EL-17-2527Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit
Permit NO. EL -10-17-2527
Permit Type: Electrical - Residential
Work Classification: Service Change
Permit Status: APPROVED
Expiration: 05/29/2018
Issue Date: 11130/2017
Parcel Number
Applicant
130 NW 97 Street
Miami Shores, FL 33150-
1131010250060
Block: Lot:
TETRIS DEVELOPMENT
Owner Information
Address
130 NW 97 Street
MIAMI SHORES FL 33150-
130 NW 97 Street
MIAMI SHORES FL 33150-
Phone
Cell
Contractor(s) Phone
QUANTUM ELECTRIC SYSTEM CORP (786)663-4787
CeII Phone
Valuation:
Total Sq Feet:
$ 470.00
0
Type of Work: REPAIR THE SERVICE
Additional Info: REPAIR THE SERVICE
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
$0.60
$2.25
$2.00
$0.20
$150.00
$3.00
$0.80
$158.85
Pay Date Pay Type
Invoice # EL -10-17-65441
10/24/2017 Credit Card
11/30/2017 Credit Card
Amt Paid Amt Due
$ 50.00 $ 108.85
$ 108.85 $ 0.00
Available Inspections:
Inspection Type:
Review Electrical
W. W.
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, PLUMBUM = HANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: Iify that all ,,foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
orize the above-named cont ctor to do the work stated.
Applicant /Applicant Contractor / Agent
construction and zoning:uthermore,
Authoriz ature
Building De
November 30,
rt ent Copy
November 30, 2017
Date
1
BUILDING
PERMIT APPLICATION
BUILDING
ELECTRIC
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
❑ ROOFING
❑PLUMBING ❑MECHANICAL PUBLIC WORKS
JOB ADDRESS: / /V VV 9751—
r
751—
;r-' C PAVED
OCT .:2017
FBC20 j+ soh
Master Permit No. EL.- 1 — 2.5 17
Sub Permit No.
❑ REVISION
❑ CHANGE OF
CONTRACTOR
❑ EXTENSION
❑ CANCELLATION
❑ RENEWAL
❑ SHOP
DRAWINGS
City: Miami Shores
Folio/Parcel#:
Occupancy Type: .5'r Load:
County: Miami Dade Zip:
Is the Building Historically Designated: Yes
Construction Type: Flood Zone: BFE:
OWNER: Name (Fee Simple Titleholder):tl�
Address: l 30 A/1/1/l 5/1_0
c 7
City: (1 0(444 /' �(�v-2S State: l C. Zip: 7 ?/ 5Pe rk S. eAl e 0? 144
3/570
efi-7 s beAld
NO ?
FFE:
Tenant/Lessee Name:
Email:
Phone#: cYo3 70/0
CONTRACTOR: Company Name: Q J Ard` 1) (M (_ .0 \ i 1 L *H4'hone#: 1-80 -663 -(4-7s
Address: 1 S i 9 N 4-t 'NV e- 319 -
city: i"I\o.VY t . K -s
Qualifier Name: -...TL)/A, J c
State:
1L
SALCE Q6
zip: 33 0 /
Phone#: 1 — 663 cf. B)
State Certification or Registration #: / ( C OC8 25 Z Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $
ype of Work: ❑ Addition ❑ Alteration
Square/Linear Footage of Work: . `�.
a'ofcf:.. r
Repair/Replace • 0 Demolition
❑ New
escription of Work: p �d, i (� The r^ V i -cc.
Specify color of color thru tile:
Submittal Fee $ Sb
Permit Fee $ / b Gee to D
Scanning Fee $ J Radon Fee $ 2
Technology Fee $ S Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
CCF $ + -W 0 colas
DBPR $ 2 • 2-S Notary $
• 2 -CD Double Fee $
Bond $
TOTAL FEE NOW DUE$ 1 c,
85
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 he posted at the job site
for the first inspection which . rs seven (7) days'after the building permit is issued. In the absence of such posted notice, the
inspection will not be ap
Signature
spection fee will be charged.
0 NER or AGENT
Signature 7i&
)1.1,J
CONTRACTOR
The going instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of Cc.4-6lv-e,f-
lacob 6.OUd►5 ,who
me or who has produced as
,20
17
, by
Identiificatio and who c ti e anAcLa&LIS MERCEDES
NOTARY PU IC: �1 ''S MY COMMISSION #,G0112186
1; EXPIRES June 08.2021
day of OC -IJ 4/
(CAI
,20(7 ,by
jvsh( ,� 5 (CPcl 1 , who is personally known to
me or who has produced ( as
identification and who dick take an oath.
o rRY ue RAU CHAVARRIA
NOTARY PUBLIC: y.q,. _ MY COMMISSION # FF 962231
EXPIRES: March 6. 2020
Sign: L I Sign:
Print: ' G �Q' S C v c cee SPrint:
Seal: C..� ( I •Z 9 (( ;"•';; ALGELIS MERCEDES Seal:
;'E MY COMMISSION # GG112186
EXPIRES June 06, 2021
APPROVED BY
(Revised02/24/2014)
K' u",* Eond.;d Thru Budget Notary Services.f FGA
/
C /''< //'
GtpRY PUe�n RAUL CHAVARRIA
* �, R MY COMMISSION # FF 962231
l of EXPIRES' March 6. 2020
leOF ELI"' Bonded Thru Budget votary Services
Zy 4 2 7 46I ns Examiner Zoning
Structural Review Clerk
10/23/2017
Property Search Application - Miami -Dade County
FFICE Of THE PROPERTY AQP
Summary Report
Property Information
Folio:
11-3101-025-0060
Property Address:
130NW97ST
Miami Shores, FL 33150-1735
Owner
TETRIS DEVELOPMENT LLC
Mailing Address
7221 FISHER ISLAND DR
MIAMI BEACH, FL 33109 USA
PA Primary Zone
0800 SGL FAMILY - 1701-1900 SQ
Primary Land Use
0101 RESIDENTIAL - SINGLE
FAMILY: 1 UNIT
Beds / Baths / Half
2 / 1 / 1
Floors
1
Living Units
1
Actual Area
1,959 Sq.Ft
Living Area
1,780 Sq.Ft
Adjusted Area
1,757 Sq.Ft
Lot Size
8,625 Sq.Ft
Year Built
1947
Assessment Information
Year
2017
2016
2015
Land Value
$189,543
$189,543
$140,036
Building Value
$122,287
$122,287
$122,287
XF Value
$6,184
$6,259
$4,292
Market Value
$318,014
$318,089
$266,615
Assessed Value
$294,740
$267,946
$243,588
Benefits Information
Benefit ;Type
2017
2016
2015
Non -Homestead Cap Assessment Reduction
$23,274
$50,143
$23,027
Note: Not all benefits are applicable to all Taxable Values (i.e. County School
Board, City, Regional).
Short Legal Description
RESUB OF BLK 3 OF BONMAR PARK
PB 42-60
LOT 6 BLK 3
LOT SIZE 75.000 X 115
OR 16582-3238 1194 3
AISER
Generated On : 10/23/2017
Taxable Value Information
2017, 2016 2015
County
Exemption Value
$0
$0
$0
Taxable Value
$294,740
$267,946
$243,588
School Board
Exemption Value
$0
$0
$0
Taxable Value
$318,014
$318,089
$266,615
City
Exemption Value
$0
$0
$0
Taxable Value
$294,740
$267,946
$243,588
Regional
Exemption Value
$0
$0
$0
Taxable Value $294,740
$267,946
$243,588
Sales Information
Previous
OR
Sale
Price
Book-
Qualification Description
Page
01/06/2017
$390,000
30379-
Qual by exam of deed
0596
11/01/1994
$0
16582-
Sales which are disqualified as a result of
3238
examination of the deed
06/01/1994
$0
16406-
Sales which are disqualified as a result of
5315
examination of the deed
04/01/1992
$82,000
15503-
Sales which are qualified
1209
The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property
Appraiser and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asp
Version:
Electronic Articles of Organization
Florida Limited Liability Company
Article I
The name of the Limited Liability Company is:
[TETRIS DEVELOPMENT_LLC
L16000186994
FILED 8:00 AM
October 10 2016
Sec. Of State
tscott
Article II
The street address of the principal office of the Limited Liability Company is:
7221 FISHER ISLAND DRIVE
MIAMI BEACH, FL. 33109
The mailing address of the Limited Liability Company is:
7221 FISHER ISLAND DRIVE
MIAMI BEACH, FL. 33109
Article III
The name and Florida street address of the registered agent is:
ACOS GOUDIS
7221`FISHER ISLAND DRIVE
MIAMI BEACH, FL. 33109
Having been named as registered agent and to accept service of process for the above stated limited
liability company at the place designated in this certificate, I hereby accept the appointment as registered
agent and agree to act in this capacity. I further agree to comply with the provisions of all statutes
relating to the proper and complete performance of my duties, and I am familiar with and accept the
obligations of my position as registered agent.
Registered Agent Signature: JACOB GOUDIS
Article IV
The name and address of person(s) authorized to manage LLC:
Title: AMBR
JACOB GOUDIS
7221 FISHER ISLAND DRIVE
MIAMI BEACH, FL. 33109
Signature of member or an authorized representative
Electronic Signature: JACOB GOUDIS
I am the member or authorized representative submitting these Articles of Organization and affirm that the
facts stated herein are true. I am aware that false information submitted in a document to the Department
of State constitutes a third degree felony as provided for in s.817.155, F.S. I understand the requirement to
file an annual report between January 1st and May 1st in the calendar year following formation of the LLC
and every year thereafter to maintain "active" status.
L16000186994
FILED 8:00 AM
October 10 2016
Sec. Of State
tscott
Electronic Articles of Organization
For
Florida Limited Liability Company
Article I
The name of the Limited Liability Company is:
TETRIS DEVELOPMENT LLC
L16000186994
FILED 8:00 AM
October 10 2016
Sec. Of State
tscott
Article II
The street address of the principal office of the Limited Liability Company is:
7221 FISHER ISLAND DRIVE
MIAMI BEACH, FL. 33109
The mailing address of the Limited Liability Company is:
7221 FISHER ISLAND DRIVE
MIAMI BEACH, FL. 33109
Article III
The naive and Florida street address of the registered agent is:
JACOB GOUDIS
7221 FISHER ISLAND DRIVE
MIAMI BEACH, FL. 33109
Having been named as registered agent and to accept service of process for the above stated limited
liability company at the place designated in this certificate, I hereby accept the appointment as registered
agent and agree to act in this capacity. I further agree to comply with the provisions of all statutes
relating to the proper and complete performance of my duties, and I aim familiar with and accept the
obligations of my position as registered agent.
Registered Agent Signature: JACOB GOUDIS
Article IV
The name and address of person(s) authorized to manage LLC:
Title: AMBR
JACOB GOUDIS
7221 FISHER ISLAND DRIVE
MIAMI BEACH, FL. 33109
Signature of member or an authorized representative
Electronic Signature: JACOB GOUDIS
I am the member or authorized representative submitting these Articles of Organization and affirm that the
facts stated herein are true. I am aware that false information submitted in a document to the Department
of State constitutes a third degree felony as provided for in s.817.155. F.S. I understand the requirement to
file an annual report between January 1st and May 1st in the calendar year following formation of the LLC
and every year thereafter to maintain "active" status.
L16000186994
FILED 8:00 AM
October 10 2016
Sec. Of State
tscott
C
Construction Tivedvs ng Board
BUSINESS CERTIFIOIXT€ OF COMPETENCY
14E000252
UM ELECTRIC SYSTEM COW.
SCEDO JUAN C
Is certified under the provisions ofC
0 0t Mlarnt cede
Quantum Electrical System, Corp.
15969 NW 64th Ave. Suite 317
Miami Lakes, FL. 33014
License No. ER 13015009
786.663.4787
Quantumelect63@gmail.com
License No. 14E000252
Date: October 25, 2017
State of Florida
County of Miami -Dade
Before me this day personally appeared Juan Salcedo, who, being duly sworn, deposes and says:
That he will be the only person working on the project located at: 130 NW 97th 5t., Miami Shores, FL 33150
Sworn to (or affirmed) and subscribed before me this 25st day of October 2017, by Juan Salcedo.
•4:4•1k OLGA DELGADO
'' My COMMISSION # FF987328
EXPIRES April 28, 2020
(407)•396-0163 FloddallouryServloe•aom
Personally Known
Or Produced identification X
Type of identification Produced Driver
License 5423-420-63-177-0
t�
&Public Notary
Miami Shores Village
Building Department
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 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 BELO OWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this 2-0
SEAL:
personally known
as identification.
ALGELIS MERCEDES
MY COMMISSION # GG112186
EXPIRES June 06, 2021
,20 .
e or has produced