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ELC-17-498 'ELIC 2" ?-498 Miami Shores Village Permit Type Ej ct [111'N1er'0lod 10050 N.E.2nd Avenue NE � tra r AcYtlition/Aiterawn Miami Shores,FL 33138-0000 Phone: (305)795-2204 Permit Status;A"Q�tP E Expiration: 08128/2017 Project Address Parcel Number Applicant 9723 NE 2 Avenue 1132060134210 Miami Shores, FL 33138- Block: Lot: GATOR 9723 NE 2ND AVE LLC ! Owner Information Address Phone Cell GATOR 9723 NE 2ND AVE LLC 1595 NE 163 Street (305)949-9049 NORTH MIAMI BEACH FL 33162- 1595 NE 163 Street NORTH MIAMI BEACH FL 33162- Contractor(s) Phone Cell Phone Valuation: $ 1,000.00 AP POWER ELECTRIC CORP (954)822-4496 _.... Total Sq Feet: 0 Type of Work:LIGHTING AND EXHAUST FAN FOR NEW AD Available Inspections: Additional Info:LIGHTING AND EXHAUST FAN FOR NEW AD Inspection Type: Classification:Commercial Final Scanning:1 Meter Box Alteration Relocation Fire Alarm Service Change Review Electrical W.W. Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 DBPR Fee Invoice# ELC-2-17-63080 $2.25 02/27/2017 Credit Card $50.00 $109.10 DCA Fee $2.25 Education Surcharge $0.20 03/01/2017 Credit Card $ 109.10 $0.00 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $159.10 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. March 01, 2017 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy March 01,2017 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972Q�t/ INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 BUILDING Master Permit NoCG-/a -2 �3q PERMIT APPLICATION Sub Permit No.F IG 19 -Q'q8 ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP MM CONTRACTOR DRAWINGS JOB ADDRESS: aZ93 /yG d2 677x-7 City: Miami Shores County: Miami Dade Zip: 3/ 3 5r,' 3 d Folio/Parcel#: �,%96 6 ` 013 - qa d d Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: . Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): &-A-bK. 17.2 3 u&' ;LA%,6i LLL Phone#: ,3o 4't 4o`( 9 Address:SBS b V.w A((,. Sf- City: a,.r,; L-K4L State:_rL Zip: 33f 39 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: ( f n c•r Phone#: Address:`_�7,�R _'51L-• Al S "- City: �{ wII State: Or( Zip: J 30 ! 2 Qualifier Name: � c c.,!L 4 r-2­6 t Phone#: State Certification or Registration#: g- Certificate of Competency#:CG 16G. DESIGNER:Architect/Engineer: S c �C-1 r'u 4`lay &14W1 / _' Phone#: !S y�p f y .3 A9[/ Address: q �' ,JrD�p r v City:&14 %dl-%, State: F- Zip: 3 3 Value of Work for this Permit:$ ,D bo•sSquare/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: l a L x�i-�4� t c -• r ,u cw / byJ /L4 Arv.-- Specify colorrC of color thru tile: Submittal Fee P-fr( !-") 'Permit Fee$ CCF$ Y O CO/CC$ Scanning Fee$ '3 Radon Fee$ Z S DBPR$ 2• ZS Notary$ Technology Fee$ 0 S0 Training/Education Fee$ 2 o Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ I Del t RPvi;Pdn7/74/7m 41 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a inspection fee will be charged. Signature Signature OW or AGENT CONTRACTOR The foregoing instrume w s acknowledged before me this The foregoing instrument was acknowledged before me this -7 day of .20 by day of 64P�- ° 20 f , by �- e- r� who is personally known to hp Pow�c , ��� who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. idenI.R ho did take an oath. NOTARY PUBLIC: NOTA ®ELKA ACUNAJ15 MY COMMISSION#FF15582EXPIRES September 1 2018Sign: Sign:Print: G� Print Seal: a°`,_. °�3 Seal: - €,; MY COMMISSION#EXPIRES SeptembW�39"159 FIorldallot® IcIeic$+k#k#akk##%kkffikkkk[e#k#kkkk*3k�Ie[eAt#its#{akakkkk*% kkk# k4kRk+kkkk APPROVED BY (�A' Plans Examiner Zoning Structural Review Clerk (P—A An*)MAi,)nlnt AP Power Electric, Inc 3758 SW 16 ST FT. Lauderdale, FL 33312 Date 2/27/2017 State of Florida Miami Dade County Before me this day personally appeared Hector Arzola who being duly sworn,deposes and says: I Hector Arzola will be the only person working on the project located at 9727 NE 2 Ave. Swo to and subscribed before me this 27th day of February 2017, by �- 2olq Personally Known Produced ID CARLOS FERNANOEZ Notuy Pdit-Bid$of FWM ConxaisSIN 0 FF X8822 MY Comm.Expires Aug 4,2018 BM*d N9asiNotaryAsan. Notary Stamp SEs G cost Miami bhores Village `-r g��� Building Department 0R>C ' 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 nnsurance 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 hill-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,parttime employees or subcontractors. BY SIGNING BELOWYO ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Owner State of Florida County of Miami- e The foregoing was acknowledge before me this a;:?7 day of Zgo- ,20�. By,'nit. e,5 /,p s—At who is personally known to me or has produced S �+ ��`o•.a as identification. Notary: SEAL: „u.+u CARLOS FERNANDEZ O•�,r n ao� °�•� Notary PuEa11C-State of Florid' Commission#►FF 908822 se `o;, My Comm. xp res u °'......,O. Bmiedthrowh Natinnal Notary Assn.