EL-16-2459 3
- 40
64
Miami Shores Village PWm*,Tj41"ICtta
10050 N.E.2nd Avenue NE }� G #p
Miami Shores,FL 33138-0000
WNL C1gS8i`d �Ir�3n
Phone: (305)795-2204
Ex iration: 03112/2017
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Project Address Parcel Number Applicant
390 NE 91 Street 1132060190190
Miami Shores, FL 33138- Block: Lot: KENNETH WILKINSON
Owner Information Address Phone Cell
KENNETH WILKINSON (973)632-2529
FL
Contractor(s) Phone Cell Phone Valuation: $ 6,000.00
ELETRICAL SOLUTIONS FOR ALL LU (786)663-0025
_._...._. Total Sq Feet: 0
Type of Work:INTERCONET SMOKE DETECTORS,NEW E Available Inspections:
Additional Info:INTERCONET SMOKE DETECTORS,NEW E Inspection Type:
Classification:Residential
Review Electrical
Scanning:1
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $3.60
Invoice# EL-9-16-61230
DBPR Fee $4.50 09/13/2016 Check#:3699 $271.60 $50.00
DCA Fee $4.50
Education Surcharge $1.20 09/06/2016 Check#:2176 $50.00 $0.00
Permit Fee-Additions/Alterations $300.00
Scanning Fee $3.00
Technology Fee $4.80
Total: $321.60
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.
+L September 13, 2016
Auth�d,Aiea Signature:-Owner / Applicant / Contractor / Agent Date
Building Department Copy
September 13,2016 1
Miami Shores Village ' c ,IA,
CSEP 6 2016
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 2014
BUILDING Master Permit No. RC l6 ~!'707
PERMIT APPLICATION Sub Permit No. - L. •-Z4s9
❑BUILDING ® ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: b®1) IN e. 9� s-t
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
o bGIN" , Tp�dv��aV cti
OWNER:Name(Fee Sim ple,Titleholder): �C�_���; � i���1S��1 4) Phone#:(c("1"3)'2.4b- ,Qfb-1'0
Address:
City: VVccYiiState: Zip: 3'-�� �'►
Tenant/Lessee Name: Phone#:
Email: n / ,�,
CONTRACTOR:Company Name: G /G C. »°Ca ZQQ1dh' KCld✓ ��t `Le Phone#:TgC) 6 6 S ®o��
Address: �'z/ £ �rh st
City: A- �G A // State: FL ova-d c, Zip: '3 0/0
Qualifier Name: P&1ax,& Cau7y PhoneMbeQ66,3 OOHS
State Certification or Registration#: G ie
UD14 798 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: ,M-1c-r c.®c'%,e* a y-v4g, 8e'\-e—C.,Vo C-S +�J �Ce�, Cl-CA
c1 Yv�-cir�eco. a�c�d �y q c•o o�•� n -eJ�cr �c i �'�,e
Specify color of color thru tile:
Submittal Fee$ �1�` Permit Fee$ CCF$ �' - �0 CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Cf. Notary$ �,
Technology Fee$ 90 Training/Education Fee$ ( 2-0 Double Fee$ i,)�
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ I
(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. 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 approved and a reinspection fee will be charged.
Signature 96ignature
OWNER r AGENT - NTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
Co day of A4.jQ'� ' 20 V(o by _ZJr—day of fi 20 by
rt- l
V t� ho' ersona I nnown to C&_KXrJ0 QAC61. who<Aonal nown to
me or who has produced as me or who has pro uced as
identification and who did take an oath. identification and ho did take an oath.
NOTARY PUBLIC: NOTAR P LIC: "'y p�/,� RODOLFO E SOSA
= Notary Public•State of Florlda
R nay Comm.Explree May 4,2017
Sign: Sign: hfFOFF�°PO,, Commla8ion#EE 878848
Print: ODOLF0 E SOSA print:
�aogP Y , N a Pub11C- q,2017
Seal: =_* My mm.Expires May Seal:
Co mission#EE 873648
Sonde
Through National Notary Assn. ,
APPROVED BY � �P � Plans Examiner Zoning
Structural Review Clerk
(RevisedO2/24/2014)
s� Miami shores Village
Building Department
10050 N.E.2nd Avenue
lOR1DA Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
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 BEL YOU A KNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENT
6
Signa e,n"-t' =t�`
er
State of F rida
County of Miami-Dade
The foregoing was acknowledge before me this QQ, day of cv� ,20 1( .
BUJ l I Y--1 n rz>Orl . who is6i�i�kwn.to me or has produced
a on.
,RY Notary Public-State of Florida
Notary: o ¢ ° _ RAv Qnmm Fypires may 4,2017
" commission#EE 873648
SEAL: Bonded Through National Notary Assn.
1
r
COMPANY LETER HEAD
Date:August 29,2016
State of Florida
County of Miami Shores Village
Before me this day personally appeared Eduardo Cueto who,being duly sworn,and say:
That he will be the only person working on the project located at:390 NE 91 St Miami Shores Fl,33138.
Sworn to or affirmed)and subscribed before me this 29 da of August 2016 by produced identification
driver license C356-200-70-330-0.
oti'�r'n"�eo�� RODOLFO E SOSA
Notary Public-State of Florida
z' « My Comm.Expires May 4,2017
Commission#EE 873648
Bonded Through National Notary Assn.
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