EL-16-2663�st!O1sL,�
Miami Shores Village
10050 N.E. 2nd Avenue N
Miami Shores, FL 33138-0000
Phone: (305)795-2204
FLORLOp'
Permit No. EL-9-16-2663
Permit Type: Electrical - Residential
Pen " Work Classification: Addition/Alteration
Permit Status: APPROVED
Issue Date: 3/28/2017 j Expiration: 09/24/2017
Project Address Parcel Number Applicant
9400 N BAYSHORE Drive 1132050100110
AMINE DOUKKALI MARIELA B F
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
AMINE DOUKKALI MARIELA B ROVITO 801 N VENETIAN Drive (305)992-6776
--- MIAMI BEACH FL 33139-
801 N VENETIAN Drive
MIAMI BEACH FL 33139-
Contractor(s) Phone Cell Phone
MV ELECTRICAL SERVICES (305)216-0677
ype of Work: REWIRE NEW BRANCH CIRCUITS THROUGH
dditional Info: REWIRE NEW BRANCH CIRCUITS THROUGH
lassification: Residential
canning: 1
Fees Due
Amount
CCF
$25.80
DBPR Fee
$22.09
DCA Fee
$22.09
Education Surcharge
$8.60
PermitFee- Additions/Alterations
$1,472.59
Scanning Fee
$3.00
Technology Fee
$34.40
Total:
$1,588.57
Valuation: $ 42,074.00
Total Sq Feet: 4000
Pay Date Pay Type Amt Paid Amt Due
Invoice # EL-9-16-61501
03/28/2017 Credit Card $ 1,538.57 $ 50.00
09/28/2016 Credit Card $ 50.00 $ 0.00
Available Inspections:
Inspection Type:
Final
Meter Box
Alteration
Relocation
Fire Alarm
Service Change
Review Electrical
Underground
W. W.
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 zoAia. FuthermDre Amuthorize the above -named contractor to do the work stated.
March 28, 2017
: Wner /—/Apoficdnt / Contractor / Agent
Building Department Copy
March 28, 2017 1
Miami Shores Village RECEIVED
BUILDING
PERMIT APPLICATION
Building Department SEP 28?016
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 5 1
FBC 201q
Master Permit No. R C 1(6
Sub Permit No. 6 / I(jp - Z(o &J
❑BUILDING [M ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [—]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 01400 Nord , ga,v-�)Olre driV9
Folio/Parcel#: r I 3 a 1) ! — C) 1 0— 01 f b Is the Building Historically Designated: Yes
Occupancy Type: �. r/AQ Load: Construction Type: Flood Zone: �e BFE: _
OWNER: Name (Fee Simple
No K
FFE:
State: Zip: 3 3 /3l�
Tenant/Lessee NarMP,: Phone#:
Email:
67 "" D
CONTRACTOR: Company Name: ILIV CI eCTi_l C4Z SPUU(CC'S , ��C' Phone#: S) do :?-�
Address: 1831 % N Gy ?� Z C r/
City: /j . (P�G/IL State: J� C- Zip:
Qualifier Name: ( 'k4 oy"r_�'S L) a Phone#: o0 - off/
State Certification or Registration #n/: �C /3005(o C)Certificate of Competency #:
DESIGNER: Architect/Engineer: & /fEG L) :¢�/ r �t 0' 19 S ��C ,C • Phone#: -7OS (P �3
Address: - / q `r S w �%y22 �.� City: !. ,/� • ` State: i Z Zip: 3 3 / .S s�
Value of Work for this Permit: $ �77.7 C 0 0 r-y Square/Linear Footage of Work: 'ilk 0-0
Type of Work: El Addition u Alteration L� New LTRepair/Replace ❑ Demolition
Description of JWork: K ,P !iy r 2 t 7 A/ 4 /C—j //..4 nG j
l� t,J � J 2L > � �� Gl /G:� c�/ „(_. � l /� �%%Z !' t �L ...SP/ [�J / C-� ✓
Specify color of color thru tile:
Submittal Fee $ I ' Permit Fee $ & Tz s
Scanning Fee $ cam/ Radon Fee $ 2-2
Technology Fee $ �_ /1 Training/Education Fee $
CCF $ 21 CO/CC $ '—
DBPR $ 2Z. O 18 Notary $
Double Fee $
Structural Reviews $
(Revised02/24/2014)
Bond $
TOTAL FEE NOW DUE $ 3�
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
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
incnertinn will not he nnnroved and a reinsnection fee will be charaed.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of 20 1 y , by
who is personally known to
me or who has produced � (Q) V - as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: C) . �v
Print: L i �l
Seal:
Notary Public State of Florida
C Rodriguez
�j �P� My Commisslon EE 861704
*******
APPROVED BY
Signature
CONT�
The foregoing instrument was acknowledged before me this
&0 dayof/7UyuSr ,20 /� ,by
?64 n "1 U" r s who is personally know to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC: IN
4"
g IM: May 04, 2020
Sign: n^w°
Print:
Seal:
*******************************************************************
Plans Examiner Zoning
(Revised02/24/2014)
Structural Review Clerk