EL-18-1089 Permit NO. EL-4-18-1089
Miami Shores Village Permit Type:Electrical -Residential
10050 N.E.2nd Avenue NW ° *4" I
.,. ,.,,.� Work Classification:Addition/Alteration
Miami Shores,FL 33138-0000PA Pei7nit Status:APPROVED
Phone: (305)795-2204
F�ORtDA
Issue,oate.81'112018 Expiration: 10128/2018
Project Address Parcel Number Applicant
269 NW 111 Terrace 1121360010360
Miami Shores, FL 33168- Block: Lot: BLESSED MANAGEMENT GROL'
Owner Information Address Phone Cell
BLESSED MANAGEMENT GROUP LLC 269 NW 111 Terrace
MIAMI SHORES FL 33168-3324
269 NW 111 Terrace
MIAMI SHORES FL 33168-3324
Contractor(s) Phone Cell Phone Valuation: $ 700.00
SUNSHINE ELECTRICAL CONTRACT( (305)268-4958
Total Sq Feet: 0
Type of Work:REPLACE KITCHEN CABINETS Available Inspections:
Additional Info:REPLACE KITCHEN CABINETS Inspection Type:
Classification:Residential
Scanning: 1 Final
Meter Box
Alteration
Relocation
Fire Alarm
Service Change ;
Review Electrical
W.W.
Underground
4
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
` CCF $0.60
DBPR Fee $22.2255 Invoice# EL-4-18-67292 J
DCA Fee $2.00 05/01/2018 Credit Card $308.85 $0.00 t
I Education Surcharge $0.20
Permit Fee-Additions/Alterations $150.00
Scanning Fee $3.00
Technology Fee $0.80
Work without Permit Fee $150.00
Total: $308.85
t
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 an zonin Irermore, I authorize the above-named contractor to do the work stated.
i C�,,rq. \ r'!_ek.- May 01, 2018
AuthoiizecY Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
May 01, 2018 1
Miami Shores Village RECE14EL
Building Department APR 25 7-118
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949. �Q
�FBC 20Tq
BUILDING
Master Permit No.
PERMIT APPLICATION . sub Permit No.
<< �
❑BUILDING �- LECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL;
❑PLUMBING ❑MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
l CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip:
1
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Tifleholder):(�j�SC k- CPhone#:-
i
Address: ad c> ��••�� t ".} �t�r
City: State: X11— Zip: 1
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name:_ Cao--\tYC4cAw; CQ)- Phone#:
Address:
City: State:F
� Zip:�J\'�-1�-i �
Qualifier Name: "_\C%kY`f.nZ� �Il-��P3arr� Phone#:
State Certification or Registration#: Certificate of Competency#:,
DESIGNER:Architect/Engineer:
Phone#:
Address: City: State: Zip:
r
Value of Work for this Permit:$ � V Square/Linear Footage'of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New '?�epair/Replace ❑ Demolition
1
Description of Work: iie mci 1.
I Y
I
1
Specify color of color thru tile: Y
Submittal Fee$ Permit Fee$l✓YmiOd' CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
l TOTAL FEE NOW DUE$
(Revised02/24/2014)
}
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 reinspection fee will be charged.
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of f�Q,(%N 120 by a day of 20 by
�t ', Qiryw.ci�L w o is ersonally known o personally 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 PUB
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Sign: ( Sign:
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Print: Print:
Seal: ` obi}�,,,,, Rosa Maria Sabeteia Seal:
1 FF97306G `� F�P!r, S:AW 26;20110
rQ e�'�'. Commission# 02ii �" ° �E,d_.>.. w, s��t�a Ink�sw'
*• " Expires: March 20,2 _
fro
APPROVED BY Plans Examiner Zoning
i
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Structural Review Clerk
(Revised02/24/2014)
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SUNSHINE. ELECTRICAL CONTRACTORS CORPORATION
LICENSE # EC 13005807
PHONE NUMBER 786 443 9590
Date:April 25, 2018 t.
COUNTY OF MIAMI SHORES VILLAGE
Building Department
4
Before me this day personally appeared Mariano Santiesteban who, been duty sworn deposes and says:
E
That he will the only person working on the property located at
Cordially:
Marano Santiesteban
Sworn to and subscribed before me this S day of 20119 by Mtj 1,(,� h-l(nStQjjQn
Personally Know !�
Or produced Identification
Type of identification
ANTONIO E.GONIEZ
COMMISSION.#FFQ13115
4ES:AUG 25,2019
" • kmjMW
Print,Type or stamp seal of NotaNy
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OR
4 Miami Shores Village
.... Building Department
10050 N.E.2nd Avenue
�COR 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. Stai. § 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
4 State,Division of Corporations.
i
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 day of 11/IC�►� '20
By 101, 1 a �R X V)Dn&A who is personally known to me or has produced
(XJ► ` as identification. ?"°""'�""�""•
s'r'r'ue•., MAHARAI K.GONZALEZ
= MY COMMISSION#GG 044602
I Notary: :*; *'
EXPIRES:November 2,2020
'•',;ea;Fro;; Bonded Thru Notary Public underwriters
SEAL:
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