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EL-15-1498 49 `SCORES`f Miami Shores Village -"` @i!X1f z �� f! L a 3 10050 N.E.2nd Avenue NE Ql 'ralkldS,4 �� iEE riw�te Miami Shores,FL 33138-0000 � � � r t �S EVED �E a� Phone: (305)795-2204 ee,» . Expiration: 1. FGORtDp p. 2/20/2015 Project Address Parcel NumberApplicant 1401 NE 103 Street 1132050310130 JAMES OBENOUR Miami Shores, FL Block: Lot: Owner Information Address Phone Cell �JA�SON0UR1401 NE 103 ST MIAMI SHORES FL 33138-2625 Contractor(s) Phone Cell Phone Valuation: $ 250.00 MOODY ELECTRIC INC (305)758-2000 Total Sq Feet: 0 Type of Work:chub pool Available Inspections: Additional Info: Inspection Type: Classification:Residential Final Scanning: 1 Light Niche Bonding Review Electrical Alarms Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# EL-6-15-56017 DBPR Fee $2.25 DCA Fee $2.25 06/23/2015 Check#:6670 $ 109.10 $50.00 Education Surcharge $0.20 06/18/2015 Check#:6668 $50.00 $0.00 Permit Fee-Add itions/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 information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above-namedntra to to do the work stated. 24, June 23, 2015 Authorized Signature:Owner / Applican Contractor / Age ate Building Department Copy June 23,2015 1 Vp Miami Shores Village g 'u, Z", Building Department: 1 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305)795-2204 Fax: (305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 Ib BUILDING master Permit No.9??-6 —/S=/3 72 PERMIT A=ON Sub Permit No. GL 113,- 1 _\q U ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: / I �� a/4 3 Sr _ City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: l �Q!^�4,3/ d/,�d Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): �Aptk* ©heli ova .�iL Phone#: 3�4' Address: 1110' ,e &�f '�03 fi City:Z [QAy� cl'o f e'f State: Zip: 33139 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: Ae Phone#: Address: S City: / ! State: ZIAZip: �� Qualifier Name: /7/U `/� Phone#: ��SG State Certification or Registration#: �C_ ()(()(040 !l 7 Q /G Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ J ' Square/Linear F otage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: zo Specify color of color thru tile: Submittal Fee$ Permit Fee$ I�✓r`CortDO CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ q . (Revised02/24/2014) 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 OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of oM_ Q 20 , by day of = 61AAE- 20 1 P by D. Ob-fl) v i is personally known to J- -C:)H 0 �1- MOO ,who is personally known to me or,w s produced 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: Sign: Sign: Print: Notary Public State of Florid2 Print: Sandra dee Hart MARY PAT BRIGGS Seal: My Commission FF 010644 Seal: Notary Public-State of Florida o.r. expire:04r2v20,7 y do My Comm.Expires May 11 y ,2018 pF r. Commission N FF 120746 APPROVED BY ,✓�Sl 'S�L- % �/!/�/S� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)