EL-12-1303Miami 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
Permit Type: Electrical
FBC 20
Permit No. F -L -7' � ' 130
Master Permit No.kC1 a- O9I-
JOB ADDRESS: r 76 ! A/E Z3 Av&;ov (-�
City: Miami Shores County: Miami Dade Zip:
Foho/Parcel#:
Is the Building Historically Designated: Yes
NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): &Z A�S �- / - M 2 Phone#:
City: State
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: �/�% �`�-r C- �'' � " Phone#: q.5 Zf
Address ��-� / �=�✓ /- `�?�=�✓�
City: /` tt Mr State: - Zip: *3> '-Z-> 0 as
Qualifier Name Phone#:5
State Certification or Registration #: L / .-' VO Agc3 Certificate of Competency #:
Contact Phone#: 024 5 Email Address:'% M L`� ����- Gf JA-�
DESIGNER: Architect/Engineer. Phone#:
Value of Work for this Permit: $ %Ti Gye 'a Square/Linear Footage of Work
Type of Work: OAddress DAlteration ew Ijeai€Replace
Deseription of Work: AS
&6 , wx-nnz. f$T2. 1-..-g6Ff/s � �75RcC:c f c
rA-,y 6;G s
Submittal Fee $ Permit Fee $
Scanning Fee $
Notary $
Radon Fee $
;-'i; evz�'
Training/Education Fee $
Double Fee $ Structural Review $
CCF $ CO/CC $
DBPR $ Bond $
Technology Fee $
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
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 approved and a reinspection fee will be charged.
Signature �l' Signature
Owner or Agent Contractor
The fore in ent was ackn wledged be me ��
day of 201, b
identification and who did take an oath.
PUBLIC: • - ,
The foregoing instrument was acknowledged before me this
day of Au GUS f', 201.2�*JG�� rjat'cL-i T�&a
who ' personall�1��moi tome or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign: Sign s
Print: —s ci'b y 1 L QQ1TH OVA1UO Print: .State
Notery ly�zat �xpi�4 2bbju
My Commission Exp My Comm. Expires Jun 13.2017 My Co sion a My Comm EE
n # pssa
Commission 8 FF 813940 • e a_ COm�n�ssw Na�jo�,atN°tary
Sanded Through National Notary Assn :sa.. �P: poaded�htuu9h
::;, g5t, /l;
APPROVED BY ��- / e/PPlans Examiner Zoning
Structural Review Clerk
(Revised 3/12/2012XRevised 07/10/07XRevised 06/10/2009XRevised 3/15/09)
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CHANGE OF CONTRACTOR I ARCHITECT
f ermit N.
diners Name .(Fee; impte Title H Ider): — �.►TA�o Phone #..
q _
City: )FL AM Sic sr . State : t-.• Zip Code:
Job Address (Of where work is being done): Cj'l (gli I`�� 6L • t 3AV (L
City: Miami Shores State:^Florida Zip Code:
Contractor's Company Name: ie; T Ag, Phone #: ° N(� �Z
Addre ,LJ, Ik AvXL
City:16-Ag-31,A -`I • State: X312 Zip Code:
Qualifier's Name: Lic. Number:
Architect/ Engineer of Record Name: Cot Llk AmIA Phone #:
Address:
City: State: Zip Code:
Describe Work:L�I.�►i.G �c c n�, C ►'�, C4gAJ TnAw'To�
I hereby certify that the work has been abandoned and/or the contractorlarchitect is
unable or unwilling to complete the contract. I hold fiwE kilding Offl;Al and the
Miami Shores harmless for all leg im
Signature Signature
,1orftorAgent
The foregoing instrument was aknoviedged bef1'kgAVv-%o
TheV
ing in
thls� day of �,2q by - this day
Who is personally known to me or who has produced who is pelrsonall
as Indentiflcation.
.Arcltii
aknowledged before me
_, 20133 i�• r'vl rjv�.
known to me or who has produced
JAIME wAPPEREA
f PdfiO $late of
7
• ; 115 S. Andrews Ave., Rm. A-1 00, Ft. Lauderdale, FL 33301-1895 — 954831-4000
VALID OCTOBER 1, 2013 THROUGH SEPTEMBER 30, 2014
DBA:
Business Name: TML ELECTRIC INC
Owner Name: LYTTLE TOYSON
Business Location: 9531 DUNHILL DR
MIRAMAR
Business Phone: 954-245-5889
Receipt #: 181-2510
Business Type: (MASTER ELECTRICAL
Business Opened:08/27/1997
State/County/CertfRP.9:EC13 001823
Exemption Code:
Rooms Seats Employees Machines Professionals
4
For Vending Business Only
Number of Machines. Var" inn Tvnn-
Tax Amount
Transfer Fee
NSF Fee
Penalty Prior Years . _
Collection Cost
Total Paid
27.00
0.00
0.00
2.70 0.00
0.00
29.70
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is
non -regulatory in nature. You must meet all County and/or Municipality planning
WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when
the business is sold, business name has changed or you have moved the
business location. This receipt does not indicate that the business is legal or that
it is in compliance with State or local laws and regulations.
Mailing Address:
LYTTLE TOYSON Receipt #01C-13-00000663
9531 DUNHILL DRIVE Paid 10/30/2013 29.70
MIRAMAR, FL 33025
i
2013 -2014
8