EL-17-195 m tt x 174 9
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Miami Shores VillageP
10050 N.E.2nd Avenue NE l�SS ffC8If3fI •fid i �A1te0
Miami Shores,FL 33138-000
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Phone: (305)795-2204
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Expiration: 9/24/2017
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Project Address Parcel Number Applicant
561 NE 95 Street 1132060140750
MICHAEL HETTICH
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
MICHAEL HETTICH 561 NE 95 Street
MIAMI SHORES FL 33138-2731
Contractor(s) Phone Cell Phone Valuation: $ 1,600.00
J&J TELECOM S ELECTRIC INC (954)864-8091
Total Sq Feet: 0
Type of Work:SPOT LIGHTS SWITCH+G,F,F Available Inspections:
Additional Info:SPOT LIGHTS SWITCH+G,F,F
Inspection Type:
Classification:Residential
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 $1.20
Invoice# EL-1-17-62722
DBPR Fee $2.25 03/28/2017 Check#:1059 $ 110.70 $50.00
DCA Fee $2.25
Education Surcharge $0.40 01/25/2017 Check*1056 $50.00 $0.00
Permit Fee-Additions/Alterations $150.00
Scanning Fee $3.00
Technology Fee $1.60
Total: $160.70
In consideration of the issuance to me of t is ermit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity wit t e plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I a pqrne responsibili r all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICALI UMBING,MEC ANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT. rti that all th fo going information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. ermore,I a horize a above-named contractor to do the work stated.
March 28, 2017
Authorized Signa u :Owner / Applicant / Contractor Agent Date
Building Dep Copy
March 28,2017 1
r
Miami Shores Village
rD
JA 2L52�O7
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 [BY:
Tel:(305)795-2204 Fax:(305)755-8972
INSPECTION LINE PHONE NUMBER:(30S)762-4949
FBC 201'x'
BUILDING mnw Permit NO.-F-C
PERMIT A=ON Sub PermitNo. EL �-'1-7
E]BUILDING ELECTRIC ® ROOFING ❑REVISION ®EXTENSION ❑RENEWAL
F-1 PLUMBING []MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑SHOP
I * , CONTRACTOR DRAWINGS
JOB ADDRESS:_ I (a 1��F
City Miami Shores County. Miami Dade Zip: �� 1
Folio/Parcel#. Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: gyp. Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): eY\ o b'1� ` �-�C-1 �'i L� Plrore#
Address• T / N �_ 9 S
City: a. 'Sho'e. State: Zip:
Tenant/Lessee Name: Phone#:
6q—AdEmail: -�r f /► ,, f— (�
CONTRACTOR:Company Name: .11�Q "'� Phone# '7 96q—
Address:
dress: q� Q
ik) . C54 -.64-9 -
City: R `6\y4 State: o zip:
Qualifier Name: 1 ` R. bN Phone#-
State Certification or Registration# O C 1 J Q'00(0 �, Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#: ^�
Address:
City: State Zip:
Value of Work for this Permit:$ I LOO 0 Square/Linear Footage of Work:
Type of Work: ❑ Addition 1 ❑ Alteration ❑ New ❑ Repair/Replace ❑Demolition
Description of Work:
Specify color of color thru tile: o
$FCCF ca/cc Permit Fee C'f��®� ca/cc$
Submittal Fee$�O Z S
Scanning Fee$ Radon Fee$ DBPR$ Nary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews S Bond$ ^�-
TOTAL FEE NOW DUE$ L J •
(Rer;sedo2/24/2014)
I
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.....
OWNEWS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
a az a haws mqp1a*ffe owmMmilfim and
"WARNING TO OWNER YOUR FAI
WRE To-RECORD A NOTICE IDF�COMMENiMEM 11lBAlf
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$250D,the applicant must
promise in good faith that a copy of the notice of commencement and construction lien low brochure will be delivered to the person
whose property is subject to attachment. Also,a certiTied 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.
/O'-'—�
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrume t was acknowledged before meefthis The foregoing instrument was acknowledged before me this
.749 day of .20 / ,by `� ''d1 ay,of u 4'� _,20 J by
/C who i rsonally know o �8�-101% �� _ '&,%►lf®ho is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY P G
Sign: Sign:
Print: L Print•
4 ,
SERGI
Loly Martinez
Seal: ;gam a� Notary Public State of Florida Seal: :• My COMMISSION#FF9150
My Commission FF 019208 ?1130'
„• EXPIRES May 25,2020
po” Expires 06/1912017 I153 FbrndaN*w =0
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revlsed02/24/2014)
PICK SCOTT.GO'IERNIOR
KEN LAWSON.SECRETARY
STATE OF FLORMA
OE�4R P t ,ENT OF BLS,11 ESS riAID PROP=SSIONAi REGU,A7:0
CONS c . �'�OAI RVO JSTPY CEhSINGBrJ;?R?
kUG 3' 'v 8
.4 1671M
g} JCA
SS! E:G C`3?.2vsc -':SP-AY AS REQUIRED3Y•
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I . DRIVER
?!TA,%sE�
8650-801-55-?3 •0
TIMOTHY ALLEN
13RUNO
P 2009 NW 21 AVE
FORT LAUDERDALE FL 33311.3439
,R D08 0&10.195S SEX IWL
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BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT
115 S.Andrews Ave., Rm.A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000
VALID OCTOBER 1,2016 THROUGH SEPTEMBER 30,2017
DBA: Receipt
& J TELECOM & ELECTRIC INC ReCeipt#:ELECTRICAL/ALARMS/CONTRACTOR
Business Name: Business Type:(ELECTRICAL CONTRACTOR)
Owner Name:TIMOTHY ALLEN BRUNO Business Opened:11/20/2002
BUSineW Location:2009 NW 21 AVE State/County/Cert(Reg:EC13006062
FT LAUDERDALE Exemption Code:
Business Phone:954-864-8091
Rooms Seats Employees Machines Professional
1
For Vending Business Only
Number of Machines: Vending Type:
Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid
27.00 3.00 0.00 0.00 0.00 0.00 30.00
Ij
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
i
THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is
! non-regulatory in nature.You must meet all County and/or Municipality planning
WHEN VALIDATED and zoning requirements.This Business Tax Receipt must be transferred when
the business is sold, business name has changed or you have moved the
business location.This receipt does not indicate that the business is legal or that
it is in compliance with State or local laws and regulations.
ii
Mailing Address:
TIMOTHY ALLEN BRUNO Receipt #03A-15-00010206
2009 NW 21 AVE Paid 09/23/2016 30.00
FORT LAUDERDALE, FL 33311
i .
I i
i '
2016 - 2017
- -- - RI?l]W�D.1].f AII�T_Y.111r.A1- p11c�lUc�t� T_wv_atn�Inr -_.
OR
d.®. IMMM MiamishoresV illage
& iM
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305)795.2204
Fax: (305) 756.8972
Notice to Owner -m Workers' Compensation Insurance Exemption
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat: § 440.05 i
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: i
An employer in the construction industry who employs one or more part-time or full-time
employees,including the owner,trust obtain workers'compensation coverage. Corporate officers
or members of a limited liability company (LLC) in the construction industry may elect to be
exempt if:
i
I. 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
allov&,ed 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 BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature.
!/ Al [!
Qwner
State of Florida
County of Miami-Dade
The foregoing was acknowl e before me this O� day of J�i � y 20/7
B Z1
J I F �► � who is personally known to me or has produced
as identification.
Notary:. is
SEAL: Loy Martinez
My Cammis® FF 019206
W IV Expires 08/194017
J & J Telecom & Electric, Inc. EC13006062
2009 NW 21 Ave,Fort Lauderdale,Florida 333111954-864-8091 954electric@gmail.com
2/15/2017
State Of: Florida
County Of: Dade County /
Before me this day Personally Appeared--L-------------- --11�----------------who being duly sworn,deposes and
Says:
That he or she will be the only person worldng on the property located at-5
- --------------------
m 1 aw Shores� X11 3313P
Sworn to(or affi n s1fasSribed before me this-&day of-- e=l---.20-� ,by
--------------------------
Personally know-----------�-----------
Or Produced Identification----------------------------
Type of Identification Produced---------------------------------
SERGIO GONGORA
••: MY COMMISSION#FF9W150
EXPIRES May 25.2020
s
Print,Print Type Or Stamp Name Of Notary