EL-16-129 Permit No. EL-1-16-129
t,,� Miami Shores Village Permit Type:Electrical -Residential
Miami
N.E.2nd Avenue NW 'Per
I
Work Classification:New
- - - Miami Shores,FL 33138 0000 Pern7it Status:APPROVED
Phone: (305)795-2204
toR1oA
Issue Date: 1128/2016 F Expiration: 07/26/2016
Project Address Parcel Number Applicant
11004 NW 2 Avenue 1121360020240
Miami Shores, FL 33168- Block: Lot: LSP HOMES LLC
Owner Information Address Phone Cell
LSP HOMES LLC 455 NE 210 Circle Terrace (305)527-3643
MIAMI FL 33179-
455 NE 210 Circle Terrace
MIAMI FL 33179-
Contractor(s) Phone Cell Phone
Valuation: $ 10,400.00
METPLANET ELECTRICAL (754)214-1695
Total Sq Feet: 00
Type of Work:200 AMP RANGE A/C&WIRING Available Inspections:
Additional Info: Inspection Type:
Classification:Residential Final
Scanning: 1 Meter Box
Alteration
Relocation
Fire Alarm
Service Change
Review Electrical
Underground
W.W.
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $6.60
Invoice# EL-1-16-58361
DBPR Fee $5.46
DCA Fee $5.46 09/26/2015 Credit Card $50.00 $345.52
Education Surcharge $P.20 01/28/2016 Credit Card $345.52 $0.00
Permit Fee-Additions/Alterations $364.00
Scanning Fee $3.00
Technology Fee $8.80
Total: $395.52
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 ELECT CAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWN S AFF AVIT: I ce fy th t all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
cons nd zoning. Fu erm re,I thorize the above named contractor to do the work stated.
January 28, 2016
A th rized Sig ature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
January 28, 2016 1
Miami Shores Village
Building Department JAN I5 2016
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305)795-2204 Fax:(305)756-8972 lay: la—__
INSPECTION LINE PHONE NUMBER:(305)762-4949 `
FBC 20/
y
BUILDING Master Permit No.9.0 )l 57-:;, — 2002.
PERMIT APPLICATION Sub Permit No.�! , j6 —Z 2.9-
❑BUILDING X ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL Ej PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
U / CONTRACTOR DRAWINGS
i
JOB ADDRESS: 1 10Q -( NO Z/►•�G AV le, p
City: Miami Shores ,1 County: Miami Dade Zip: 33) Cp
Folio/Parcel#: �)– y�'"tot 0Zy17 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): L5? L c t Phone#: 3Uj 5 27 3,. '4
Address: t(,� &CILO 0_,Jc_ e -0 18-2Z?—
City: $;,A N ' State: �" Zip:
Tenant/Lessee�Name: p Phone#:
/
Email: �` 7.7(9
tj
CONTRACTOR:Company Na Phone#: �(T? lo ��C/^��
Address:
City: State: ` Zip:
Qualifier Name: _z4zee ` Phone#:
State Certification or Registration#:AfZl_� D �. Certificate of Competency Mz! ( �
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ U v Square/Linear Footage of Work:
Type of Work: EJAddition ❑ Alteration New ❑ Repair/Replace ❑ Demolition
Description of Work:
''�ts�C�wrt:�h•c%�•al3lMJ'1;:+vt!fY.s!!.Cx^i•�=t.nf�:'s:.f�'i� ?'�.w';'�a
Specify color of color thru tile: fi _:•. .,.a , .,�•»� .�==.}t ": _ "
Pj
Submittal Fee 0 Permit Fee CCF$ l�J w`'"� ''"`°CO/CC$
Scanning Fee$ Radon Fee$ J 2— DBPR$ • .5� Notary$ )'
Technology Fee$ Training/Education Fee$ 6 Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(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 Signa r
WNER or AGENT CONTRACTOR
The foregoi/ginstruTIL&W
was acknowledged before me this The regoing instrument was acknowledged before me this
day of 20 , by day of 20,0j6 by
Ay- who is personally known to who is personally known to
me or who has produced L-1 CM as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Si Sign:
pr i Print:
Seal: Seal: ^�`~ VALTY RAYMORE
JENNIFER CLAPES _'``� °
0
NOUrp Public-State of Florida '? MY COMMISSION#FF020273
MY COMM.Expires Jun 26,2018 'rE EXPIRES June 19,2017
( JSE#9s****#�tbRcltAkbt9M8snris�ks *** *************
APPROVED BY / AA- Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
[M:ETPL:ANET ELECTRICAL
Letter Head
Date {/�-P-0/-o
State of Sex-6,A1-4L • .
County of .49-A -
Before me this day personally appeared
- - L 22�-1- ---` ------------ Who being sworn, deposes and says
That or she will be the only person working on the project located
------ //00y N�d
Sworn to (or affirmed and subscribed before me this O�--day of
20-4--by----
G Personally know-L---------
Or produced identification------
Type of identification produced-------------
VALTY RAYMORE
?N^ MY COMMISSION#FF020273
e EXPIRES June 19,2017
} ..
-"'-"'-"-------'- ---- !-9h*S"--'i-'I6iT6allo'[ary5ervice:com
Print type or stamp name of notary
Metplanet Electrical Contractor INC 6231 Grant Court Hollywood FL 33024
t
PHONE NUMBER AREA CODE 754-214 1695
S ORES
l.,. sliest" Miami shores Village
Building Department
oo
ORiIDp' 10050 N.E.2nd Avenue
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 CKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
Owner
State of Florida
County of Miami-Dade �`
The foregoing was acknowledge before me this ?"O day of _ ,20
Bywho is personally known to me or has produced
14gp&ification.
Notary: ..
16 =_
SEAL: - NOTARY PU91IC .'
u' Commission #
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