EL-15-1435s,!
Miami Shores Village
10050 N.E. 2nd Avenue NE
CCF
Miami Shores, FL 33138-0000
DBPR Fee
Phone: (305)795.2204
Project Address Parcel Number Applicant
8901 NE 4 Avenue Road 1132060460001
SHORES VILLAS CONDOMINIUB
Miami Shores, FL 33138- Block: Lot:
Owner information Address Phone Cell
SHORES VILLAS CONDOMINIUM 8901 NE 4 Avenue Road (305)785-7760
-- - - - - MIAMI SHORES FL 33138-
8901 NE 4 Avenue Road
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone
MOODY ELECTRIC INC (305)758-2000
of Work: REPAIR POST LIGHT. REUSE SAME ELECT
onal Info:
ification: Residential
iinq: 3
Fees Due
Amount
CCF
$0.60
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.20
Permit Fee - Additions/Alterations
$100.00
Scanning Fee
$9.00
Technology Fee
$0.80
Total:
$114.60
Valuation: $ 680.00
Total Sq Feet: 0
Pay Date Pay Type Amt Paid Amt Due
Invoice # EL -6-16-55940
06/11/2015 Credit Card $ 50.00 $ 64.60
06/17/2015 Credit Card $ 64.60 $ 0.00
Available Inspections:
Inspection Type:
Review Electrical
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, PLUMB,*6, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: Ifl that all the foregoing inforn9ion is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning ut a e,1 thnrize the abo named contractor to do the work stated.
June 17, 2015
Authorized Signature: Owner / App c pt / Contractor / Agent uaie
Building Department Copy
June 17, 2015 1
os1 IS hods"
Miami Shores Village qo Ai
Building Department C VED
90050 N.E.2nd Avenue, Miami Shores, Florida 33138 JUN 12015 i
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949 X:)v.
BUILDING
PERMIT APPLICATION
Permit Type: Electrical
FBC 2010
Permit No. c
Master Permit No.F-�-t5
JOB ADDRESS: 20 ��, `f dub
City: Miami Shores County: Miami Dade Zip:3J �S
Foho/Parcel#:
Is the Building Historically Designated: Yes
OWNER: Name (Fee Simple Titleholder):
Address: a94e /
City: J GI�Q~
State:
NO ''/ Flood Zone:
W -M
Tenant'Lessee Name: Phone#:
Email:
Is 3' C-3z-
CONTRACTOR: Company Name: �� n� Phone#:�7'�7�'
Address: 66 q juC2 qo!a°
City: I
Qualifier Name:
State Certification or Registration #: Cao e000 11 q Certificate of Competency #:
Contact Phone#: 36�r -159 - Email Address:
DESIGNER: Architect/Engineer.
l0®
Value of Work for this Permit: $ °J®`�® Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration UNew ®Renair/Renlace ODemolition
Submittal Fee $ J 901 00 Permit Fee $ ZOO,, ®y CCF $ CO/CC $
Scanning Fee $
Notary
Radon Fee $
Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $ T • GO
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
V
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien. law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven ;1) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature n
Owner or Agent
The foregoing instrument was acknowledged before me this
day of 20 L!'>—, by W i �1
of
who is ersonally known tom or las produce
MARV PA.
As
NOTARY PUBLIC:
Print: '
My Commission Expires:
Contra r
The foregoing instrument was acknowledged before me this
day of 201: , by �� ,
ho is personally known to me or who has produced
rltifbMNke Soat®atlFiorida
My Comm. Expires May 11, 2018
Commission # FF 120746
BRIGGS
State of Florida
es May 11, 2018
N FF 120746
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My
Mary Public - State of Florida
Comm. Expires May 11, 2018
Commission # FF 120746
APPROVED BY /l %)'GPP /--$ Plans Examiner Zoning
Structural Review
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
Clerk