EL-16-1613 Permit No. EL-6-16-1613
Miami Shores Village Permit Type:Electrical -Residential
10050 N.E.2nd Avenue NE Per IWorts Classification:Low Voltage
Miami Shores, FL 33138-0000 Permit Status:APPROVED
Phone: (305)795-2204
Issue Date:6/14/2016 Expiration: 12/11/2016
Project Address Parcel Number Applicant
35 NE 91 Street 1132060130100
Miami Shores, FL 33138- Block: Lot: JEAN-BAPTISTE RAMET
Owner Information Address Phone Cell
JEAN-BAPTISTE RAMET 35 NE 91 Street (954)667-5242
MIAMI SHORES FL 33138-
35 NE 91 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 300.00
ALES GROUP ELECTRICAL CONTRAI (786)223-6096
__ ._ �,..._ w._... ..__ ... .... ........ Total Sq Feet: 0
Type of Work:LOW VOLTAGE EXISTING Wiring(5 WATT Available Inspections:
Additional Info: Inspection Type:
Classification:Residential
Review Electrical
Scanning: 1
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60
Invoice# EL-6-16-60140
D13PR Fee $2.00 06/14/2016 Credit Card $58.60 $50.00
DCA Fee $2.00
Education Surcharge $0.20 06/09/2016 Credit Card $50.00 $0.00
Permit Fee-Additions/Alterations $100.00
Scanning Fee $3.00
Technology Fee $0.80
Total: $108.60
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strictlonformity wi"plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assurfid responsibil' for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,FLOM13ING,MEI HA CAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
�
OWNERS AFFIDAVIT �� i that all=fhe f - oing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zo a or' a the above-named contractor to do the work stated.
)`J June 14, 2016
Auth rized 'i e`.Owner Applicant / Contractor / Agent Date
Buildin ' nt Copy
June 14,2016 / 1
11 Miami Shores Village aBY'
D
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel: (305)795.2204 Fax: (305)756.8972
INSPECTION'S PHONE NUMBER: (305)762.4949
-f1A
FBC 201 t-(
BUILDING Permit No. f f 6 1 3
PERMIT APPLICATION Master Permit No. 06
Permit Type: Electrical �.
.TOB ADDRESS: 35-
City:
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated:Yes NO e Flood Zone:
OWNER: N me(Fee Simple Titleholder): � � � 7 res�N Phone#: S 66 SZ�Z
Address: �� ��
Citv: State: Zip:
Tcnant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: A�U (,�r,]..1..0 RUC ,,i(AX Ct,1YAC40, Phone#:35
Address: 1:�Ol(O SL,) _l1741- AVC
City: I� t A ►i State: EL Zip: 3?51Q�A
Qualifier Name: Phone#: �4b_ZZ3—toCt(p
State Certification or Registration#: FC Mot Z Certificate of Competency#:
Contact Phone#: Email Address: 0'I-e_S01Y0QP tC- @ cev► I. uy'n
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit:$ 3W-00 Square/Linear Footage of Work:
Type of Work: ❑Address. ❑Alteration Al ❑New i ' epair/Replace ❑Demolition
Description of Work: LAW V 0 i-V V_
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$ • 6O
Bonding Company's Name(if applicable)
Bomling 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. T 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 cope 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 Signature
O e or Agent 9b Cont actor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
r S�
clay of- Z 20 t(a,by day of�.J= 20 A,by �AYI�101) WVa-^-L"— _
x„h is personally knuwr ,me or who has produced who is personally known to me or who has produced
t as identification and who did take an oath.
,,ti:T`• '�z SUANYCOMAS
NOTARY PUBLIC: MYCAMMISSION#FF941225 NOTARY PUBLIC•
• EXPIRES:December 6,201!
Bonded Thru Notary Pubk UnderwrlleR
n
Sign avd T Sign:
Print: Ki QPrint: ✓1 Gwe C�t`r DI
ADRIANA 01My Commission Expires: My Commission Expires: 4 := MY COMMISSION#EE 867174
EXPIRES:January 22,2017
of Fyd Bonded Thru Notary Public Underwriters
N�xk�*.k*8=k
APPROVED BY �f� �'r/A”' of ns Examiner Zoning
Structural Review Clerk
(Rei iced 1/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revked 3/15/09)
A
WEFF ATWATER
CHIEF FINANCIAL OFFICER STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS'COMPENSATION
CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law,
EFFECTIVE DATE: 1/3/2016 EXPIRATION DATE: 1/2/2018
PERSON: LORENTE RAMON
FEIN: 592157712
BUSINESS NAME AND ADDRESS:
LES GROUP INC
RC-6 SIA, 70 AVENUE
FL 33144
'COPES OF BUSINESS OR TRADE:
CELASED GENERAL LICENSED ELECTRICAL DOOR AND WINDOW
�,ONT RACTOR CONTRACTOR INSTALLATION
Sk 7'ry't3 Chapter 440 05(14),F S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section
,i lo:'ecover t)enefits or compensation under this chapter.Pursuant to Chapter 440 05(12),F.3-Certificates of election to be exempt.-apply only
V�Ilrir,:he scope of the business or trade listed on the notice of election to be exempt,Pursuant to Chapter 440.05(13),F,S..Notices of election to be
.exemO and cenif,,cates of election to be exempt shall be subject to revocation if,at any time after the filing of the notice or the issuance of the certificate,
'he person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a
DFS-F2-DV%1C-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609
ORE
Miami Qhores V illage
Building Department
®RtiUA 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to Owner-- Workers' Compensation Insurance Exemption
I or da [_,,w�, requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05
'1!!0\%_`ca;porae officers in the construction industry to exempt themselves from this requirement for any construction project prior to
00t,1111il'12 s building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure:
i 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 (LI.-C) in the construction industry may elect to be
i
exempt if.
1. The officer owns at Least 10 percent of the stock of the corporation,or in the case of
E an L.I.C,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
Depar rment 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 j
voluntary revocation is filed or the exemption is revoked by the Division.
Y')ui contractor is requesting a permit under this workers'compensation exemption and has acknowledge that he or she will not use
c!, :.ibor,part-Lime employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will
be dw only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of
wv;'kers' compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors.
BY SIGNING BELOW YOU, ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
! Signature:
i
er
j State of Florida
County of Miami-Dade
The i'ore,aiug was acknowledge before me this (D -.day of
'20 I._1v
-
. tSt who is personally known to me or las produce
_ b- as identification.
1
-... _......__�..-..._.� .._._. .,rV.pU i, ADRIANA GIRARDI
MY COMMISSION#EE 867174
SEA EXPIRES:January 22,2017
'";F of ttq",• Bonded Thor Notary Public underwriters
1_
'A ' L ES CROUP 896 SW 70T" AVE,
MIAMI, FL 33144
7777r,-TRIGAL. rC3NTRAC=RS PHONE 305-262-1388
" FAX 305.262-1389
LICENSE #EC0001288
alesgroupec@gmail.com
June 2, 2016
State of Florida
County of Miami-Dade
Before me this day personally appeared Ramon Lorente and David Gonzalez who, being
duty sworn, deposes and says:
That they will be the only persons working on the project located at: 35 NE 91St Street,
Miami Shore, FL 33138.
"� 2!?v
Sworn to (or affirmed) and subscribed before me this 20 day of 20ko, by
man lz►%jk-.-� a,& f�avt
Personally Know
OR Produced Identification
Type of Identification Produced
Print, Type or Stamp Name of Notary
�� "s' ADRIANA GIRARDI
+: .: MY COMMISSION#EE 667174
-' EXPIRES:January 22,2017
N'.;,,6;;c c Bonded Thru Notary Public Underwriters