EL-17-598 Permit NO. EL-3-17-598
0 RFS- Miami Shores Village Permit Type:Electrical-Residential
10050 N.E.2nd Avenue NE ' Work Classification:Alteration
Miami Shores,FL 33138-0000 Pen
- " Permit Status:APPROVED
Phone: (305)795-2204
f<ORIDp`
Issue Date: 3/22/2017 Expiration: 09/18/2017
Project Address Parcel Number Applicant
161 NE 106 Street 1121360060380
Miami Shores, FL 33138-2036 Block: Lot: SECTION M INC
Owner Information Address Phone Cell
SECTION M INC 3821 EL PRADO Boulevard (786)408-3661
MIAMI FL 33133-
3821 EL PRADO Boulevard
MIAMI FL 33133-
Contractor(s) Phone Cell Phone Valuation: $ 2,000.00
SUNSHINE ELECTRICAL CONTRACT( (305)268-4958
_._.._ ._ Total Sq Feet: 0
Type of Work:REPLACE FIXTURES,OUTLETS,SWITCHES Available Inspections:
Additional Info: Inspection Type:
Classification:Residential Review Electrical
Scanning:3
Fees Due Amo]25
Pay Date Pay Type Amt Paid Amt Due
CCF
DBPR FeeInvoice# EL-3-17-63208
03/22/2017 Check#: 1691 $ 116.70 $50.00
DCA Fee
Education Surcharge 03/07/2017 Check#: 1666 $50.00 $0.00
Permit Fee-Additions/Alterations $Scanning Fee Technology Fee Total: $16
In consideration of the issuance to me of this permit, I ree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plan dra ings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all ork one by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING, MECHANI L, NDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVI rt' formation is accurate and that all work will be done in compliance with all applicable laws regulating
construction and in er r a ove-named contractor to do the work stated.
March 22, 2017
thorized Signature:Owner /—Applicant / Contractor / Agent ate
Building Departm t Copy
March 22, 2017 1
-how'
Miami Shores Village
g
Building Department
\� 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 7 2017
Tel: (305)795.2204 Fax: (305)756.8972
INSPECTION'S PHONE NUMBER: (305)762.4949 BY --
FBC 201q
BUILDING Permit No. P-G "L�
PERMIT APPLICATION Master Permit No.f 1 I
Permit Type: Electrical T
JOB ADDRESS:_161 l !IV-r I p G � r e-eET
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): --_�77DO M . l G. Phone#: Z S
Address: 363/ cL (7�1> ?>.11/D1 MIAMI EL 3/3
City: /\, /. /tel i
,� ( State: Zip: 3513�j
Tenant/Lessee Name: /v � Phone#:
Email:
CONTRACTOR: Company Name: C0KF144e?M Phone#: ?e6 gL13 15 fl d
Address: -.!37W 5 �/
City: /t/�oyq- State: FL Zip: 3 3/V
Qualifier Name: A 4ko-lU D c54wT1f,3a: my Phone#:
State Certification or Registration#: 3O7-5 8Z�`certificate of Competency#:
Contact Phone#: 4/CHW &616W ' Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑Address `` ❑r�i4 EL-11-1,S-
l/Alteration / ❑New —7❑Repair/Replace ❑Demolition
Description of Work: / E_1\16 L 1—l� — 2-/2-
***************************************Fees********************************************
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$ 1 ' `
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 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 we char d.
W'NO
Signature P ignature
Owner or Agent Contractor
The foregoing instrument was acknowledged be r% The foregoing instrument was acknowledged before me thi x
day of PYAMOA, ,20L,by day of SCr✓1 20 -6 by 11C mx end
who is personally known to me or who has produc `v who is personally known to me or who has produced
As identification and who d of �oa h. as identification nd.-�whoaicTta7, %tKRRO
NOTARY PUBLIC: NOTARY PUBLIC: _ . n MY N#FF90 0EAR 20,2020
h v Bonded tnrowh 1st State Insurance
Sign: Sign: '�w
Print: Print:
My Commission Expires: My Commission Expires:
APPROVED BY /Y°&A- /!'Plans Examiner Zoning
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
`ygaR 3ES Grit
Miami shores Village
Building Department
s
�CpgtUA 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel;-(3Q&)7952204
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 BE YOU CKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
wn
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me thian 14 day of 2017
B7::2F1%r=12�1 who is personally known to me or has produced
as identification.
Notary:
.4
. EXPIRES:JUN 21,2019
SEAL: Bonded through 1st State Insurance
SUNSHINE EIX---,',,CTRJCAL CONTRACTOR
1300 SW 85 Ct Miami FL 33144 Phone (786) 443 9590
03/22/2017
Miami Shores Village
Building Department
10050 NE 2nd Avenue, Miami Shores FL 33138
State Of Florida
County Of Dade
Before me this day personally appeared MARIANO SANTIESTEBAN who, being duly
sworn, deposes and says, that he will be the only person working on the project
located at 161 NE 106 Street Miami Shores FL 33138
MARIANO SANTIESTEBAN
EC13005807
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed bfore me this 72-- day of HA 0 � ?, by
(name of person making statement). 1,Y1 21AA b(i�,�64M
Y„ MARY D.CAMARGO
(04,—
Mw"uMMISSION#FF242221
(NOTARY SEAL) EXPIES:JUN 21,2019
,,, Fronded through 1st State Insurance
ersonally Known R Produced Identification
ype o Identification
Produced