EL-18-73 Permit:No. EL-1-1 -73
Miami Shores Village Permit Type.Electrical -Residential
10050 N.E.2nd Avenue NE
..,..� Wor�cClassiticatics»:Addition/Alteration
Miami Shores,FL 33138 0000
_- Permit Status:APPROVED
Phone: (305)795-2204
�O1
RLDA
issue Date: 1/2912018 Expiration: 07/28/2018
Project Address Parcel Number Applicant
9225 NE 12 Avenue 1132050270390
Miami Shores, FL 33138- Block: Lot: LOURDES B KASANZEW
Owner Information Address Phone Cell
LOURDES B KASANZEW 9225 NE 12 Avenue (786)355-1124
MIAMI SHORES FL 33138-2928
9225 NE 12 Avenue
MIAMI SHORES FL 33138-2928
Contractor(s) Phone Cell Phone Valuation: $ 200.00
JN ELECTRICAL CONTRACTORS LLC (786)693-3392
Total Sq Feet: 30
Type of Work:ELECTRICAL WIRING RENOVATION Available Inspections:
Additional Info:ELECTRICAL WIRING RENOVATION Inspection Type:
Classification:Residential Final
Scanning:3
Meter Box �
Alteration
Relocation
Fire Alarm
Service Change'
Review Electrical
Review Electrical
W.W.
Underground
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60
DBPR FeeInvoice# EL-1-18-66092
$2.25
DCA Fee $2.00 01/29/2018 Check#:2234 $364.85 $50.00
Education Surcharge $0.20 01/10/2018 Check#:210 $50.00 $0.00
Penalty Fee $100.00
Permit Fee-Additions/Alterations $150.00
Scanning Fee $9.00
Technology Fee $0.80
Work without Permit Fee $150.00
Total: $414.85
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 Ay either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDO ,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify tha I the for oin informal is accur and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Fu or I ri he bove-na d cont for to do the work stated.
January 29, 2018
Authorized Signatu e: wne / Applicant / n ctor / Agent Date
Building Department Copy
January 29, 2018 1
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,fie, Miami Shores Village RECEIVED
Building Department JAN 1.0 1018
` 1 10050 N.E.2nd Avenue, Miami Shores, Florida 33138
\ Tel:(305)795-2204 Fax:(305)756-8972
` \\ INSPECTION LINE PHONE NUMBER:(305)762-4949 5•�-
FBC 20
BUILDING Master Permit No.
1-4- t9?-1
PERMIT APPLICATION Sub Permit No.gA 18 " 13
❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION []RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
ME" /n CONTRACTOR DRAWINGS
M
JOBADDRESS: 9aDn E"
City: Miami Shores County: Miami Dade Zip:
CFolio/Parcel#:1 Is the Building Historically Designated:Yes NO
d
Occupancy Type: Load: Construction Type: /�Fllood Zone:/ ' BFE: FFE:
OWNER:Name(Fee Simple Titleholder): �y&.9 �T,4i ,, e `�-)hone#:
Address: —I aa` ��JU7,, Q� G Ye. 1
City: I�'I(�1 9- �f�V(-f�� State: T(./ Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: J\y .!-((-An-CCd I'dYGi(';kfl LLC Phone#: �G93— 33 9�-
Address: L Sfi
City: Mf 6)YYl i r State: �� Zip: 33 1 L4-4
Qualifier Name: , S G U i r-'s, `Phone#:'?R(v—(,a C)S - 33C-0-
c-
State Certification or Registration#: Ci 13012L.91-2- Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ �)OO "01Square/Linear Footage of Work: S'n� �T
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: P.- ' I r6-4 1ly)
Specify color of color thru tile:
Submittal Fee$ ' 0.7 Permit Fee$ l9'�`�'6 CCF$ 0 CO/CC$
l&6'r mG
Scanning Fee$ Radon Fee$ �;L. g1 DBPR$ 2 Notary$
Technology Fee$ 0 -00 Training/Education Fee$ C3 2 Double Fee$
Structural Reviews$Z Bond$
TOTAL FEE NOW DUES • S
(Revised02/24/2014)
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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 bepp oved and a reinspection fee will be charged.
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this` The foregoinglinstment was acknowledged before me this
`j
day of C) ! -MtW,20 11 by ' day of ( f 20 -1 by
�J c Y OGG n2aD,who is personally known to : UO CIS JGt LUXirQ�,who is personally known to
me or who has produced �1�`P `� as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOT4PBLIC:Sign: 90SignPrint: Y Prin
Seal: Seal:
Not"PLac Sala vt florida Nowy of ftft
. Adriana Garde Aditw Qwds
Mr comml.elon o0 —%4, �Canar toa oci oatao�
APPROVED BY ?YW—P"119 Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
S�OR
Else a�oM Miami shores 'Village
• ' Building Department
OR 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:
-Ah employer in,the construction iindustry who employs' one or more part-time or full-time
i 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:
l. 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 registeredand 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'compensati ins nc coverage from the contractor's company for day labor,part-time employees or subcontractors.
t BY 'SIGNING . W YO ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND IT'S
CONTENTS.
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Signature: '
wner
h
State of Fl 'da
'County of Miami-Dade
1 The foregoing was acknowledge before me this day of 20A—t
Byy, 1'lzAlo who is personally known to me or has produced
as identification.
SE
'" aSIM Garaa floriaa
Adftna t�pt..oaoezz,
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JN Electrical Contractors LLC
2811 NW 103`d St.
Miami, FL 33147
Date: 1-10-18
State of: Florida
County of: Miami Dade
Before me this day personally appeared iftM who, being duly
sworn,
Deposes and says:
That he or she will be the only person working on the project located at:
9225 NE 12th Ave. Miami Shores, FL 33138.
ContractOffure
SWORN TO AND SUBSCRIBED BEFORE ME this 0 day of 20JB
by e t who is personally known to me or proAced
Ys identification, and did take an oath. _
(Nam Public)
NOWY wear FbrW
Adriana Garda a
UY COfflR&WW GG 081024
• E40M 0410812021
I
JN Electrical Contractors,LLC.
2811 NW 103 Street.
Miami FL 33147.
Cell:786-693-3392,fax:305-6949284 1
EmailJsa1gueiros@yahoo.es
Date: 14/11/17.
CONTRACT.
Asa4 26 �.
This is a document between JN Electrical Contractors LLC and duan-K2_-aAseU, for the works that our
company will do at the 9225 NE 12 Ave,`Miami Shores:
Works:
• Asking the Permits at the City, and calling for the inspections visits, and been present at the moment
of them.
• Wiring the-bathroom at the property.
a
For all this work JN Electrical Contractors, LLC is estimating $300.00.
In the price; we are including, the materials and the services of our company. If some other job has to be
done, these jobs are not included.
The money would be paid as follow: $150.00 at the moment of the sign of the contract, and$150:00 when
the whole job is done.
RECEIVED
i
JAN 17 2018
Jorg iron
JN I Contractors, LLC. Owner.
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