EL-18-1132Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit
Permit NO. E L-4-18-1132
Permit Type: Electrical - Residential
Work Classification: Alteration
Permit Status: APPROVED
Issue Date: 5/22/2018
Expiration: 11/18/2018
Parcel Number
Applicant
230 NE 94 Street
Miami Shores, FL 33138-
1132060133630
Block: Lot:
WILLIAM ROBERT SMITH
Owner Information
Address
Phone
Cell
WILLIAM ROBERT SMITH
230 NE 94 Street
MIAMI SHORES FL 33138-2830
Contractor(s)
ONLY ELECTRIC CO INC
Phone
305-785-6059
Cell Phone
Valuation:
Total Sq Feet:
$ 250.00
0
Type of Work: BOND HANDRAIL , GFI BREAKER FOR POO
Additional Info: BOND HANDRAIL , GFI BREAKER FOR POO
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Amount
$0.60
$2.25
$2.00
$0.20
$150.00
$3.00
$0.80
Total: $158.85
Pay Date
Invoice #
04/30/2018
05/22/2018
Pay Type
EL-4-18-67342
Check* 315420 $ 50.00 $ 108.85
Check #: 315492 $ 108.85 $ 0.00 '
Amt Paid Amt Due
Available Inspections:
Inspection Type:
Review Electrical
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 informati 'sa urate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the a -named contrabtor to do the work stated.
May 22, 2018
Authorized Signature: Owner / Applicant / Contractor / Agent
Date
'Building Department Copy
May 22, 2018 1
rib
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
• Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION.
BUILDING I ELECTRIC
I
ROOFING
El PLUMBING ❑'MECHANICAL flPUBLIC WORKS
JOB ADDRESS:
City: Miami Shores
County:
.R.ECE1 V T _-
FBC 201?
Master Permit No. eVP 0 ' aiL
Sub Permit No. a ' 4-18-113Z
REVISION ❑ EXTENSION ❑ RENEWAL
,CHANGE OF CANCELLATION n SHOP
CONTRACTOR DRAWINGS
Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type:
Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee SimpleTitleholder):JM ►Tv}
Address: a3o fJS "`lynx
City: MIAMI Sl orsr) State:
Tenant/Lessee Name:
Email:
Phone#:
Phone#:
Zip: 3SI 38
CONTRACTOR: Company Name: tL 'R,pti.Op Pooc_. Jto../1 GICGirtt Ce Phone#: 305 9 5 bO,,5
, w o 2. -EIJKK
MI4,441/ rcAi r(��//D`/State: �..
Qualifier Name: - '"O&._`(o v iN kC'A Phone#:
Address:
City:
Zip: 333 Zu
3os 3-gsGos°k,
State Certification or Registration #: _ l — ') O4 23 15 Certificate of Competency #: ....-----
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
,a,
aS
Value of Work for this Permit: $
Square/Linear Footage of Work:
Type of Work: I I Addition ❑ Alteration I I New Repair/Replace
Description of Work: L0
r m t,breaker i-o r �oo. QLW 9
ll
Demolition
Specify color of color thru tile:
Submittal Fee $ CDo114:Cid Permit Fee $ `6"&t4p CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ 108 • 8 5
(Revised02/24/2014)
4(
Bonding Company's Name (if applicable) '414
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 cf such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
18 day of 1 , 20 I) , by (ll day of Aef• I , 20 ISM , by
11/443 ESM I. 114 Obt51— ,who is personally known to To yoq,/ \QI , who isersonally known to
me or who has produced as me or who has produced as
identification and who did take an oath.
identificatio► .nd ho did take an oath.
NOTARY PUBLI NOTAR
Sign:
Print:
Seal:
************************************************************************************************************
APPROVED BY 1x f1'd- )//A Plans Examiner Zoning
(Revised02/24/2014)
Structural Review Clerk
ONLY
ELECTRIC CO, INC.
Florida State Certified Licensed Electrical Contractor
Residential, Commercial, Industrial
EC13002313
onlyelectriccompany@gmail.com
348 NW 102 Terrace Plantation, FL 33324
Tel: (954) 476-5617 Fax: (954) 476-6189 Cell: (305) 785-6059
Date: MA1l8 ao18
State of 't k•ar kora
County of ,vy-sul..
Before me this day personally appeared TOt (A J Ao,wn who, being duly sworn, deposes and
says:
That he or she will be the only person working on the project located at:
aSo 59 rec.+
Contractor Signature
Sworn to (or affirmed)' and subscribed before me this k% day of `MAI , 20 lS
Personally know
Or Produced Identification
o�,3y, Type of identification Produced
scY�1� ;
Name of Notary
-I,
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'ocuntii•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 S day of MA., , 20 IY
who i ersonally known o me or has produced
Notary:
SE
as identification.