DEMO-17-1435 pom*INt
-'
Miami Shores Village P8t7t311 Tjie: lrilil�Qn
10050 N.E.2nd Avenue NE Work CJassiftCatiotll:Electric
Miami Shores,FL 33138-0000M �..
Phone: (305)785 2204 ~PerM�,5 1us:A1PR0VE0
P
Ex iration: 11/29/2017
Drdtt3 12W
Project Address Parcel Number Applicant
240 NE 97 Street 1132060134020
Miami Shores, FL 33138- Block: Lot: PROPERTY ACES LLC
Owner Information Address Phone Cell
PROPERTY ACES LLC 240 NE 97 Street
MIAMI SHORES FL 33138-
240 NE 97 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 500.00
SASSON ELECTRIC INC (305)933-4442
...�. . ...... Total_,, _ Total Sq Feet: 0
1
Type of Demo:Electric Available Inspections:
Additional Info:REMOVE LIGHTS AND OUTLETS FOR DEMO. Inspection Type:
Classification:Residential Final
Scanning:1 Review Electrical
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60
Invoice# DEMO-5-17-64143
DBPR Fee $2.00 05/30/2017 Credit Card $50.00 $63.60
DCA Fee $2.00
Education Surcharge $0.20 06/02/2017 Credit Card $63.60 $0.00
Notary Fee $5.00
Permit Fee $100.00
Scanning Fee $3.00
Technology Fee $0.80
Total: $113.60
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 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.
O ERS AF I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
cons ning. ore,I authorize the above-named contractor to do the work stated.
_ June 02, 2017
Authorized Signature:Ow r / Applicant / Contractor / Agent Date
Building Department Copy
June 02,2017 1
�-C� L � � � `� �
®\S�k
�\ Miami Shores Village RECEIVED
'�� Building Department MAY 3 0 2017
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 n"
T,
INSPECTION LINE PHONE NUMBER:(305)762-4949 -.
FBC 20 i q S � I
BUILDING Master Permit No.—DEMO ))- I3 Y 3
PERMIT APPLICATION sub Permit Nor,4 y -)- 1 Q/3 j
❑BUILDING �LECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL PUBLIC WORKS [:] CHANGE OF CANCELLATION ❑ SHOP
C CONTRACTOR DRAWINGS
JOB ADDRESS: 240 NVY 97 St
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-3206-013-4020 Is the Building Historically Designated:Yes NO X
Occupancy Type: Sgl fam Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):Property Aces LLC Phone#:
Address:240 97 St
City: Miami Shores State: FI Zip: 33138
Tenant/Lessee Name: Phone#:
Email: 6
CONTRACTOR:Company Name: S a-5°S®A Fle �`"°�L 1 Phone#: J70S 933 YY`lL
Address: .9S0/ 5L
City:;M I a_gn l State: A774-- zip: ?.?12a
Qualifier Name: r5 d_eez- Phone#: Sc-A"e
State Certification or Registration#: CC 0 DC7 Z S2 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ ®® Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace Demolition
Description of Work: ans —A �_� r JAf C2,
'�'
Specify colors of color thru tile:
Submittal Fee$ OZ) Permit Fee$ Co 6P,0 CCF$ Co/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(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 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 will be charged.
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of A Cq 20 by c�n_day of ��Q_�t� - ,20 ,by
-� L who is personal) now
to `)qC.I C, S\/U.)On who is personally
Qknown to
me or who has produced as me or who has produced ZSR ��-qC�
identification and who did take an oath. identification and who did take an oathP0y-(dq I (1294IS�9-
NOTARY PUBLIC: NOTARY PUBLIC:
Sign:
°` MY COMMISSION#GG 044602
Print: bYYAi(n V'e L Print: -,2020
Seal: t KELLY J DOMIIdQUEZ Seal:
��,y;� j/� FeF�� Bonded Tiuu Notary Public UrKIM iters
'`7Q+z
•3 MY COMMISSION#GG029346
EXPIRES September 12,2020
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
SASSON ELECTRIC im
ELECTRICAL CONTRACTOR
PRES:ISAAC 305-933-4442
STATE EC#2527&AIC SERVICE
2501 N.E. 195 ST.N.M.B.FL.33180
Date:
State of :E\ 1 (�Q,
County of 1- 7D1(,
Before me this day personally appeared Isaac Sasson who, being duly sworn,deposes and says:
That he or she will be the only person working on the project located at:
240 NE 97 St Miami Shores
Contractor Signature
Sworn to(or affirmed)and subscribed before me this "--KJ day of 20
by kSQOC- SOk
Personally known
OR Produced Identification1 I C QX1�P
Type of Identification Produced S Z 5n-UM—u;S -C2Z-C
=o1�'vr'ueYo: MAHARAI K.GONZALEZ
MY COMMISSION#GG 044602
EXPIRES:November 2.2020
•'c;of r°•• Bonded Thru Notary P-HIr Underwriters
Print,Type or Stamp Name of Notary
got um, Miami Shores Village
Building Department
Ams 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305)795.2204
Fax: (305)756.8972
Notice t® 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 fa11.-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.
fi1. The of owns at least 10 percent of the stock of the corporation,or in the case of
an LLC,a statement attesting to the minirmm 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 time 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.
Signature:.
r
State of Florida
County of Miami-Dade �}
The.foregoing was acknowledge before me this � day of 120a.
By u, l lc� dLope z- who is personallown to me or has produced
^n _ as identification.
..�C
Notary: � k
SEAL: FGG029346!CELL J DOMINGUEZ
MY COMMISSION�
EXPIRES September 12,2020