EL-15-2127 Miami Shores Village
10050 N.E.2nd Avenue NE
NM N _ SYN} £ R y £ i✓�"m, £S,
Miami Shores,FL 33138-0000
Phone: (305)795-2204
Expiration: 03112/2016
Project Address Parcel Number Applicant
1151 NE 99 Street 1132050180070
Shima VII LLC
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
Shima VII LLC 1235 NE 100 Street (786)253-2869 (305)796-4922
Miami Shores FL
1235 NE 100 Street
Miami Shores FL
Contractor(s) Phone Cell Phone Valuation: $4,500.00
SOUTH DOM ELECTRIC INC (305)626-5904 rrmmyy Yrr � Total Sq Feet: 00
Type of Work: Available Inspections:
Additional Info: Inspection Type:
Classification:Residential Final
Scanning:3 Meter Box
Alteration
Relocation
Fire Alarm
Service Change
Review Electrical
Underground
W.W.
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $3.00 Invoice# EL-8-15-56795
DBPR Fee $3.38 09/14/2015 Credit Card $248.76 $0.00
DCA Fee $3.38
Education Surcharge $1.00
Permit Fee-Additions/Alterations $225.00
Scanning Fee $9.00
Technology Fee $4.00
Total: $248.76
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-named contractor to do the work stated.
September 14,2015
p Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
September 14,2015 1
Miami Shores Villaa Questions/Comments/Concerns?
- g Please call either
RECr Building Department a rt m e n t Monique: 786-253-2869 or
Aug 2 ® t019 p Louis: 305-796-4922
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
BYINSPECTION LINE PHONE NUMBER:(30S)762-4949
FBC 20H Sh j
BUILDING Master Permit No.
e.;- Z126
PERMIT AP L Q:ATION sub Permit No J 1� 21 ,�
❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWALtt
PLUMBING [:] MECHANICAL PUBLIC WORKS [:] CHANGE OF CANCELLATION [:] SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS'
City: Miami Shores County: an@9&iami Dade Zip:
Folio/Parcel#: O/3010 S O r Y Oto 7 o Is the Building Historically Designated:Yes NO sCo
Occupancy Type:sl� Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Dame(Fee Simple Titleholder): /f/ �" 4 L Phone# ®�����— g
Address:, /o®
City: .00/i Y✓'!l S<4�y -Mate Zip: .
Tenant/Lessee Name: Phone#: _
Email: _3ifo7 .,"i4 ✓ L 7-6
CONTRACTOR:Company Name: �Z /G Phone#: 9�2
Address: r--
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City: 1 `! k State: - Zip: ,5 V/S
Qualifier Name: L j S� fk L. C) S Phone#: S ✓��\
State Certification or Registration#: (�-7i✓ ertificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
S
Wo
Value of Work-for this Permit;_$ � v C> Square/ 1hear Footage of Work:
Type of Work: ❑ Addition W Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:• M QVie S 0 ge- AAa 0--e To ® oPA.o S e 7 �
;. AJ.
Specify color of calor,t�iru�#jfe €i;Y s
Submittal Fee$ a e Permit Fee$y r� o CCF$ &e5 0' CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ • Notary$
Technology Fee$�! ' a jQ Tralning/Education Fee$ 1,012 ' Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ 2 9
(Revised02/24/2014)
� s
R
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 an a reinspection fee will be charged.
� +lintrumernt
Signature '� Signature
OWNFt or AGENTCONTRACTOR
The foregoing instrument was acknowledged before me this The foregwas acknowledged before me-�this
day of �� II��-M20/�,by day of d3'l�l .20 /Sr- ,by
6)- D o is personally known to G( who is personally known to
me or who has produced���� as me or who has produced fL as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign Sign•
P
►dotery public St MDtstlt
Seal: fit• joanne M Feliciano Seal: .ioarm8 M F
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############################################################################################################
APPROVED BY -714tWC A,0--Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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Cts lett OMC®t STATE OF RLDA
DEPARTRNTOF FB144DIC AL SERVICES
DIVISION OF WORKERS'COMPENSATION
CERTvtCATE OF ELECTM 7013E E1a3IPTFROM FICA S'COMPEM11ON LAW;
CONSTRUCTION INDUSTRY EJ iIGN
Tide cartiffinlitatthe dual listed below has el dfi be exemptfront Florida WodoW ConWensedon law.
EFFECTWE DATE 6!162015 E ATION DATE 6/152017
PERSON: MATOS JOSE
FEW. 200699M
BUSINESS NAME AND ADDRESS:
SOUTH DOM ELECTRIC INC
5M NW 192 ST
MIAMI FL 33015
SCOPES OF SUSINESS OR TRADE:
LIC@! '9LECTRICAL
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