EL-13-1751Miami 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
JOB ADDRESS: 1208 NE 99TH STREET
F�M_ g T ,�
AUG O is 3 DI
FBC 20
Permit NoE-1 1 cJ I
Master Permit No I
City: Miami Shores County: Miami Dade Zip: 33138
Folio/Parcel#: 11-3205-009-0200
Is the Building Historically Designated: Yes
NO X Flood Zone:
OWNER: Name (Fee Simple Titleholder): Daniel N. Berger and Hara R. Berger Phone#: 305-542-6098
Address: 1208 NE 99TH STREET
City: MIAMI SHORES State: FL Zip: 33138
Tenant/Lessee Name: N/A Phone#: N/A
Email: dnberger@gmail.com
CONTRACTOR: Company Name: I )h 1'F8 � (�P �� Cry Go -t sh CQ4 Phone#:
Address: Z(O 6.3 C OO. ZT
city: State: f Zip: 330s?
Qualifier Name: 2 OrC Lo► Phone#: -7 9'6 "-79 7-
State Certification or Registration #: 0 lzbiip �j ' Certificate of Compete cy #: O® O` Z
Contact Phone#: 7 86 - IT) -2 l P i Email Address: Q r i & 1Q, Ice ej� e C0. _Q40 c (_Ct,
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ 10#*2609° Square/Linear Footage of Work:
Type of Work: OAddress MAlteration ONew ORepair/Replace ODemolition
Description of Work: l2 QFSj 4 !�'O t!1A Vy1, 0 Ay ,`A A-<--) I C.0Z0-i,;AJ
Submittal Fee $ Permit Fee $_7®0�✓� CCF $ CO/CC $
Scanning Fee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
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
Owner or Agent
Signature 111-1
Contractor
The foregoing instrument was acknowledged before me this i The foregoing instrument was acknowledged before me this
day of IV� , 2013 by __yk �°� day of 20 � by �r7ak SACCI ,
who is personally kno�e or who has produced who is personlily known to me or who has produced
As identification and who did take an oath.
identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
APPROVED BY
Structural Review
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
Clerk
GNMAM
. ' 1�'IssicJrt a EEB"112
February 21, 2017