSTRUCTION Valuation: $ 400.00 Inspection Requests: 305-762-4949 Total Sq Feet: 946.00 Fees Amount Application Fee -Other $50.00 CCF $0.60 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.30 Permit Fee $50.00 Scanning Fee $3.00 Technology Fee $10.00 Total: $117.90 Payments Date Paid Amt Paid Total Fees $117.90 Credit Card 09/14/2022 $67.90 Credit Card 09/08/2022 $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 POOLwork. 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 the work stated. GbLl N47 CY) cD4 // 4 Signature: Owner / Applicant / Contractor / Agent Date September 14, 2022 Page 2 of 2 Miami Shores Village ENTERED Building Department sEP 08 2022 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY. Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 BUILDING Master Permit No. RC.- PERMIT APPLICATION Sub Permit No. CL-0-u- Z3d I BUILDING [4 ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: �j Ml KfAl k City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: -S ^06 �2 6 is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: mp'2lh gc-2GUt� OWNER: Name (Fee Simple Titleholder): GINVII GL 615LL J 06 Phone#: �6 'ZS Z f� Address: `1SO�I f j MI 11M 1 id U City: lA/l t p nn k S i Lo & f=C State: Zip: 3 3 SCE Tenant/Lessee Name: Phone#: Email: u<KfLi 1( kG `5 (-CO^t Mil L.. C(9m CONTRACTOR: Company Name: ��R D 1 IA t_Lfit� l C2 C C Phone#: Address: Zy 67 zs 5\to � 2�7 City: 1A0MFS E,1,5y) State: Zip: Qualifier Name: nu---N� SM \ 1 VA Phone#: Wro 4 cls 1p096 State Certification or Registration #,:tC � 2JQb�� I 2� Certificate of Competency # DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ Cl 00 Square/Linear Footage of Work: Type of Work: I& Addition ❑ Alteration ❑ New ❑ Repair/Replace M. ❑ Demolition Description of Work: -T ILIA P (L FO n- C.p N ST (LU C"Z I O1.J Specify color of color thru tile: Submittal Fee $ 50.CO Permit Fee $ i]� .00 CCF $ ' /0.' CO/CC $ Scanning Fee$ .r30 Radon Fee$ 2 �>y DBPR$?.ov Notary Technology Fee $ 1 o C'i Training/Education Fee $ 430 Double Fee $ Structural Reviews $ Bond $ (Revised02/24/2014) TOTAL FEE NOW DUE $ 6 1 . QD 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 reinspection fee will be charged. . Signature NER or AGENT The foregoing instrument was acknowledged before me this day of 20 by , who is personally known to me or who has produced I'I- �� JPXs �--' �- as identification and who did take an oath. NOTARY PUBLIC: Signature CONTRACTOR The foregoing instrument was acknowledged before me this day of 20 Z--"' , by :S 4, who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Sign: Print: �I 1 �/ -P� ^e CL-0 Print: V �v"�`� �( �'c'`� Seal: ��,�Y' plI/,�i V'N�enne Yao v • Seal: ��, ymenne yao Pva�,+ ''� '• ` Comm.:HH 222410 �o.�r!! �� ' •; -� Comm.:HH 222410 Jan. 31, 2026 •.• Expires: Jan. 31, 2026 -yN, 01 wNota �`�� Public • State of Florida ,.,. Expires: ��.,','� :� a� Notary Public State Florida ***********��** APPROVED B Plans Examiner Zoning Structural Review Clerk (Revised02/2412014)