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EL-18-411 Permit N0. EL-2,18-411 i,� Miami Shores Village ■ Permit Type:Electrical -Residential 10050 N.E.2nd Avenue NE a n I Work Class cation:Addition/Alteration ' - Miami Shores,FL 33138-0000 Phone: (305)795-2204 Permit Status:APPROVED CORLDA issue©ate:2t�2018 Expiration: 08/22/2018 ProjectAddress Parcel Number Applicant 107 NE 91 Street 1132060133300 Miami Shores, FL 33138- Block: Lot: SAM SZABLA Owner Information Address Phone Cell SAM SZABLA 107 NE 91 Street (305)781-5895 MIAMI SHORES FL 33018- 107 NE 91 Street MIAMI SHORES FL 33018- Contractor(s) Phone Cell Phone Valuation: $ 950.00 EVOLUTION ELECTRICAL CONTRACT (786)351-5784 Total Sq Feet: Type of Work:EXISTING KITCHEN AND BATH 1 TO LEGA Available Inspections: Additional Info:EXISTING KITCHEN AND BATH 1 TO LEGA Inspection Type: Classification:Residential Final Scanning: 1 Meter Box Alteration Relocation i Fire Alarm Service Change Review Electrical W.W. Underground i Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 DBPR Fee Invoice# EL-2-18-66478 $3.38 02/15/2018 Credit Card $50.00 $ 185.23 DCA Fee $2.25 Education Surcharge $0.20 02/23/2018 Credit Card $ 185.23 $0.00 Permit Fee-Additions/Alterations $225.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $235.23 l r 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 certi that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. F ,I authorize the above-named contractor to do the work stated. February 23, 2018 ' Auth0fized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy February 23, 2018 1 ,. d a t ' " �... 2AV�� n-� Miami Shores Village p�''" RECEIVED Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 FEB 15 1018 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 V F//B��C 201U b BUILDING Master Permit No. 94f— PERMIT APPLICATION Sub Permit No. ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL ❑PLUMBING• ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP nCONTRACTOR DRAWINGS JOB ADDRESS: /y7 N �71 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): ��A M 5' 2-4,61,�' r Phone#: Address:_ .tJX! / s 7 City:_�� State: Zip: 53 0/9 i Tenant/Lessee Name: Phone#: Email: r / CONTRACTOR:Company Name: ✓IJ ZV-4,0 W E(ec774-1 C C 6)PJ/ phone#: 3S`�3C7 `:►' Address: /6 -3/ �✓ul! -5-8 /�G I' f City: ��i►��r9i`� State: �C Y�R�-�� Zip: 33 f Qualifier Name: oo' ✓7 0W4 57 1 Phone#: State Certification or Registration#: Certificate of Competency#: f0 46-000 610 DESIGNER:Architect/Engineer: Phone#:' Address: �y City: State: Zip: Value of Work for this Permit:$ % 5Q- O O Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace eplaace Demolition 4- / - FJDescription of Work: 4 j6 A421'i 404 -LO /e 9,4 ,4 ©- Specify color of color thru tile: Submittal Fee$ Permit Fee$ my 3/ CCF$P CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond.$ TOTAL FEE NOW DUE$ 1 A (Revised02/24/2014) i 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 • f Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or Installationhas 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..... r 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. { r Signature Signature OWNER or AGENT C NTRACTOR The foregoing instrument was acknowledged before me this The foregoing Instrument was acknowledged before me this day of /"•-b '20 /'X .by 2.q day ofof PRy 20,1 by 57.4- GI- whoCperson:a1:1yk:n:o:w�n i�–. Go S —_-Vw a'is-oersonaily known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: '..�t_... I M PAEZ .a.. Sign: Sign: �'' Print: Print: ;'~ EXPIRES A r'1 av P�4 (sol)398-0153 FloridallotaryService.com Seal: 46, °��; Notary Public-State of Florida Seal: Commission#FF 206163 isr'rFOFe�oPo` My Comm.Expires May 5,2019 National Notary Assn. rrsrrsrsis�f'rswWsss sssssssssssssssssrsrssrsssssssssrssrsassrssssssssssrrsrsrsssrs APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revisedo2/24n014) r • SNORES Miami shores Village millsJ ""`l" Building Department d 9 p TES 10050 N.E.2nd Avenue �QRIDp' Miami Shores, Florida 33138 ` Tel: (3b5) 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: f 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: Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this I/J day of 12�� ,20�. 'By .S/4-,-J 57AZ4 w is personally known to a or has produced as identification. Notary: aY'a"� % MARIJAIR RAVELO y' 'SEA., SEAL: ,<P a" .. y r:; Notary Public-State of Florida' " =.iA , •y Commission#FF 206163 '4r mm.Ex ires May 5,2019 0'� Bonded through National Notary AssR., EVOLUTION ELECTRICAL CONTRACTORS INC. 11631 NW 58TH PL HIALEAH,FL 33012 Telf:(786)718 8562—Fax:(305)822 8211 Date: Oz /8 i a State of �i�tjS-1 Country of P Before me this day personally appeared who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at: f D-7 N r 91,S741z,1&1_ /c{&1 Sworn to(or affirmed)and subscribed before me this �`� day of �e62✓A2Y .20 by j�✓�,✓j J �GOS G�. / I Personally know Or Produced Identification Type of identification Produced t CO Oto—AC A IVEZ KA LAP. GARCIA My COMMISSION#FF140421 ` EXPIRES:July 10,2018 t 0Fvv Print,Type of Stamp Name of Notary l