EL-16-76Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit
Permit NO. EL -1-16-76
Permit Type: Electrical - Residential
Work Classification: Alteration
Permit Status: APPROVED
Issue Date: 1/13/2016
Expiration: 07/11/2016
Parcel Number
Applicant
652 NE 105 Street
Miami Shores, FL
1122310120140
Block: Lot:
KILUAN, INC
Owner Information
Address
Phone
Cell
KILUAN, INC
652 NE 105 Street
MIAMI SHORES FL 33138-
150 SE 2 Avenue
MIAMI FL 33131-
Contractor(s) Phone Cell Phone
CASSIA ELECTRICAL CONTRACTOR: (954)650-5840 (954)274-6277
Valuation:
Total Sq Feet:
$ 2,600.00
0
Type of Work: INSTALL 125 AMP ELECTRIC PANEL AND
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
$1.80
$2.25
$2.25
$0.60
$150.00
$3.00
$2.40
$162.30
Pay Date Pay Type Amt Paid Amt Due
Invoice # EL -1-16-58300
01/13/2016 Credit Card $ 112.30 $ 50.00
01/12/2016 Credit Card $ 50.00 $ 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 a aboveeentractor to do the work stated.
January 13, 2016
Authorized Signature: Ow
Applicant / Contractor / Agent
Building Departhfent Copy
January 13, 2016
Date
1
.d&
BUILDING
PERMIT APPLICATION
BUILDING ELECTRIC
(PLUMBING (l MECHANICAL
JOB ADDRESS: 652 N. E. 105 St.
City: Miami Shores
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
'ED
JAN 1 2 2016
31
FBC 20 I`l
Master Permit No }O—� 1 » 2:399
Sub Permit No.
❑ ROOFING n REVISION 1 1 EXTENSION (RENEWAL
Ft PUBLIC WORKS n CHANGE OF n CANCELLATION (i SHOP
CONTRACTOR DRAWINGS
County:
Miami Dade Zip: 33138
Folio/Parcel#: 11-2231-012-0140 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone:
OWNER: Name (Fee Simple Titleholder):
Address: 652 N.E. 105 St.
Kiluan, Inc.
BFE: FEE:
Phone#:
City: Miami Shores State: Florida
Tenant/Lessee Name: N/A
Email:
Zip: 33138
Phone#:
CONTRACTOR: Company Name: Cassia Electrical Contractors
Address: 8261 NW 48 St.
Phone#: (954) 650-5840
City: Lauderhill State: Florida Zip: 33351
Qualifier Name: Glenworth Walker Phone#: (954) 650-5840
State Certification or Registration #: 3o 0 s -q o '7 Certificate of Competency #:
DESIGNER: Architect/Engineer: A & I Associates Phone#:
Address: 370 N.E. 101 St. City:Miami Shores State: FI. Zip: 33138
Value of Work for this Permit: $ 2,600.00 Square/Linear Footage of Work:
Type of Work: ❑ Addition n Alteration n New ❑ Repair/Replace n Demolition
Description of Work: Install 125 amp electric panel and lights and switches on rear porch/ pool, 'patio
Specify color of color thru tile:
Submittal Fee $ ' • Permit Fee $ /0727, GU
Scanning Fee $ ? -
��`` Radon Fee $ pp C�
Technology Fee $ •V Training/Education Fee $
Structural Reviews $ (%)
(Revised02/24/2014)
CCF $ 1
DBPR $ - Notary $
Double Fee $
Bond $
CO/CC $
TOTAL FEE NOW DUE $
cD
0
Bonding Company's Name (if applicable) N/A
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable) N/A
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 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.
rector Kiluan, Inc) Cassi Iectric
Signature
The foregoing instrument was acknowledged before me this
11 day of JQYIUG V� , 20 ) (D , by
tic( vet) )JYUr..I , who is personally know� to
(19evsoitc4 1, v -ow^)
identification and who did take an oath.
me or who has produced
NOTARY PUBLIC:
Sig
Print:
Seal:
Lucie CT / QS"
as
: LUCIA G ISASI
• 'r )" MY COMMISSION #FF182628
ra.
li d? 1 * RE: ber«Sd1; ,8*.g
(407) 399.0153 FloridallotaryService.com
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
)) day of JO t1 uI� Y , 20 l(o , by
611.0/TX ,e �./&ho is personally known to
me or who has produced Q�VI Je y0' jurise as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
*******************
APPROVED BY/0.1.-44-2,42IZ sai2"/6 Plans Examiner
(Revlsed02/24/2014)
Structural Review
Luce )5051
;;;;°fie,
• ... LUCIA G ISASI
• ri MY COMMISSION #FF182628
-''.6iive� EXPIRES December 10, 2018
(407) 398-0153 FloridallotaryService.com
************
Zoning
Clerk
RICK SCOTT, GOVERNOR ,
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD
LICENSE NUMBER
EC13005907
The ELECTRICAL CONTRACTOR
Named below IS CE3T1FIED Ky
Under the provisipns of Chapter 489 FS.
Expiration date: AUG 31, 2016
WALKER, GLENWORTH C . ,.
CASSIA ELECTRICAL CONTRACTORS, INC.
8261 NW. 48TH STm -- '
_LAUDERHILLFt 33351
0
r
0
}SUED: 08/13/2014
SEQ # L1408130002029
ice--- -- - - _------- .
BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT
z
115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000
VALID OCTOBER 1, 2015 THROUGH SEPTEMBER 30, 2016
DBA: Receipt #:181-2559
CASSIA ELECTRICAL CONTRACTORS INC ELECTRICAL/ALARMS/CONTRACTOR
Business Name: , Business Type: (ELECTRICAL CONTRACTOR)
Owner Name: GLENWORTH WALKER/QUAL Business Opened:10/01/2004
Business Location: 8261 NW 48 ST State/County/Cert/Reg:Ec13005907
LAUDERHILL Exemption Code:.
Business Phone: 954-650-5840
Rooms
Seats
Employees
1
Machines
Professionals
For Vending Business Only
Number of Machines:
Ven
Tax Amount
Transfer Fee
NSF Fee
Penalty
Prior Years
Collection Cost
Total Paid
27.00
0.00
0.00
0.00
0.00
0.00
27.00
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
THIS BECOMES A TAX RECEIPT
WHEN VALIDATED
Mailing Address:
GLENWORTH WALKER/QUAL
8261 NW 48 ST
LAUDERHILL, FL 33351
This tax is levied for the privilege of doing business within Broward County and is
non -regulatory in nature. You must meet all County and/or Municipality planning
and zoning requirements. This Business Tax Receipt must be transferred when
the business is sold, business name has changed or you have moved the
business location. This receipt does not indicate that the business is legal or that
it is in compliance with State or local laws and regulations.
2015 - 2016
Receipt #108-14-00011151
Paid 09/16/2015 27.00