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EL-17-379 Permit NO. EL-2-17-379 `aNOREs L,� Miami Shores Village t Permit Type:Electrical-Residential 10050 N.E.2nd Avenue NEP ED r� � ' Work Classification:Addition/Alter ttion ' Miami Shores,FL 3313&0000 Perini#Status:APPROVED "tea Phone: (305)795-2204 issue Date:7131/2017 Expiration: 01/2712018 Y Project Address Parcel Number Applicant 922 NE 91 Terrace 1132060000030 Miami Shores, FL Block: Lot: BBJJB LLC Owner Information Address Phone Cell BBJJB LLC 922 NE 91 Terrace (954)558-3959 MIAMI SHORES FL 33138- 922 NE 91 Terrace MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 6,500.00 RYAC ELECTRIC COMPANY CORP (305)308-5061 ° Total Sq Feet: 0 Type of Work:REWIRE ELECTRICAL THROUGH ENTIRE HO Available Inspections: Additional Info:REWIRE ELECTRICAL THROUGH ENTIRE HO Inspection Type: Classification:Residential Final Scanning: 1 Meter Box Alteration Relocation Fire Alarm Service Change Review Electrical W.W. Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $4.20 Invoice# EL-2-17-62936 DBPR Fee $4.50 DCA Fee $4.50 07/31/2017 Check#:2405 $323.20 $0.00 Education Surcharge $1.40 Permit Fee-Additions/Alterations $300.00 Scanning Fee $3.00 Technology Fee $5.60 Total: $323.20 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 and zoning. Futherm e, I authorize the above-named contractor to do the work stated. July 31, 2017 Authorized Signatur .Ow r / Applicant / Contractor_ / Agent Date Building Department Copy July 31, 2017 1 1 Of 1r11Qlln 011V1 GJ V 111Q�;G Buildin Departmentx� g FEB 14 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 207 Tel: (305)795.2204 Fax: (305)756.8972 13 Y INSPECTION'S PHONE NUMBER: (305)762.4949 1 _ FBC 20 BUILDING Permit No. PERMIT APPLICATION Master Permit No. EL 11 -3 Permit Type: Electrical JOB ADDRESS: 9.292 11/19. J ewolt City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder): )oW Phone#: Address: ©I�?. N• C' el / 7-e Y ra( e City: n'1�Yh�' S�D,r r_S State: T 1pkele, Zip: L .3/3 Tenant/Lessee Name: Phone#: Email: J CONTRACTOR:Company Name: 02. �� Phone#: ��/ Address: LU 3 J City: State: Ez Zip: 3 3 Z Qualifier Name: GGr 6 14c,61 Phone#: State Certification or Registration#: ie 3 Oy 6 S6 l Certificate of Competency#: Contact Phone#: Email Address: DESIGNER: Architect/Engineer:orCA;fQC�vr e.� Z7A4PV;4I J h a GG rci(n Phone#:,-Q--�Ql -iq j b Value of Work for this Permit: $ x.15019 0-0'� Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New ORepair/Replace ❑Demolition Description of Work: Qwi r 1'GC±ri'Caj f'h to✓gAfi L�l� �✓'� tie�� 3ov�oo 19 ✓ ,v1J; Submittal Fee$� Permit Fee$ �� CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ 1,,h6` �� y i3oddng Company's Name(it 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 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 delive to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be p d at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of su posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature • Owner or Agent Contra for 10 The foregoing instrument was acknowledged before me this JO The foregoing instrument was acknowledged before me this day of- P'P,,6 20±�,by Z4,/ �4a jma 4h day of fi 20/-2,by be.YrA &Cf fe, who is personally known to me or who has produced sD L, who is personally known to me or who has produced L�, & As identification and who did take an oath. as identification and who did take an oath. NOTARY I NOTARY PUBL C: Sign: Sign: Print: Print: LV !REZMy Commission ,'i _ EUZq ALVgR� My Co s �t3MMISSION#F52 COMMISSION#FF974952'•,9!„,• EXPIRES A • ,,, EXPIRES April 05,(107)388-0153 pnl 05,2020 (407)3W-01x3 aryervlc�.c FkXidallotary&n ba.00m kkk*k&kkkkkkkkkle4ek&*kkkk8e,k�&ok*kkkk:kk:kkk �:k:kkk:kkk�:k*kkkkkkkkkk�kk*kkkkkkkkkkkk:kkkk:kkkkk:kkkkkkk#kk*8:kkkk APPROVED BY /�Si� Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) 1� OR Miami shores Village Building Department 10050 N.E.2nd Avenue �LORIDp' 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. I 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: , Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of ,20L By f / : J /�nA c 4 who is personally known to me or has produced as identification. Notary: uEuZA ALVAREZ MY COMMISSION#FF974952 f SEAL: EXPIRES April Os,2020 (407)399-0IS3 Fbridallot� awlLy,COn• { Company Letter Head Date: State of 0 �(/l� County of { I Y Before me this day personally appeared" o, ing duly sworn,deposes and says: That he or she will be the only person working on the project located at Sworn to or(affirmed)and subscribed before me this day of 20Ciy n / Personally known V Or Produced Identification Type of Identification Produced MELIZA ALVAREZ MY COMMISSION#FF9749S2 EXPIRES April 05,7020 (407)39"153 FbrWANGU h MOM fY P int, yp r Stamp of Notary y r