EL-15-1460 T 01
'�yNoREs Miami Shores Village # POO @t"1 E311t1al .
10050 N.E.2nd Avenue NE \\k
—�"`""' Miami Shores,FL 33138-0000
Phone: (305)795-2204
LORIdA... c \
81 �t115 Expiration: 12/2312015
Project Address Parcel Number Applicant
401 NE 94 Street 1132060140480
JACQUELINE BECERRA
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
JACQUELINE BECERRA 401 NE 94 Street (786)201-4321
i
MIAMI SHORES FL 33138-2845
Contractor(s) Phone Cell Phone $ 300.00
ATLANTIS ELECTRICAL CORP (305)551-4043 Valuation:
Total Sq Feet: 0
Type of Work:REMOVE AND REPLACE 2 POOL LIGHTS Available Inspections:
Additional Info: Inspection Type:
Classification:Residential
Review Electrical
Scanning: 1
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60 Invoice# EL-6-15-55972
DBPR Fee $2.25
DCA Fee $2.25 06/26/2015 Credit Card $ 109.10 $50.00
Education Surcharge $0.20 06/15/2015 Credit Card $50.00 $0.00
Permit Fee-Additions/Alterations $150.00
Scanning Fee $3.00
Technology Fee $0.80
Total: $159.10
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 certify that all the foregoing infor is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the ab ed contractor to do the work stated.
/,7
Authorized
June 26, 2015
Authorized Signature:Owner / Ap icant / Contractor / Agent Date
Building Department opy
June 26,2015 1
Miami Shores Village
Building Department artment JUN 152015
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY--
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 (0G
BUILDING Master Permit No. t3 P (!5- &4
PERMIT APPLICATION Sub Permit No.,:Et S- lq(;n
❑BUILDING 0 ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: OI
City: Miami Shores County: Miami Dade Zip: �3I
Folio/Parcel#: `I`� �' (�q, 0+F-'50 Is the Building Historically Designated:Yes NO_/
Occupancy Type: Load: Construction Type: Flood Zone: /(J BFE: FIFE:
OWNER:Name/(Fee Simple Titleholder):_ 1 "ptLQ t(N6 `'�Pi�1. � Phone#: ( �" / ' -1��/
Address: kd( CT-
City:_ �`�`t / ��_State: Zip: -731�a
Tenant/Lessee Name:_ iJ� Phone#:
Email:
CONTRACTOR:Company Name: &—E-W-�. TITS /j-Crn/C Phone#: 7M " J `� �T�C)
Address:
City: State: �(� ?T( 7
,,�� Zip:
Qualifier Name: Il�u),VC►f CyP6 /Zez-- Phone#:
State Certification or Registration#: C 3 00 19 t Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: -�^� City: State: Zip:
Value of Work for this Permit:$ .�r`�v. Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteratiion ,�, ❑ New P Repair/Replace F-1Demolition
Description of Work: — rc F-GV'(Ar(f 1/2, ��� L{GT4-T5
Specify color of color thru tile:
Submittal Fee$ - Permit Fee$ X f 0 r®!:�' CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ (� /
TOTAL FEE NOW DUE$ iy9 l
(Revised02/24/2014)
w
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 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 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 insp Ion w - occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will t be a ro ed and a r inspection fee will be charged.
Signature Signature `
OWNER or AGENT CONTRACTOR
The foregoin nstrument was acknowledged before me this The foregoing instrument was acknowledged before me this
ay of 't�1G 201 , by day of yAe= —,20
�
n , by
LQ()e k.ne &Oeffa who is personally known to T,-r0.Ae(%►p 9e(42- who is rsonally know o
me or who has produced E-��� as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Si \`1_ Sign:
Print: � Cka,- Print: a
Seal: 2 b Seal: 4r�,
i3ECA M:pAS DTRANA � `i;+ A M.PASTRANA
`1„ )MMISSf 1L1;SSION#EE8�� :GS February 07,2017
**************************** # ******************
APPROVED BY %S_ �L�6� Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)