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ELC-17-123Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Permit NO. ELC-1-17-123 Permit Type: Electrical - Commercial Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 1/25/2017 Expiration: 07/24/2017 Parcel Number Applicant 415 NE 105 Street Number: CHURCH BLDG 1122310430010 Miami Shores, FL Block: Lot: ST ROSE OF LIMA CATHOLIC CI Owner Information Address Phone Cell ST ROSE OF LIMA CATHOLIC CHURCH 9401 BISC BLVD MIAMI FL 33138-2970 (305)758-0539 Contractor(s) MOODY ELECTRIC INC Phone (305)758-2000 Cell Phone Valuation: Total Sq Feet: $ 100.00 0 Type of Work: CARNIVAL Additional Info: CARNIVAL Classification: Commercial Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $0.60 $15.00 $15.00 $0.20 $1,000.00 $3.00 $0.80 $1,034.60 Pay Date Pay Type Invoice # ELC-1-17-62636 01/17/2017 Credit Card 01/25/2017 Check #: 2778 Amt Paid Amt Due $ 50.00 $ 984.60 $ 984.60 $ 0.00 Available Inspections: Inspection Type: Final Meter Box Alteration Relocation Fire Alarm Service Change Review Electrical W. W. Underground -, 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. onst uct oS Aand zonl i., MI - IIha _• e, I au he rize the above-namedoing tion ls accurate and contractorr to do the work statall work dll be done in compliance with all applicable laws regulatingMikill Authorize Building Dep / Applicant / Contractor / Agent ent Copy January 25, 2017 Date January 25, 2017 1 /01441/51'' ‘\q, ( • BUILDING PERMIT APPLICATION Miami Shores Village 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 RECEIVED JA tU 7 2017 BY' Jau. FBC 2014 Master Permit No. E, L I 11 - 12.3 Sub Permit No. S44) ❑ BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 4/%5— HE 6-�fce-� City: Miami Shores County: Miami Dade Zip: 331 3 ' Folio/Parcel#: Is the Building Historically Designated: Yes NO x Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): �� •V.,bSE' of 1.-2,(1(101 Phone#: 30.5 7.3-g () Address: y/s /V i= /OS City: i 4m I cJ 1--?r,('e S State: F/ Zip: 33138 Tenant/ Lessee Name: Phone#: Email: CONTRACTOR: Company Name: 8/7-, fie //(2) Phone#: _*5- 750 ,200 O Address: City: 7k /l, G4 -)''©a State: �7�lc:// t' ocorlq? Qualifier Name: State Certification or Registration #: Zip: J T g Phone#: 75-8000 Certificate of Competency #: DESIGNER: Architect/Engineer: /VA ' Phone#: Address: City: State: Zip: Value of Work for this Permit: $ •U/4' Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: G,- V' y i Va.. 1 1 P rck r l N kw a nil F C I c+r i C_ for &y -n) va .( PO f ). .4 { +... i . + . 4 Specify color of color thrtip tile: Submittal Fee $r " Pesrmit Fee $ 60.001 w CCF $ ' COO CO/CC $` oQ- 00 Scanning Fee $ Radon Fee $ 15 ' DBPR $ 1 5' • Notary $ Technology Fee $ • 80 Training/Education Fee $ . 2.. O Double Fee '$ Structural Reviews $ Bond $ (Revised02/24/2014) GO TOTAL FEE NOW DUE$ 61-48 _I • Bonding Company's Name (if applicable) Bonding Company's Address City State , Zip A///4 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 apd and a reinspection fee will be charged. Signature OWNER or AGENT The foregoing instrument was acknowledged before me this 1/ day of J flix:X.r 20 1.7 , by -Vv-cr r, � .x ,il+fivtrho is personally known to me or who has produced Sa_4 . as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: ��t411111N11,11�� Dikc,�N�Leo' moi 4.• .. J\ssioN • .� QOmber 49zr.c'9• • • *� - ;• ?p' S . v YFF 055949 • J Qr ' ******************44• *,** ******�s'********(*�************************ • AiC•'1•• OF Signature CONTRACTOR The foregoing instrument was acknowledged before me this 1� ill day of j(.�1'll)CiI�i/ , 20 11 , by ' hn r - M�11 , who is personally known to me or who has produced f identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: as APPROVED BY (Revised02/24/2014) 1: • � t;1001... • O a e,%/t7-- Plans Examiner Structural Review Zoning Clerk