EL-18-1478Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Pe
M„_
Permit NO. EL-5-18-1478
Permit Type: Electrical - Residential
WorkClassifcation: Addition/Alteration
Permit Status: APPROVED
Issue Date: 6/812018
Expiration: 12/05/2018
Parcel Number
Applicant
116 NE 97 Street
Miami Shores, FL 33138-
1132060132560
Block: Lot:
WATERSEDGE SHORES LLC
Owner Information
Address
Phone
Cell
WATERSEDGE SHORES LLC
1094 NE 91 Terrace
MIAMI SHORES FL 33160-3313
(305)336-7100
72 GOLDEN BEACH Drive
GOLDEN BEACH FL 33160-
Contractor(s)
B.L.F ELECTRICAL INC
Phone
(786)380-2509
Cell Phone
Valuation:
Total Sq Feet:
$ 1,000.00
0
Type of Work: INSTALL 3 SD INSTALL 4 RESET LIGHT
Additional Info: INSTALL 3 SD INSTALL 4 RESET LIGHT
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA�Fee
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
$0.60
$2.25
$2.00
$0.20
$150.00
$3.00
$0.80
$158.85
Pay Date Pay Type Amt Paid Amt Due
Invoice # EL-5-18-67746
06/08/2018 Credit Card $ 108.85 $ 50.00
05/30/2018 Credit Card $ 50.00 $ 0.00
Available Inspections:
Inspection Type:
Final
Meter Box
Alteration
Relocation
Fire Alarm
Service Change
Review Electrical
W. W.
Underground
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
construction and zonin
Auth
c
t
at all the foi tregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
ore, I_authoriz the ove-n�m d, contractor to do the work stated.
ON1`20
gture: Owner / Applicant / Contractor / Agent
June 08, 2018
Date
Building Department Copy
June 08, 2018
1
•
(AV
BUILDING
PERMIT APPLICATION
BUILDING
PLUMBING
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
'--►
MAY°3 0 2018
Master Permit No. RC:)- / / 2 2-
Sub Permit No. Ete -ik..42.I3
4
E.ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR
JOB ADDRESS: / i' AiE G% j/ 9
City: Miami Shores County:
Folio/Parcel#:
Occupancy Type: Load:
Miami Dade
Is the Building Historically Designated: Yes NO
Construction Type: Flood Zone:
OWNER: Name (Fee Simple Titleholder): tV a letz 5t2P ��ofrT L LC
Address: 29 00 ,tf pC.Qc r
i
City: O l y�)
)Tenant/Lessee Name:
Fl
Email: ' 1W ICor1?I ?$7dP . eov 7
CONTRACTOR: Companyp�Name: e
Address: 9 "/ /(%(,� : J �7�
City: - I Gt /Qa � State: P1
Qualifier Name: V/a•bf)r,i, 44/24 Gael.Phone#:
State Certification or Registration #: E C ()Ooifg 5`3 Certificate of Competency #:
Address:
DRAWINGS
zip: 3313
BFE: FFE:
Phone#: 33 )5-33' WO 0
zip:33o /5
Phone#: 305- 33G— / as
Phtne#: 79' st
zip: 33 D'S
•
DESIGNER: Architect/Engineer: 4 Phone#:_.
State:
�4. 4 _':
• ., Q.. . 1 '-r R1‘r.
City:
Value of Work for this Permit: $
1000
Type of Work: ❑ Addition ❑ AlterationT,'
Descriptio of Work:
Insl C
esli
rl i
Zip:
Square/Linear Footage of Work:
❑ New
121 Repair/Replace
r ,,
Demolition
,kf
•
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ fd0
Scanning Fee $ Radon Fee $ 2 "
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
CCF $ CO/CC $
DBPR $ 2 . 25 Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ (C9 'J
rrt
Bonding Company's Name (if'applicable)
Bonding Company's Address I
• t V ! p, ❑.
City '. _ t State Zip
Mortgage Lender's'Name.(if applicable)
Mortgage Lender's Address
City - e i +tState Zip
g >. -4-
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 thlat 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. = ; t,' ,�;4 ,\
"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 $2509 the'applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must'be posted at the job site
for thesfirst inspection which'•occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved a d a reinsp; gtion fee will be charged.
Signature
,, ,, OWNTRorAGENT
The foregoing instrument was acknowledged before me this
3 0 day of M , 20 ? , by
2)//426V/C Ka/2 AQ, who is personally known to
me or who has produced P/- C bcasg L ie.S.¢y as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
* * * * * * *
*
APPROVED BY
(Revised02/24/2014)
� w
Signature P'.
CONTRACTOR ,
i
The foregoing instrument was acknowledged before me this
p' dayof� ,4 20 %9 ,by
V 10 4 k l0hA ,f{ , who is personally known to
me or who has producedgPiedit 1%$Ue2 b s, '5► as
identification and who did take an oath.
NOTA:Y U:LIC:
Sign:
Print:
Seal:
. i
i .
v Plans Examiner
T CAMPBELL,
ubllc - State of. Florida
*
**
Zoning
Structural Review Clerk
1
BLF ELECTRIC INC.
Date: //
State of f ogrba
County of wZ( brr/ bad
Before me this day personally appear ula04044: G Lei who, being duly
sworn, deposed and says:
That he or she will be the only person working on the project located at:
/U E crF h-r / G -t' S 2 04--e `3 3 / 3 ?
Contractor Signature
Someone to (or affirmed) and subscribed before me this ) day of
,T6J1/ 20 ly , by
Personally known v�
Or produced identification
Type of.identification Produced %� b��a�k
7/13
YINETCAMPBELL*'1e•;..:.,.t ►t;
otar ublic ...State of Florida
C n. Expires.Oct 30,-2018 ► a 2;
mission # FF 173169,,
Print, Type or Stamp Name of Notary
Z is_os
Notice to Owner — Workers' Corn
p
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
ensation 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 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 7 day of 3U it/
,20(? .
who is personally known to me or has produced
identification.