EL-02-22-417Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
1224 NE 96TH ST, Miami Shores, FL 33138
contacts
Issue Date: 02/25/2022
Parcel Number
1132060143931
Permit NO.: EL-02-22417
Permit Type: Electrical - Residential
Work Classification: Alteration
Permit5tatus: Approved
Expiration: 08/25/2022
TONY SEIDEN TRSJ AND W LAND TRUST
Owner
ALL QUALITY ELECTRICAL SERVICES, INC Contractor
i AGREEMENT
SAMUEL LIGHTBOURNE
1224 NE 96 ST, MIAMI SHORES, FL 331382554
14750 S RIVER DR, MIAMI, FL 33167
Business: 3057905899
Description: PANEL SWAP
Valuation: $ 1,800.00 Inspection Requests:
305-762-4949
'..
Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$1.20
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.40
Permit Fee
$50.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$111.10
Payments
Date Paid
Amt Paid
Total Fees
$111.10
Credit Card
02/16/2022
$50.00
Credit Card
02/25/2022
$61.10
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 POOL work.
OWNERS AFFIDAVIT: I certiU that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regu i o struction andV11
Ng. Fu hermore, I authorize the above named contractor to do the work stated.
�'��i.K
Signature: Owner
Contractor / Agent
Date
February 25, 2022 Page 2 of 2
BUILDING
PERMIT APP (CATION
F-IBUILDINE ELECTRIC
Miami Shores Village � M 9 M� T D
FE
Building Department B 1 6 Z022
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 By
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION UNE PHONE NUMBER: (305) 762-4949
FBC 20 Z6
Master Permit No. 17 Q2- 2 Z-- T
Sub Permit No
❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
-3.20 6-
Occupancy Type: sr— Load:
OWNER: Name (Fee Simple
City: 11 1
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name:
Address: //4/7 S�d J
City: /V1 1 G. fti J
Qualifier Name:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
.27 J / Is the Building Historically Designated: Yes NO
Construction Type: C /3 S Flood Zone: _ BFE: FFE:
er): G Phone#: It /'/!aO 2 i u�/
S p
e J State: L Zip: �� 1 3p
Phone#:
JCL d Q-L / 7-V tt--Ach-/c Phone#: �J g� 7B31_
State: Zip: 33 / 6 7
-7t" Phone#:
C / J 0 () �2-y',/ Certificate of Competency #:
I /A Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ g�0 ' Square/Unear Footage of Work: N ��
Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: ��Y% 'e (. S(.r/Jq Zi
Specify color of co/lour thru tile:
Submittal Fee $ 0` Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $ CO/CC $
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $,—
(Revised02/2412014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
M.
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 o 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 Signature u l/ i G toles
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
_ day of1\,AMAPe-1,4 .20�'��✓ ,by _dayof t&LJr9202,L by
, \ N b_�. f_ z SlL kDzo 'who is personally known to
y} o Zu e l �,c AA � J perso who i nally know o
V me or who has produced 7 � �1 U-� J-D � me or who has produced
identification and who did take an oath. identification and who did take an oath.
NOTA PUBLIC: NOTARY PUBLIC:
V
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Sign: Sign:
Punt` �l �D(� Pr�3 Print: LJL ��� �- �-r/CC/✓r1 i,
Seal: Seal: n
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�•'&.....: GUI___NMOACALUEROs 2 >••�o'o
Notary ouWic- State of F:o,ica o'o
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+SAY.. •..,•. SINDIA ALV ..an,,, N. �u�•ir. czpresur :,. .�,3
•'� MY COMMISSION# GG 238273 Barco: ^-ro;h Nations!+c: :een.
APPROVED EXPIRES: Seolember 3.2022 fans Examiner Zoning
o
¢rFOFW gonae4Trym Notary Public Undenurilera
lStructural Review Clerk
(Revised02/24/2014)
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