EL-16-638 o� Miami Shores Village
10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000 !
�. G.iff '•r h..
Phone: (305)795-2204
Expiration: 0911292016
Project Address Parcel Number Applicant
10276 NE 12 Avenue 1132050190020
Miami Shores, FL 33138- Block: Lot: RAPHAEL LEVY
Owner information Address Phone Cell
RAPHAEL LEVY 10276 NE 12 Avenue 305/758-9065 305/812-3637
MIAMI SHORES FL 33138
Contractor(s) Phone Cell Phone Valuation: $ 3,755.00
EMPIRE ELECTRIC MAINTENANCE& 305-2649982
Total Sq Feet: 120
Type of Work:FURNISH AND INSTALL 7 HI HATS 1 SMO Available Inspections:
Additional Info: Inspection Type:
Classification:Residential Review Electrical
Scanning:1
Fees Due Amount Pay Date Pay Type Amt Paid Arnt Due
CCF $2.40
DBPR Fee Invoice# EL-3-16-58976
$2.25 03/16/2016 Check#:4157 $113.90 $50.00
DCA Fee $2,25
Education Surcharge $0.80 03/10/2016 Credit Card $50.00 $0.00
Permit Fee-Additions/Alterations $150.00
Scanning Fee $3.00
Technology Fee $3.20
Total: $163.90
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate *
II o 'll be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the above-named contractor to a at
March 16,2016
Authorized Signature:Owner / Applicant / Contractor / rAgent Date
Building Department Copy
March 16,2016 1
Miami Shores Village
;2016
MAR
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 ;.,_•..,:",
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 to
BUILDING Master Permit No. � ".;;k'
PERMIT APPLICATION Sub Permit No. �-16' — �
❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1 DQ`3(0 t'�97 19,, Pio
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): Phone#:3yy_2?f_!A=
Address: 9 cXX I Co "t✓ IQ t%Y c
City: Y` iNty7m _n)KCS-z S State: IF Zip: 33i 3A
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name:�TA/ /Z!�
Address: j ore
City: State: Zip:
4ualifier Name: 47VA01,11eDPhone#:
State Certification or Registration#: _ Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
r
Value of Work for this Permit:$ o Square/Linear Footage of Work:
Type of Work: ❑ A-d-ditionAlteration ElNew ElRepair/Replace ElDemolition
Description of Work:/5 44I j � Y�c 'XF_'7;e'f7-Z91
Specify color of color thru tile:
Submittal Fee$ SD.�-� Permit Fee$ �� ��®® CCF$ Q• 6 CO/CC$ tiU
Scanning Fee$ ° 06 Radon Fee$ DBPPRR/�$$Q • Notary$
Technology Fee n QTraining/Education Fee$ Ute' Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ 3 ,9 V
(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 noticegf commencemen ust b ted at a job site
for the first inspection which occurs seven (7) days after the building permit is u d. In the ab en po d tice, the
inspection will not be approved and a reinspection fee will be charged.
Signature ! r Signatur
OWNER or AGENT O
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged be re me this
r" day of V'd7 ,20 ,by day off ,20 by
{'u ct U4 who is ersonally known o f / / hF ho is persona ly known to
me or who has produced as me or who has produced as
identification and who did take an ath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBUC:
Sign: Sign:
Print: Nk KNxda Print: SIXTO
Seal. ,• WANDA Seal. _ 4_ Notary Public-State of Fi�21
a
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•'� MY C�iiIM19S10N9FF928798 :v, boQ�r My Comm.Expires Feb e, 7EXPIRES Odobw 19,2019 �� Commission#EE 8548
t40 X0159 •wm
APPROVED BY /6 Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)