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EL-16-683 Miami Shores Village g Building Department r 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 MAR 1 g 2016 Tel: (305)795.2204 Fax: (305)756.8972 INSPECTION'S PHONE NUMBER: (305)762.4949 BY: FBC 20 J`I BUILDING Permit No. (40� PERMIT APPLICATION Master Permit No.g..l Permit Type: Electrical JOB ADDRESS: I I I& 0E 9 2 W ' City: Miami Shores County: Miami Dade Zip: 3 Folio/Parcel#: I I — 320 S— �� ' �'ZU Is the Building Historically Designated: Yes NO Flood Zone: OWNER:Name(Fee Simple , Titleholder): Sc��KP�4FPO r 1 Phone#: 3045_ `7b Address: l t Y� I`�' �2 IyIJ� W_ S ffi)Vm— FCA City: M 1*V-"1 State:( Zip: 3 129 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Compan ame Phone#: Address: City: Oy State: Zip: 7�% eo Quali der Name: V2.4 Phone#:za; State Certification or Regis ration#: C� j 4 of Competency#:�l L' o 0 b Contact Phone#: _ Email,Address: . » �-•^"i DESIGNER: Architect/Engineer: Phone#: 14,12 o_0 n �'v Value of Work for this Permit: $ �C?�� Square/Linear Footage of Work: Type of Work: ❑Add``ress Alteration // ❑New ❑Repair/Replace ❑Demolition Description of Work':k. CC11 en eft'C'A'A E-144"13 j t4C,F.C,i. , OL Wr For A micl'owNVP Submittal Fee$ Permit Fee$ /�©'�® CCF$ 1 - 2-0 CO/CC$ 0 Scanning Fee$ 3 �- Radon Fee$ a- DBPR$ 2"9'S Bond$ Notary$ Training/Education Fee$O' 6 Technology Fee$ Double Fee$ lG 0 , CV*" Structural Review$ 0 TOTAL FEE NOW DUE$ 2 6a '-7-10 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 ELECTRICAL WORK,PLUMBING, SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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 hick occurs seven (7) days after the building permit is issued. In he absence of such posted notice, the inspection will not be roved and a reinspection fee will be charged. Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The fo oing instrument was acknowledged before me this day of ,20 L_,by ��d Oy,.4 day o ` 20�,by who is personal y known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUB Sign: Sign: Print: Print: My Commission Ex ir• ':."�a•,, My Commis i:'`�xp�res: VALTY RAYMORE ALTY RAYMORE MY COMMISSION#FF020273 MY COMMISSION#FF020273 �' •••'Foy map;: EXPIRES June 19,2017 •'-:focr4`?.:' EXPIRES June 19. 2017 407)398-0153 FloridallotaryService.com Rg •k**ieie 9e 9e ieeF*9r9r�tic* d(�c Mjg�j9e�e9eie lYl��cla l`lolary�erv`�ce coin**** ******�****'�********'�** ****��*� APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) E LANET ELECTRICAL Letter Head Date P,/ Dl( State of County of Before me this day personally appeared ------------- Who being sworn, deposes and says That or she will be the only person working on the project located Sworn to (or affirmed and subscribed before me this -/-,//--day of- 2016-by---- Personally know- ----- Or produced identification------ Type of identification produced------------- 0 RZ'P ----" -------- �`:. ALTY RAYMORE Print type or stamp name of n aMy COMMISSION#FF020273 o: FOFF�°P;' EXPIRES June 19, W07)398-0153 F ar'da 201 7 Metplanet Electrical Contractor INC 6231 Grant C rt o yw ice.corn PHONE NUMBER AREA CODE 754-214 1695 logo Miami shores Village res Building Department O 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.89?2 Notice to Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if. 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLED HAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signat e: Own State of Florida County of Miami-Dade T foregoing was acknowledge before me this_/3—day ofJ fJ f X X y,20/,j�_, y who is personally known to me or has produced AMMM A.MVWentifi tion. No"pwft-no O1 Rol" Notary: my Contin•EOW Ap T,2614 E SEAL: NIMMWfl ' CTQB Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY 07E000659 METPLANET ELECTRICAL CONTRACTOR INC D.B.A.: ELF T JEAN LESLIE Is certified under the provisions of Chapter 10 of Miami-Dade County I fl I I I I . I JEFF ATWATER CMIEF FINANCIAL 0 'ICER STATE E OF FLORIDA 1 DEPARTMENT OF FINANCIAL,SERVICES DIVISION OF WORKERS'COMPENSATION " CER FlCA7 E CONSTRUCTION I OF ELECTION TO 8E EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW*7 DU8'i ky.:kXEMPTION This cert! es that th individual listed below has elected to be exempt,from Florida WolkwV Compensation law, EFFECTIVE DATE: i 4/24/2019 EXPIRATION DATE: 4/2412018 PIERSON: TELF, T. JEAN FEIN: 13433 T. BUSINESS NAME AI D ADDRESS: (METP. ANET ELECTRICAL CONTRACTOR INC it • 6231 GRANT COUR� HOLLYWOOD FL 33024 i SCOPES OF BUSIN 83 OR TRADE: LICENSED ELECTRf�AL CONTRACTOR Pursuant to Cbgnter 440.()6(4)•F.3•,pn officer of a may not reogver banellts":1 Drporetivn motto erects ex$hapten 44 lam beta C,,Cer by fEng a artglcata d ere411on under this eeMon R1 mpenaegCn under this ohaPEer•PtxauaM b Chapter 4f0,fy4(72),F.$.,CertK( e exempt fha scope of the buain as or insets Rhea On the nattoe d eteglgt to be ekfm t PUratuent cAft d election to be axernpt•..apply�►b Utempt anal gsrttf c8les of e ' ion to'be exem p b Chapter 440.a6(f3),F.&,Notice*of eholon to be a certifkste n0 lon9 m seNa Iheb revocation M,at any thne effartne fiting of the notfOa or the uuanee of the the person named on the not ottrfdtcata . roQa��ftt3 d thfs atxlaxt for Issuance d a oeruflcato•The dsPtttneM shag revoke a DFS-F2-DVVC-252 CER FICATE OF ELECTfON TO 8E EXEMPT REVISED OB-13 QUESTIONS?(850)413.1909 I ' II , I I i I i I i i j j • I ' i it ... zzo ( C- QP, I Permit No. EL-3-16-683 `S�aORES y' Miami Shores Village Permit Type: Electrical -Residential 10050 N.E.2nd Avenue NE Work� M Work Classification:Alteration Miami Shores, FL 33138-0000 Permit Status:APPROVED Phone: (305)795-2204 f<ORIDP Issue Date:4112/2016 Expiration: 10/09/2016 Project Address Parcel Number Applicant 1116 NE 92 Street 1132050270420 Miami Shores, FL 33138- Block: Lot: SUSAN PINNAS Owner Information Address Phone Cell SUSAN PINNAS 1140 ALFONSO Avenue CORAL GABLES FL 33146- 1140 ALFONSO Avenue CORAL GABLES FL 33146- Contractor(s) Phone Cell Phone Valuation: $ 1,200.00 METPLANET ELECTRICAL (754)214-1695 Total Sq Feet: 1500 Type of Work: KITCHEN REMODEL 4 HIGH HATS 4 GFI 1 Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning: 1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 Invoice# EL-3-16-59025 DBPR Fee $2.25 DCA Fee $2.25 03/15/2016 Credit Card $50.00 $260.70 Education Surcharge $0.40 04/12/2016 Credit Card $260.70 $0.00 Permit Fee-Additions/Alterations $150.00 Scanning Fee $3.00 Technology Fee $1.60 Work without Permit Fee $150.00 Total: $310.70 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 ELdA - PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS Af ertify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constructionthermore, I authorize the above-named contractor to do the work stated. April 12, 2016 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy April 12, 2016 1