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EL-17-216Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 90 NE 96 Street Miami Shores, FL 33138- Owner Information Address Permit Permit NO. EL -1-17-216 Permit Type: Electrical - Residential Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 2/2712017 Expiration: 08/26/2017 Parcel Number 1132060130600 Block: Lot: Applicant VERO HOMES LLC Phone Cell VERO HOMES LLC 701 BRIECKELL AVE MIAMI FL 33131- (305)902-4660 701 BRIECKELL AVE MIAMI FL 33131- Contractor(s) Phone CeII Phone EVOLUTION ELECTRICAL CONTRACT (786)351-5784 Valuation: Total Sq Feet: $ 6,000.00 0 Type of Work: REPLACE EXISTING RECEPTACLES AND SW Additional Info: REPLACE EXISTING RECEPTACLES AND SW Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Notary Fee Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $3.60 $3.38 $3.38 $1.20 $5.00 $225.00 $3.00 $4.80 $249.36 Pay Date Pay Type Invoice # EL -1-17-62743 01/26/2017 Check #: 2221 02/27/2017 Credit Card Amt Paid Amt Due $ 50.00 $ 199.36 $ 199.36 $ 0.00 Available Inspections: Inspection Type: Final Meter Box Alteration Relocation Fire Alarm Service Change Review Electrical Underground 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, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFI VIAcerti. that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and.. . F /' . re, I authorize the above-named contractor to do the work stated. _ February 27, 2017 or ed Signatory / Applicant / Contractor / Agent Owner Building Department Copy Date February 27, 2017 1 BUILDING PERMIT APPLICATION ❑BUILDING IN 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 Tz71- BY: JAN 2 6 731/ FBC 20 IL( Master Permit No. ,A66 C Ke" us Co Sub Permit No. i�"Z,lI( 0 ROOFING 0 REVISION E EXTENSION E RENEWAL PLUMBING 0 MECHANICAL El PUBLIC WORKS JOB ADDRESS: E CHANGE OF CONTRACTOR y0 NE 9C �h El CANCELLATION ❑ SHOP DRAWINGS City: Miami Shores County: Miami Dade Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Flood Zone: Verb art7e5 , L L C zip: 3 l 3 v OWNER: Name (Fee Simple Titleholder): Address: /yin Ick ( ► C t �P�% City: / // Q27-17 / Tenant/Lessee Name: Email: av-e ' t /S) BFE: FFE: Phone#: 305-90a- 7 6 c, o State: FL Zip: 33/ 3! C l f €CQ hoes i/c3aO0-LQ�t-iceC[[JO 04-1-c41<-5 hone#: 6 7- `T Address: / 613/ Z City: /460N 4 State: Ode /4\ Zip: 33 Di Qualifier Name: //ee%-f-V e✓/O ,4O -fCh Phone#: State Certification or Registration #: Certificate of Competency #: /©mac lOcO 6/ DESIGNER: Architect/Engineer: Phone#: Address: CONTRACTOR: Company Name: Phone#: City: State: Zip: Q9 Value of Work for this Permit: $ l', Square/Linear Footage of Work: 3000 Type of Work: ❑ Addition�n Alteration El New ElRepair/Replace ❑ Demolition " Description of Work: �--k C° r. (ST\ /L �-e �p-^ c. S i— c.., C.4/2/S , 4 b cess-�� a•.��,�- �S Pia.wzA-- Specify color.of color thru tile: F Submittal Fee $ 52 P • Permit Fee $ x73 '''' CCF $ CO/CC $ Scanning Fee $ - Radon Fee $ J DBPR $ J • Notary $ /, Technology Fee $ `'1 . Training/Education Fee $ /• Z — Double Fee $ Structural Reviews $ (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE $ /7 l 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 reins•ection fee will be charged. Signature OWNER or AGENT The foregoing instrument was acknowledged before me this Z 3 day of JC3-ri/ • , 20 1:7- , by +fl LL MZ_ DK- LA. C'AN^,Vho is personally known to me or who has produced r..j2i i identification and who did take an oath. NOTARY PUBLIC: %11111000001, .00M,y,••. 4 - Machssi .4 (3••••.01-1- Sign: • " : = Print: 9 �: %s j2 Seal: o .c"h+� : �*/. j, 0„.,;OP`C)1'' �� fl as Signature C NTRACTOR The foregoing instrument was acknowledged before me this 23 day of q�► , 20 \\ , by C bCAS'rDr', who isonally know me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: ************************************************4,4.4,4.**4,********* APPROVED BY z,G�6-yL f (Revised02/24/2014) Plans Examiner Structural Review Mt\c $074,1:0 '���� 7,1: , CHARLES GONZALEZ � t. Notary Public - State of Florida = Commission # FF 239788 hi My Comm. Expires Aug 1, 2019 ,* scilla * Begeled fit ,91A ' I' ! Na Assn. * ** Zoning Clerk cz 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 BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: 1 ner State of Florida County of Miami -Dade ^� The foregoing was acknowledge before me this Z7 day of J r1 , 20 1 . By "�`� ���-• 1. � LA- C- N-L-1%ho is personally known to me or has produced 01111110,10 '4 ks identification. Notary: ,a.) • • SEAL: .T.-72 ®. ' MY (13 EVOLUTION ELECTRICAL CONTRACTORS 11631 NW 58 PL. HIALEAH FL 33012 786-357-5784 1/26/201E State of Florida County of Dade Before me this day personally appeared Antonio Acosta who,being duly , deposes and says: that he will be tl only person working on the project located at 90 NE 96 ST, Miami Shores FI. 33138 Contractor Signature Sworn to (or affirmed) and subscribed before me this Personally Known Or produced Identification Type of ID C)(11Zes me� 2e day of 3-1.3r ,2017, by Chain Gouda: Notery Mac, Stove of Rod& My Comm. Expires IMg t, 2015 Camiiaion No. FF 23$788 Print,Type or Stamp Name of Notary