EL-16-1607 6057
y, Miami Shores Village
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10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000
r � Phone: (305)795-2204
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ue laa z 6/29/201 Expiration: 12/26/2016
Project Address Parcel Number Applicant
1208 NE 95 Street 1132060144100
PEDRO DE MELLO
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
PEDRO DE MELLO 1208 NE 95 Street (305)753-5504
MIAMI SHORES FL 33138-
1208 NE 95 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 1,800.00
UNITED ELECTRICAL SERVICES INC (786)797-2188 Total Sq Feet: 0
Type of Work:ELECTRIC PANEL FOR POOL,2 LIGHT AN Available Inspections:
Additional Info: Inspection Type:
Classification:Residential Final
Scanning:1 Light Niche
Bonding
Review Electrical
Alarms
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20 Invoice# EL-6-16-60134
DBPR Fee $4.50 06/29/2016 Credit Card $270.20 $50.00
DCA Fee $4.50
Education Surcharge $0.40 06/09/2016 Credit Card $50.00 $0.00
Notary Fee $5.00
Permit Fee-Additions/Alterations $300.00
Scanning Fee $3.00
Technology Fee $1.60
Total: $320.20
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 z au o -named contractor to do the work stated.
June 29, 2016
Au onzed Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
June 29,2016 1
Miami Shores Village4BY:
�_
Building Department9 2076
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 '
FBC 20
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BUILDING Master Permit NoRF b- lcog;
PERMIT APPLICATION Sub Permit No. TUC— 16 64
FJBUILDING XELECTRIC ROOFING REVISION M EXTENSION E]RENEWAL
PLUMBING M MECHANICAL PUBLIC WORKS [:] CHANGE OF CANCELLATION r-1 SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 12 O 19 AtE 7S- X f
City: Miami Shores County: Miami Dade Zia: 33 1 3 8
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): JAAry We 0,W4 Phone#: �'os" 7S3 J S"oV
Address: l z o s
City: yttj"rte- d�a✓�/ State: FL Zip: 33/38
Tenant/Lessee Name: Phone#: 76� 791 z4fil
Email:
CONTRACTOR:Company Name: 76,t+le,( 44,t)c4 _' "z e�''� Phone#: 796 7q-T
Address: 2,&,qS,3
City: ����/ o c, State: 47> Zip: - 903 Y
Qualifier Name: /'�T 274L4 q Phone#: �� `�-'/ jP
State Certification or Registration M �;e 130Al d&6 9 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
it
Address: $ ��5 0-D p City: State: Zip:
Value of Work for this P*xn lit:. ► l o Square/Upearp" ofASfark
Type of Work: ^°Addition .� tion [ New ° Repa�i�Jiie !-F Demolition
Description of W69k: k
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ 2 CO/CC$
Scanning Fee$ 3 ' C Radon Fee$ Y DBPR$ c-1• Notary$ -
Technology Fee$ - 0 Training/Education Fee$ Cl ® Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ lO 2-07
(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.,dellvered 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.
Sig a Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
Ae day of r °� ,20 by 0(p—day of 20 f(p .by
Wc c ,who is personally known to �� 0. ,who j��Q.t.�onally no_wn to
me or who has produced __..,��,,.. as Lne^or who has produced as
identification and who did to etM�' ! identification and who did take an oath.
.{Oaf �tao�
NOTARY P J LIC: NOTARY PU C: � gOBSE`
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Sign: Sign:
Print: � -0� Print:-4
Seal: Seal:
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Miami shores Village
Building Department
R 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305)795.2204
Fax: (305)756.8972
Notice to Owner — Workers' Compensation Insurance Exemption
r � !
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 BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signa
Owner
State of Florida
County of Miami-Dade ^r
The foregoing was acknowledge before me this day of J V 20 CD
B % Y>RQ N RIQUt 0-1)C— 1 k" who is personally known to me or has produced
TL- —DV-1 kKve Lk'VF10)-cc as identification.
Notary:
otic P�a� Notary Pubilc State of Florida
SEAL: a Sindia Alvarez
e� My Commission�FF 156750Expires09f03;2
United Electrical Serv. Inc
26453 Sw 135Ct Homestead F1
Uni tedelectric67@yahoo . com
DATE: June 24, 2016
State of Florida, Miami Dade County
Before me this day personally appeared Manuel O Garcia who, being duly sworn, deposes and says:
He will do electric work, (pool panel and electric pool system) for a new Swimming pool
That he will be the only person working on the project located at: 1208 NE 9511 St Miami Shores FL
Sworn to and subscribe before me this.1 day of 7yne .2016, by M a nLld Q C)a`rC4-'f'
ersonall kno or produced identification
z Seal
CLARA E RODRIGUEZ
Lt,ary,,N S n MY COMMISSION#FF138588
EXPIRES July 5, 2018
(407)398-0153 FloridallotarvService.com