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ELC-18-149Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Permit NO. ELC-1-1$-149 Permit Type: Electrical - Commercial Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 1/26/2018 Expiration: 07/25/2018 Parcel Number Applicant 415 NE 105 Street Number: CHURCH BLDG 1122310430010 Miami Shores, FL Block: Lot: ST ROSE OF LIMA CATHOLIC CI Owner Information Address Phone Cell ST ROSE OF LIMA CATHOLIC CHURCH 9401 BISC BLVD MIAMI FL 33138-2970 (305)758-0539 Contractor(s) ELITE ELECTRIC INC Phone Cell Phone (305)834-1469 (786)356-0652 Valuation: Total Sq Feet: $ 1,200.00 0 Type of Work: CARNIVAL TEMPORARY HOOK UP OF ELECT Additional Info: CARNIVAL TEMPORARY HOOK UP OF ELECT Classification: Commercial Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Amount $0.00 $0.00 $0.00 $0.00 $1,000.00 $3.00 $0.00 Total: $1,003.00 Pay Date Pay Type Amt Paid Amt Due Invoice # ELC-1-18-66175 01/18/2018 Credit Card $ 50.00 $ 953.00 01/26/2018 Check #: 119 $ 953.00 $ 0.00 Available Inspections: Inspection Type: Final Meter Box Alteration Relocation Fire Alarm Service Change Review Electrical W. W. Underground 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. Authorized Signature: Owner / Applicant / Contractor Building Department Copy January 26, 2018 January 26, 2018 Date 1 Miami Shores Village RECEIVE® Building Department • JAN 18 2018 a'417‘ a -el/ 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Zb x ,, BUILDING PERMIT APPLICATION FBC 20 Permit Type: Electrical -FSC,. i C 1� r i u Permit No. Master Permit No. OWNER: Name (Fee Simple Titleholder): 51 ' L(. 5 e fi Lima Phone#: g" 75,%'" &OO Address: " 4 I S Ne /05 `-T i jt�� ��- City: Atla'"` t S tor04 State: FAA Tenant/Lessee Name: Phone#: Email: Zip: 3•313V7" JOB ADDRESS: Os ,ve /I 2 5 City: Miami Shores County: Miami Dade Zip: 33/ Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: j -/ i� �Y' CONTRACTOR: Company Name:/ 1 fC_ (_.1 '`� 12/ C• C Phone#:., Address: g10 g10/ 5 154 f City: N ( i State: Qualifier Name: OS(fk \t4'uES State Certification or Registration #: Contact Phone#:0 Y DESIGNER: Architect/Engineer: Phone#: / /4 '1 °200 FfA ., . zips J33/G 2 Phone# 3 �3q /V ,9 G t Certificate of Competency #: // V O 36 3 �� i9r.�GS Email Address: 4/1"16-6/cctrife. 73a 601A 1 Value of Work for this Permit: $ Type of Work: ❑Addres ❑Alteration Description of Work: 64/2/U I VA / Square/Linear Footage of Work: ❑New ❑Repair/Replace ❑Demolition 7t C4wivso—/ ? • Tn3e, 13.4: j : ,1 ow., _ ,rte i :.i<: •fi'Muj ¢ - = +6 • writ i c" **************************************Fees************;144.4************x************** 1'1 . i,• _ .1'..,na ' i .1 . i.F}k 'f n•. e q ''qp y c `'�,.r : "J: "� 0+1 'l;.t cch.�Pb i ,t l: J e , K: �..: ;.. Permit Fee $ j 2L ©LO— CCF -$..r''''''' :w_. ' :.,. .. CO/CC�$k" `c Subm>;ttal�•Fee $ i 1.'13:P26 t 3,3'M Scanning Fee $ Notary $ Double Fee $ Structural Review $ Radon•Fee'$ Training/Education Fee $ DBPR $ 'Bond'$ Technology Fee $ TOTAL FEE NOW DUE $ 1:53' C i Bonding Company's Name (if applicable) ti Bonding Company's Address City' State Zip Mortgage Lender's Name (if applicable) hl A 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 ndt be r . ed and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged�7 before me this lb day of GtvJ 201(6, b 6 %?G veil ,t/21 , who is per nallyki o n to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commissi V ************ ,��,, :: "••,, NICOLE A. BERGERT ff. •.' ? MY COMMISSION # GG 123196 •��- EXPIRES: July 11, 2021 APPROVED BY -41027, ***** Signature Co} actor The foregoing instrument was acknowledged before me this 1kr...) day of , 20 (8, by .s -L CL"{cv'v5 who is per ovally k Own to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sig Print: tiU ccs - (3...„2„) My Commi **************** Plans Examiner Structural Review (Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) ** •J 4:;144••. NICOLE A. BERGERT • �� i_ MY COMMISSION # GG 123196 •�; hIA '..g ;;; uonaed hru Natary Pubhe tin erwiiter *** Zoning Clerk Elite Electric 870 NE 156TH TERR North Miami Beach, IT, 33162 Tel: 305-834-1469 Date: 01/26/2018 State of Florida County of Miami Dade Before me this day personally appeared Elite Electric who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at: 415 NE 10S° St. Miami Shores, FL 33138 Jph Yanes (Conti tor) Sworn to (or affirmed) and subscribed before me on this (�day of -TOM , 2018. BvJDSQ/1Th 6_0-C Personally Known Or Produced Identification Type of Identification Produced Print, Type s r p fame of Notary 4 4. 4,11N;p,, ° Notary Public - State of Florida Commission # FF 244555 :? My Comm. Expires Aug 1, 2019 Oi;, � Bonded through National Notary Assn. KATHERINE SOTO 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: State of Florida County of Miami -Dade The foregoing was acknowledge before me this �% day of U4' ByG who i as identification. ersonall know , 20 18 . me or has produced SEAL: ,`VOla,, CRISTINA M FRECHETTE /,,�: State of Florida -Notary Public �= ' Commission # GG 124806 "��;,o- My Commission Expires August 29, 2021 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 nspection Number: INSP-295684 Permit Number: ELC-1-18-149 Inspection Date: January 26, 2018 Inspector: Devaney, Michael Owner: CHURCH, ST ROSE OF LIMA CATHOLIC Job Address: 415 NE 105 Street CHURCH BLDG Miami Shores, FL Project: <NONE> Contractor: ELITE ELECTRIC INC Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Addition/Alteration Phone Number (305)758-0539 Parcel Number 1122310430010 Phone: (305)834-1469 Building Department Comments CARNIVAL TEMPORARY HOOK UP OF ELECTRIC FOR CARNIVAL TENTS 26 TOTAL Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Inspector Comments January 26, 2018 For Inspections please call: (305)762-4949 Page 1 of 1