EL-18-856Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit
Parcel Number
Permit NO. EL-4-18-856
Permit Type: Electrical - Residential
Work Classification: Solar
Permit Status: APPROVED
Issue Date: 8t15/2018
Expiration: 11/11/2018
Applicant
304 NE 99 Street
Miami Shores, FL 33138-2437
1132060135600
Block: Lot:
JOHN FORBES
Owner Information
Address
Phone
Cell
LILLIAN CLAVERIA
304 NE 99 ST
MIAMI SHORES FL 33138-2437
Contractor(s) Phone
CHAD OHARAS QUALITY ELECTRICA (850)879-2678
Cell Phone
Valuation:
Total Sq Feet:
$ 5,250.00
0
Type of Work: PV ARRAY SYSTEM 7.8 KW 26 300 WATTS
Additional Info:
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
$3.60
$2.76
$2.00
$0.00
$0.00
$0.00
$0.00
$8.36
Pay Date
Invoice #
05/15/2018
Pay Type
EL-4-18-67018
Credit Card
Amt Paid Amt Due
$ 8.36 $ 0.00
Available Inspections:
Inspection Type:
Final
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, PLUMING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFI
construction an
all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
I authorize the above -lamed contractor to do the work stated.
Aut razed Signature: Owner
/ Applicant
Contractor
/ Agent
May 15, 2018
Date
Buildi Department epartment Copy
May 15, 2018 1
Miami Shores Village RECEIVE/
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
Scanning Fee $
Technology Fee $
Structural Reviews $
MAY "O 1 7018
(Li
FBC 2011
BUILDING Master Permit No. — 8 ss
PERMIT APPLICATION Sub Permit No. �l l - SS&
❑BUILDING tX ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 014 I V e 9 ct
City: Miami Shores County: Miami Dade
Folio/Parcel#: I 1 — 3 ?-o(a - Di 3 ^ Sr-eC() Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
zip: ?j 3 l `3 g)
OWNER: Name (Fee Simple Titleholder): Sal3,1 1oY' e--t Q Phone#:
Address: 3O4 m/F q I
City: INl^`C4.vVt . S it o Y\.Q SState: F.1, 0,r G* CA Zip: 33 1 3 g
/
Tenant/Lessee Name: i" 4 Pr Phone#:
Email:
CONTRACTOR: Company Name: CAnad
Address: C2. Cat rc
ScrkeS,1r&c.-., L+1 Eleckcc�cti Phone#: aSV 79_2-6 70
City: tea.I I n1,7o s S-k> Q- State: It r1 L'Q_ dl
Qualifier Name:
C.t» c' 1 0` t4e,. of
'_ , Phone#:
Zip: 2_?. O
BsU-- SGz-Z 1
State Certification or Registration #: G (-IS OU SZt-IL-P Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
if
Address: City: State:
Value of Work for this Permit: $ v� I S7) 0
Type of Work: ❑ Addition 1,8,1 Alteration
Description of Work: FV O V T
Square/Linear Footage of Work:
❑ New
❑ Repair/Replace
Zip:
❑ Demolition f
Specify clo'r:'of'co/or'thru tile: :r,;i.,i►
.. *I . k,a ,+,.
+ .i 9drstiv •S= is
7 Submittal Fee $re�� :—Permit.Fee $ tL 'O CCF $ CO/CC $
DBPR $ Notary $
Training/Education Fee $ Double Fee $
Bond $
TOTAL FEE NOW DUE $
Radon Fee $
(Revised02/24/2014)
for the first inspection which occurs seven (7) days after the building permit is issued.' In the a
inspection will not be approved and a reinspection fee will be charged.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before meythis
D ' da of Ape; t , 20 IS , by
.L . 4o r bcs , who is personally known to
A06;
.
me or who has produced JJ'�' r � t i\VA$ 'Q as
who di/Kake an ath.
identificati
NOTARY P
Sign:
Print:
Seal:
APPROVED BY
Signature`
CONTRACTOR
The foregoing instrument was acknowledged before 8me this
day offl � , 20 1 , by
.Ct
Eleiorck, who is ersonally know�to
me or who has produced - as
identification and who did t. e an oath.
NOTARY PUBLIC:
Bonding Company's Name (if applicable)
Bonding,Company's Address
)
City r ' •• 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•FYOU 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 mu)be posted at the ' site
post notice, the
Sign:
Print:
Y'YPRIETO Seal:
MYCOM• ' ION #FF214031
•a: EXPIRES: March 25, 2019
,, ; Bonded That Notary Public Underwriters
t
y/e Plans Examiner
<-'r1 V1 O
.0"r'ri,%,,,KRISTINE ANNE VE OUWEN
10 _? °�r ; State of Florida -Notary PublIC
• .- . 0?;= My Commission N GG Expires 157800
Commission
yap:' November 05, 2021
Zoning
Structural Review . Clerk
(Revised02/24/2014)
656 Capital Circle NE
Suite F
Tallahassee, FL 32301
(850)879-2678
Date: 05/01/2018
State of Florida
County of Leon
Before me this day personally appeared Chad O'Hara who, being duly sworn, deposes and says:
That he will be the only person working on the project located at: 304 NE 99 St, Miami Shores,
Chad O'Hara
Sworn to (or affirmed) and subscribed before me this 1st day of May 2018, by Chad O'Hara.
Personally known
Produced Identification
Print, Type or Stamp Name of Notary
,t 14_4 KRISTINE ANNE VERGOUWEN
, ''S ; State of Florida -Notary Public
- ., Commission # GG 157800
Mali'. M Novembero 05,2021es
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:
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this
, 20 '
``gj By I A N _• Yen C': cbvtOt s who is personally known to me or has produced
r' •r
Itt6 day of
-4 as identification.
Notary.
SEAL:
;PPS.^yA YANADY PRIETO
MY COMMISSION # FF 214031
EXPIRES: March 25, 2019
,;... °.,, Bonded Thru Notary Public Undenvriter5
a
BUILDING
PERMIT APPLICATION
DBu1T.DDNG j ELECTRIC
(]PLUMBING ❑ MECHANICA
JOB ADDRESS:
City:
Folio/Parcel#: f' j20,�
Occupancy Type: Load:
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
Construction Type:
OWNER: Name (Fee Simple Titleholder):
Address: '04 06
City:
Tenant/Lessee Name:
Email:
ShofZkS
BY--
PR0� $,,lZ618
FBC 20 IA
Master Permit No. ]-Z'-0-) 8'" c��" ✓C S
Sub Permit No.:EL i 9 ` 5(0
REVISION ❑ EXTENSION El RENEWAL
CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
Miami Dade
Is the Building Historically Designated: Yes NO
Flood Zone: BFE: FFE:
�l sr
hr� Po�s
State:
Phone#:
-Ft00� z4p: 33 i 30
Phone#:
PIZO Sam 612401 GGw
Address: MOO (,i C,WA3
CONTRACTOR: Company Name:
City:
Qualifier Name:
I `,� Phone#:
State Certification or Registration #: C V C_ 6 0 2-e. Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address:
Value of Work for this Permit: $
Type of Work:
State:
City:
( • - square/Linear Footage of Work:
'❑ Addition ❑ Alteration [ / New ❑ Repair/Replace
Description of Work:
sjictLi e)4t,u3
Phone#:
zip: 331.3 0
'to z754- Zips: 32 30e
es'0 222 3 -j
State: Zip:
❑ Demolition
200 u)4 5
Specify color of color thru tile:
Submittal Fee $
Permit Fee $
CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE$ 4'9.• C:7
(Revised02/24/2014)
for the first inspection which occurs seven (7) days after the building permit is issue
inspection will not be approved and a reinspection fee will be charged.
OWNER or AGENT
The foregoing instrum nt was acknowledged before me this
day of PilDr., 20 18 , by
hh 5C be-, , who is personally known to
me or who has produced roil?' 41} 2.-
identification and who did take an oath.
NOTARY PUBUC:
Sign:
Print
Seal:
APPROVED BY .f
LI0 A. VIJIL
Notary Public - State of Florida
ti Commission # FF 198998
My Comm. Expires Feb 12, 2019
Sign:
Print:
Seal:
, Signature
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
In the absence of such posted notice, the
CONTRACTOR
The for going instrument was acknowledged before me this
day
of
Q
.,4c. FZ .(1) who i ersonally k
me or who has produced as
identification and who did take an oath.
NOTARY PUB C:
......„LA_____
, 20
gut MARA MILLSTEIN
MY EXPIRES'. DSO ber 28, 20181
��pV
***ass**ssxs*****s*s:sssxsssssssssxsssssssssssssss*yes*****
Plans Examiner
Zoning
(Revised02/24/2014)
Structural Review Clerk