EL-16-23681
Project Address
11028 NW 2 Avenue
Miami Shores, FL 33168-4304
Miami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit
Permit NO. EL -8-16-2368
Permit Type: Electrical - Residential
Work Classification: Alteration
Permit Status: APPROVED
Issue Date: 9/13/2016
Parcel Number
1121360020260
Block: Lot:
Expiration: 03/12!2017
Applicant
CORY A BROWN
Owner Information
Address
Phone
Cell
CORY A BROWN
11028 NW 2 Avenue
MIAMI SHORES FL 33168-
(913)269-1610
11028 NW 2 Avenue
MIAMI SHORES FL 33168-
Contractor(s)
ONLY ELECTRIC CO INC
Phone
305-785-6059
Cell Phone
Valuation:
Total Sq Feet:
$ 750.00
0
Type of Work: ELECTRICAL WORK FOR POOL LIGHT.
Additional Info:
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
$0.60
52.25
$2.25
$0.20
$150.00
$3.00
$0.80
$159.10
Pay Date Pay Type
Invoice # EL -8-16-61087
08/23/2016 Check #: 312222
09/13/2016 Check #: 312344
Amt Paid Amt Due
$ 50.00 $ 109.10
$ 109.10 $ 0.00
Available Inspections:
Inspection Type:
Review Electrical
1
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 13, 2016
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Date
September 13, 2016 1
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
FBC 2//0 ILI
BUILDING Master Permit No. pVP(€' 23°d
PERMIT APPLI ATION Sub Permit No El l (;) 2_,3 6 9
El BUILDING ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION E RENEWAL
El PLUMBING ❑ MECHANICAL E PUBLIC WORKS CHANGE OF ❑ CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1 1,0 A Liu.) Q' A.
City: Miami Shores County: Miami Dade Zip: 3S1GS
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Corr1 hr•ww/
Address: 1 `'J ow )44 L
Phone#:
City: M t 4M C\64.0 .0 State: 1 l-, Zip:
Tenant/Lessee Name: Phone#: 3j) `5
Email:
CONTRACTOR: Company Name:
Address:
kc. Q-0
Phone#: &'67/5_ ‘05/
City: 404/ RI State: � • Zip: z3a2,Y
Qualifier Name: .6 g cc
State Certification or Registration #: cc" /8003/3 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Phone#:
Value of Work for this Permit: $
� 11►,'l1'ii
• -4a) ' Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Al
teration New ❑Repair/Replace
❑ Demolition
Description of Work: ZJ I C - T j T3 L 4 k
j6.t�.-PLRe,E. 7-M IT - (5- ZR -Di
Specify color of color thru tile: ^
Submittal Fee $ S Permit Fee $ /re',dd CCF $ 0 - GO co/cc $ Nod
Scanning Fee $ 3 ' CO Radon Fee $ 3 ` DBPR $ . 0.45 Notary $ �"
Technology Fee $ a Training/Education Fee $ C)= '2-0 Double Fee $
Structural Reviews $ X) Bond $ ;0)
TOTAL FEE NOW DUE$ l . It)
(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. 1 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 inspec o which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will n. be approveji anf einspection fee will be charged.
Signature
OWNER or AGENT
Signature
CON
The foregoing in'rument was acknowledged before me this The foregoing instrument was acknowledged before me this
ISS day of 20 14 , by T `'A Y day/�of 4.5.04,r-, 20 K. , by
, who i personal) novV to 3k j 0,0" (M fLay , who i ersonally kno n to
me or who has produced as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
identification an' h. did take an oath.
NOTARY P
Sign: Sign:
Print: P
Seal: S
************************
APPROVED BY
(Revised02/24/2014)
as
*********************************************************************************
7719//lrl0 Plans Examiner
Zoning
Structural Review Clerk