EL-15-1005 �eNOS y Miami Shores Village 11�
10050 N.E.2nd Avenue NE
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1
Miami Shores,FL 33138-0000
�e Phone: (305)795-2204
FCORtDA k - ��
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Expiration: 12/23/2015
Project Address Parcel Number Applicant
1111 NE 91 Terrace 1132050010120
Miami Shores, FL 33138- Block: Lot: POLYMATHIC PROPERTIES INC
Owner Information Address Phone Cell
POLYMATHIC PROPERTIES INC 1111 NE 91 Street (707)451-8111
MIAMI SHORES FL 33138-
707 ALDRIDGE Road
VACAVIL CA 95688-
Contractor(s) Phone Cell Phone Valuation: $ 700.00
ALES GROUP ELECTRICAL CONTRAI (786)244-0004
_. Total Sq Feet: 0
Type of Work:REPLACE EXISTING GFI RECEPTACLE WIT 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
DBPR Fee Invoice# EL-4-15-55350
$2.25 04/28/2015 Check#: 1034 $50.00 $ 109.10
DCA Fee $2,25
Education Surcharge $0.20 06/26/2015 Credit Card $ 109.10 $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: 'rtify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zo F thermore, I authorize the above-named contractor to do the work stated.
June 26, 2015
Aut ized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
June 26,2015 1
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Miami Shores Village RFCETX7FID i
. zo15 i
Building Department APR
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 2010
BUILDING Master Permit No.�—�
L.�
PERMIT APPLICATION Sub Permit No. J— L C)03
F-]BUILDING XIELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
' / p CONTRACTOR DRAWINGS
JOB ADDRESS: / l N E / �EJ�GAC E t X114AII S/-�OI�ES �Lo/1/�fl 33/3 8
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
i
OWNER:Name(Fee Simple Titleholder): SO LYHZ7Y-i�/G IYy,6IE22 f/1/6.Phone#:7d7-45i/- 9//l
Address: 7 07.A L OZZ IO&F- 12-9 -!541176 a
City: �/fi G�4\!/L C 6i State: 6SL/ U72,C1/k zip: X15 6 $$
Tenant/Lessee Name: Phone#:
Email: o
CONTRACTOR:Company Name: AZEGTi�./GSL Goll-. Phone#:
Address: 37& $VW 704✓6-
,�A
City: /"I/,-A4 r / State: FZ0a 1V,4 Zip:
d--3-3/44-
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Qualifier Name: Z2AWC/J b/.Z�f-1TS G� Phone#:
State Certification or Registration#: E 6400/Z 8 g Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
on
Value of Work for this Permit:$ 70Lx t Square/Linear Footage of Work:
Type of Work: ❑ Addition � Alteration ❑ New 9 Repair/Replace ❑ Demolition
Description of Work: /2 E EvCI5T/ 167 C7 Fja6-66: ,TIf6LC W/7,4- t4e7b J
2aC,E)52 Ley, ; SAYE Goce0pl-/ z&:�O Ztl E-zISIAI&
W lb- 5!157EI-1. (ZZI TCCE ttJ 24iMcOEL li-&)
Specify color
of color
thru tile:
Submittal Fee Permit Fee$ /✓4"0 IlPU CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ 1 V
(Revised02/24/2014)
a
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 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_/� _ Signature GGCG�'
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of "Irl) ,20 /S , by day of rzh 20 1 by
�1D1 S• ��� ,who is personally known to �� � L�r�,.� who is personally known to
�—T
me or who has produced as me or who has produced i2i-41;r 0as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign:
4" Sign:
Sign:
Print: 1 1 1I G�'1{��1 e. iY�l.Y1122GL.� Print:
Ad
��������""""""'•""•"• ��"",Pj ADRIANA GIRARDI
Seal MICHELLE PANIZZ,1� s Seal: � ,. MY COMMISSION#E.E867174
( ? _�'•. a? EXPIRES:January 22,2017
Commission No. 1982.253 a••...•• ry
0 ! C, e°�'` Bonded Thru Nota Public Underwriters
U _ - ,' NOTARY PUE6L!C-CALIFORNIA !� P'"�'��
w n SOLANu COUNTY
'�'�y Cy`omm.�xpves JULY 16,2016
APPROVED BY«! f % �� /;rk�V/!!�Plans Examiner Zoning
Structural Review Clerk
(Revisecl02/24/2014)