EL-15-1628 Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores,Florida 33138 JUN 3 O 2015
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 28
--
FBC 20
BUILDING Master Permit No. ��
PERMIT APPLICATION Sub Permit No.
❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑ CANCELLATION ❑ SHOP
F /� p CONTRACTOR DRAWINGS
JOB ADDRESS: g 3` -) ! ' � > �4 2�-
City: Miami Shores County: Miami Dade Zip: 3313'?
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood ZoiteBFE: FFE:
OWNER:Name(Fee Simple Titleholder): L ram Phone#:
30S3VA /
Address: �2�5 Iv F S� ?
City: /G9//�16�( SI-l®f?rS L Zip: 1✓3
Tenant/Lessee Name: Phone#: 30 C? "ZZ/;
Email:
CONTRACTOR:Company Name �t� ��—a Q�G'� Phone#:.1�='
Address- u,16!� s 7 V-t,
City: �ps ecState:
Qualifier Name: n -� > �'/"� Phone#:
State Certification or Registration Me& OMIWS Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: Citi;;,. State:- Zip:
.w
Value of....Work,for.this Permit:$ Square/Linear Footage of Work: ' q
Type of Work: ❑ Addition [:1Alteration New
.
! ❑ Repair%Replace -s ❑ Demolition
X e
Description of Work: e
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ f,4 47s 0 G CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ /�Q
TOTAL FEE NOW DUE$ b 1 CJ
(Revised02/24/2014)
Bonding Company's Name(if applicable) 'y
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 TW FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CON .. •H,YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEM
Notice to Applicant: As a condition to the issuance of f permit with an estimated value exceeding$2500, the applicant must
o the notice o comme�ent and construction lien law brochure will be delivered to the person
promise ►n good faith that a copy f f
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 NTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
2 day of 20 J s ,by day of RJU IJ 4?1 ,20 16 ,by
who is personally known to ` '�n1 I l l�.who is personally known to
me or who has produced as me or who has produced as
identification and whMan, identification and who did take an oath.
Ir4QUF1DEkACRUZ
WCM9SSIQPIIFFF016797NOTARY PUBLIC: '�i+tNOTARY PUBLIC: EXPIRES:May 12,2017 imNQUELDELACRUZ
*d%U Notary Punk M mbM •� )• MY CCMCutlSSIQN 9 FF 016797
EXPIRES:May 12,2017
- j ,,,�` � rhru Notagr Pntr9e undem3ere
Sign: A Sign:
Print: 7i Print:
f ! d
Seal: Seal:
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
'46 "Peim
it ivo. FL
Miami Shores Village P8t7 #IT'p +O t:B.'`11"Ido [a�I
�S. 10050 N.E.2nd Avenue NE n /tjeY�h /1`/ {■��/�
lnrit.VlGt�I�lN`rfIFRCf, n
Miami Shores,FL 33138-0000
Phone: (305)7952204 Pem7rtPPti
Issue Date:7f6�#J115 Expiration: 01/0212016
Project Address Parcel NumberApplicant
1245 NE 94 Street 1132050100040
FRANK HOLLANDER
Miami Shores, FL 33138- Block: Lot:
Z11111—-um mn�
Owner Information Address Phone Cell
[FRANK HOLLANDER 9811 NW 1 Avenue 305/759-9681
MIAMI SHORES FL 33138-2946
Contractor(s) Phone Cell Phone Valuation: $ 900.00
PARDIME ELECTRIC INC
Total Sq Feet: 0
Type of Work:INSTALL 15 LIGHTS IN PATIO 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-6-15-56168
DFee $2'25
DCACA Fee $2.25 07/06/2015 Check#:4916 $ 109.10 $50.00 j.
Education Surcharge $0.20 06/30/2015 Check#:4906 $50.00 $0.00
Permit Fee-Additions/Alterations $150.00
Scanning Fee $3.00
Technology Fee $0.80
i
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 wor(.
OWNER'Authoriz
%De
rtify that all the foregoing information is accurate and that all work will be done in com)liance with all applicable laws regulating
constructhermore uthorize the above-named contractor to do the work stated.
July 06, 2015
ure:Owner / Applicant / Contractor / Agent Date
Buildinrtment Copy
July 06, 2015 1
Miami Shores Village cdj
Building Department DEC 292015
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. jEL is — 16 2-e
PERMIT APPLICATION Sub Permit No.
F-1 BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADoRESS: ! y S IVC
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:
OWNER;Name(Fee Simple Titleholder): ffOA47� Phone#: 305 3 ff 9—d a/C;?-
Address: 1,;2 4/S N,5 9y S
City: ALM -s/����5 State: C Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR.,Company Name: �G mime Phone#:
Address': 2� V 6 Z S s5&1,1 �Z e
(/
City I/l oyn P '!r State: L Zip.
Qualifier Name: fLj L 1//0 D/) e — o/eY ✓acIrso, J,*//K phone#: 30S f4 —80 1!�D
State Certification orRegistrationM Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:-$ C2 0 D Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑f Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:-
Specify
ork:Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(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 rAGE NT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of I)TZ — 20 I S by day of 20 ,by
40LU0-4%rZ who is personally known to ,who is personally known to
me or who has producedas 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: Print:
Seal: :��CQm�,Se X59 ®\ Seal:
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APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(ReAsed02/24/2014)
DEC 2 g 2615
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