EL-17-652Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Parcel Number
n: P+E t - P iv
Latus: APPROVE
Expiration: 10/ / 17
Applicant
335 NE 101 Street
Miami Shores, FL 33138-
1132060135211
Block: Lot:
GERARDO GUARCH
Owner Information
Address
Phone
CeII
GERARDO GUARCH
335 NE 101 Street
MIAMI SHORES FL
(786)586-7756
335 NE 101 Street
MIAMI SHORES FL
Contractor(s)
RAVEN ELECTRIC INC
Phone
305-221-3339
CeII Phone
Valuation:
Total Sq Feet:
Type of Work: pool/ spa equipment connection > he
Additional Info: pool/ spa equipment connection > he
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
51.20
54.50
$4.50
$0.40
$300.00
$3.00
$1.60
$315.20
Pay Date Pay Type
Invoice # EL -3-17-63264
05/01/2017 Check #: 3473
03/10/2017 Check #: 3394
Amt Paid Amt Due
$ 265.20 $ 50.00
$ 50.00 $ 0.00
$ 1,900.00
Available Inspections:
Inspection Type:
Final
Light Niche
Bonding
Review Electrical
Alarms
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.
May 01, 2017
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Date
May 01, 2017
1
BUILDING
PERMIT APPLICATION
❑BUILDING
PLUMBING
JOB
JOB ADDRESS:
warm bnores village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fair (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 7624949
MAR 10 2017
FBC 201 4 --
Master
Master Permit No. R) r P n- 650
Sub Permit No.
rig ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
❑ MECHANICAL ]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores County:
Miami Dade Zia: 3
Folio/Parcel#: 1 k G21 1 Is the Building Historically Designated: Yes NO
Occupancy Type: SFR Load:
Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Gt-g.4 OO 9Xt.h Phone#:
Address: '''36 �,�) �' , at 43i1t
€
�Y=
gar& �.� U%�gq State: -' j Zip: 3 l
Tenant/Lessee Name: v.) -Pc Phone#:
Email:
CONTRACTOR: Company Name: � en �� 'C Phone#:
Address:
1 7) 9,0 90 A -0-e rtzuL
P
City: tai `� t State: _.__a Zip:
Qualifier Name: a r N L n CES Phone#:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: -T.C. 6'I 101::-V-20 & Phone#: 20 0.321
Address:
Value of Work for this Permit: $
Type of Work: 0 Addition
L
,.,S ' .ac.t.-*-i.l1 City: N VN. A- State: Tip: "33IS b
1,9(4w Square/Linear Footage of Work
lAlteration Et New 0 Repair/Replace 0 Demolition
�Qtil P CoNJJec i 0n/Description Work
r
4--)PA-f
Specify color of color thru tile:
x J
Submittal Fee $ 5o
; U Permit Fee $ _r®®` CO CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ X S ° 2-0
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City s 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. 1 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.
Ignature Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
CP day of++ CA—k. , 20 by
G
6e rack) UCcrcpwho is personally known tom,
up..acwho has produced as
identification and who did take an oath.
NOTARY PUBLIC
Sign:
Print:
Seal:
:„:5 iii,
Florida
My Comm. Expires Dec 13, 2019
Bonded trough Natimud Notary Assn.
CONTRACTOR
The foregoing instrument was acknowledged before me this
CP ay of ,20 1- by
, who is personally known to
mor who has produced as
identification and who did take an oath.
NOTARY PUBLIC
Sign:
Print:
Seal:
My Comm. Expir
r•
I
a a
SADLER
Notary Public -
State 01 Florida
Commission
# FF 924098
es Dec 13, 2019
Bonded through
Naomi Notar
y Assn.
*********** ************************************************•********** R*****•**** *******************qtr****•*
APPROVED BY
(Revised02/24/2014)
/c A!;,)-, 4 Plans Examiner
Structural Review
Zoning
Clerk
RAVEN ELECTRIC
Date: March 21, 2017
State of: FLORIDA
County of: MIAMI DADE
3913 SW 90th Avenue Miami FL 33155
Before me this day appeared: OSCAR HERNANDEZ who being sworn, deposes
and says:
That he will be the only person working on the project located at:
335 NE le Street
Sworn to(or affirmed) and subscribed on this 21 day of March 2017,
By Oscar Hernandez.
Personally Known to me
Notary Signature and Notary print name
Notary Stamp
�a�4ri og � ELENA A SADLER
4\-4°° Notary Public - State of Florida
• •e Commission • FF 924095
wi. P My Comm. Expires Dec 13, 2019
''' n4SS Bonded through National Notary Assn.
IVliami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
sompensaton Insurance Notice to Owner —Worker' CiIne 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 BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this \ 0 day ofCPC t L
By
coldn
Notary:
SEAL:
, 20f .
who is personally known to me or has produced
as identificati
(?Zer-A) ikaLj 0 **
" ELENA A SADLER
Notary Public - State of Florida
Commission I FF 924095
My Comm. Expires Dec 4111t� `',� BBanded through Notary Assts.