EL-11-22885 ,p
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC 20
RECEIVED
DEC 09 2011
BY: r
Permit No. EL 1 1 .-R;)As-
Master Permit No. 17/ e- 11- 1 - 111
Permit Type: Electrical 1
OWNER: Name (Fee Simple Titleholder): 4-I urn ber o t u e .sad a
Address: 5 N E 10(.Q • _
City: t-t am ' hare S State: F l Zip: 3S I3 g
Tenant/Lessee Name: Same. Phone #:
Email:
Phone #:"1$(11 -'ia1- a02
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #:
Is the Building Histoiically Designated: Yes
NO Flood Zone:
CONTRACTOR: Company Name: date 1 S 1(ec%r is Phone(O5) 5? - 5010
Address: q 410 Ad a r■ s Ave .
Cit y: M a Yl ?leach h State: � Zi p:
Qualifier Name: Jo1.C.o b c..O he_X Phone #: 2:131L10
State Certification or Registration #: Certificate of Competency #: te) 30c 11 , d3
Contact Phone#: Email Address:
DESIGNER: Architeet/Engineer: Phone #:
Value of Work for this Permit: $ fl 0. O D Square/Linear Footage of Work:
Type of Work: ❑Address SIEeration UNew °Repair/Replace °Demolition
Description of Work; (e p (ace d 1-1 l KOH s x-I gyres
a- 6 F appu +Ie-+s
1 vin +uc re 1t4h4
I ex-talc-for -Fan C ' acemeni
P
1
Submittal Fee $ Permit Fee $ /x'4, ' 't" CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $ t
TOTAL FEE NOW DUE $ 1 S% ° 10
• rr►
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City 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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 . • oved and a reins esilon fee will be charged.
Signature
ip,,,drirdAeir6141,111111111rarrp__
Owner or Agent
g
The foregoing instrument was acknowledged before me this Ef
day of A& G , 201/ , by ,904.
who i ersonally kno o me or who has produced
NOTARY PU
IC:
AC. 4 cation a ted1 en oa
`� ., Notary Public - State of Florida
.. ' My Comm. Expires Nov 1, 2015
Commission # EE 140447
Sign: �// +'�� •c
Print: — — - - -- - - - ■ —
My Commission Expires:
tl
Mit MI
•1 141
Contractor
The foregoing instrument was acknowledged before me this S
day of MG ,20// , by, ',k A,o'%�r` ,
who is ersonally"no%y3to me or who has produced
NOTARY PUBLIC:
Sign:
Print:
......... Bonded Thrush
di.- - - - -, - • •
My Commission Expires:
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
*** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** .' * * * * * **
APPLICATION APPROVED BY-
Chc10 /14103
/70c,c
Plans Examiner
Engineer
Zoning
Jake's Electric Inc
Electrical Contractors
4410 Adams Ave
Miami Beach, Florida 33140
Office (305)532 -5070
Fax (305)538 -7697
Cell (305)796 -6237
Miami Shores Vlllage
10050 N.E. Second Ave
Miami Shores, FLorida 33138 -2382
Atten: Viviana Cubillos / Permit Clerk
Dear Ms. Cubillos,
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Please accept this letter as confirmation of the fact that Jake's Electric has not
done any work at 125 N.E. 106th Street location. We are requesting the permit
EL11 -2288 be cancelled.
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If you require any additional information please feel free to contact me on my
cellular phone: 305 - 796 -6237
Sincerely yours,
Jacob Cohen / President
Jakes Electric Inc.
jtc,ob CokoA& M4 -0
0. 2.4• 2-01°1
� CLAUDIA V. CUBILLOS
o,
,•'o`�` `B Notary Public - State of Florida
a .1 . My Comm. Expires Sep 23, 2015
%; ,°,„o9`� Bonded Through National Notary Men.
Electrical Contractors
RESIDENTIAL • COMMERCIAL • INDUSTRIAL
JAKE'S ELECTRIC, INC,
Jacob Cohen - President
Weir Do It Right The First Time
4410 Adams Ave Tel: 305.532 -5070
• Beach, Fl 33140 Cell: 305 - 796 -6237
Lamed i armed CC #94E00O4Th Fax: 305- 538 -7697
Jake@jakeselectric.com