ELC-18-1735Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit
Parcel Number
Permit NO. ELC-6-18-1735
Permit Type: Electrical - Commercial
Work Classification: Low Voltage
Permit Status: APPROVED
Issue Hate: 6/2812018'
Expiration: 1212512018
Applicant
736 NE 92 Street Number: BLDG K
Miami Shores, FL 33138-0000
113206044001
Block: Lot:
SHORES PLAZA EAST CONDON
Owner Information
Address
Phone
Cell
SHORES PLAZA EAST CONDOMINIUM 621 NE 92 Street
-- • - FL
Contractor(s)
3 WAVES ELECTRIC CORP
Phone
(305)221-3780
Cell Phone
Valuation:
Total Sq Feet:
$ 3,620.00
0
Type of Work: SECURITY CAMERAS INSTALLATION
Additional Info: SECURITY CAMERAS INSTALLATION
Classification: Commercial
Scanning: 3
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Amount
$2.40
$2.25
$2.00
$0.80
$150.00
$3.00
$3.20
Total: $163.65
Pay Date Pay Type
Invoice # ELC-6-18-68036
06/25/2018 Check #: 20604 $ 50.00 $ 113.65
06/28/2018 Check #: 20605 $ 113.65 $ 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 AF !DAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction a nd zoning. authorize the above -named contractor to do the work stated.
June 28, 2018
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Date
June 28, 2018 1
BUILDING
PERMIT APPLICATION
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
... c \%ED
JUN 018
Y:
FBC 2011 btu
Master Permit No. a.0 la - I -13S
Sub Permit No.
El BUILDING Q ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION El RENEWAL
(PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 736 NE 92nd Street
City: Miami Shores
Folio/Parcel#: 113206044001
Occupancy Type:
County:
Miami Dade Zip:
Is the Building Historically Designated: Yes
NO X
Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Shores Plaza East Condo Phone#: 305-759-9069
Address: 745 NE 91st Street
City: Miami Shores
Tenant/Lessee Name: N/A
Email: spe123@att.net
State: FL Zip: 33138
Phone#: N/A
CONTRACTOR: Company Name: 3 Waves Electric Corp. Phone#: 305-962-5889
Address: 1303 SW 124 Concourse
City: Miami State: FL Zip: 33184
Qualifier Name: Victor A. Couillard Phone#: 305-962-5889
ER00-13736 ° `
State Certification or,Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: • Phone#:
Address:
City: State: Zip:
Value of Work for this Permit: $ 3620.00
Type of Work: ❑ Addition ❑ Alteration
Description of Work: Security cameras installation
Square/Linear Footage of Work:
❑■ New ❑ Repair/Replace ❑ Demolition
Specify color of color thru tile::
Submittal Fee $. PermitFee$ /',f—C) I Ob
Scanning Fee $
Radon Fee $ p! Q
Technology Fee $ Training/Education Fee $
Structural Reviews $
rv�y; FJ ti io r.?t;, r.h q �,t. ry '
avaitS
coy.: rk .14 ' s C s4"CO/CCF CC •
$ 3 S°..
DBPR $ ' Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 13 • `(,T✓
(Revised02/24/2014)
Signature
OWNER or AGENT
1
was acknowledged before me this
,20 /' ,by
n who is personally known to_
r who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State Zip
Mortgage'Lender's Name (if applicable)
Mortgage Lender's Address
_ t
City — ' -r 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.
c.c
The foregoing instrume
2NV day of
COOL tt2
Sign:
Print: OSC�j�j �'�/• 4,2fr4O2 4
Seal:
APPROVED BY
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
Z V day
of ��yYv=—
jfG'12 ,-6Viii,121,<iuho is personallylsnawn to
n or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
,20 /7 ,by
as
%L .Xf JU/-' /, Plans Examiner
0SC
J14.
a
Notary Public State of Florida
Oscar M Zaragoza
Ar My Commission FF 939267
n'a add Expires 12/08/2019
Zoning
Structural Review Clerk
(Revised02/24/2014)
3 Waves Electric
1303 SW 124 Concourse
Miami, Florida 33184
(305) 962-5889
Date iv / Z-°f /742123
State of Florida
County of Miami Dade
Before me this day personally appeared Victor Couillard who, being duly sworn, deposes and
says:
That he or she will be the only person working on the project located at:
736 NE 92nd Street Miami Shores, FL 33138
Contractor Signature
Sworn to (or affirmed) and subscribed before me this Zv'day of �!./A1. 20 /23-,
by Victor Couillard
Personally know
OR Produced Identification
Type of Identification Produced
Print, Type or Stamp Nam Notary
iami 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) iri the construction industry may elect to be
exempt if:
I. 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 Iabor, 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 V' day of , 2011 .
B349 2t- S 7 L./'% Vt-e ,Scho is nersonall' known to m6r has produced
as identification.
Notary Public - of
Oscar M Z. agoza
ij My Comission FF 939267
ndv mExpires 12/08/2019
74 S44e4 Raga Sat ea €depaiteamc ,miatdo t, Sac.
745 North East f r'4 Street
Miami Shore.;, FL 33138
305-759-9069 /
E-MAIL: spel23@att.net
June 25, 2018
Miami Shores Village
Building Dept.
10050 NE 2nd Avenue
Miami Shores, FL 33138
Dear Sir / Madam,
This letter will serve as your confirmation, that "3 Waves Electric Corp." has been
contracted by the Shores Plaza East Condominium Asso., Miami Shores, Florida,
33138, and it is fully authorized by the Board of Directors to perform work in the
installation of "security cameras" in building 736 NE 92 Street, Miami Shores, FL
33138
Should you desire any additional information, please feel free to contact our
office at your earliest convenience.
Sincerely yours,
Carlos Talavera
Vice -President
Shores Plaza East Condominium Asso.
cc: file
2018 FLORIDA NOT FOR PROFIT CORPORATION ANNUAL REPORT
DOCUMENT# 726432
Entity Name: SHORES_ PLAZA EAST CONDOMINIUMrINCir
Current Principal Place of Business:
745 N.E. 91ST ST
MIAMI SHORES, FL 33138
Current Mailing Address:
745 N.E. 91ST ST
MIAMI SHORES, FL 33138
FEI Number: 59-0597536
Name and Address of Current Registered Agent:
ZARAGOZA, OSCAR
745 NE 91ST ST
MIAMI SHORES, FL 33138 US
FILED
Apr 27, 2018
Secretary of State
CC0406970476
Certificate of Status Desired: Yes
The above named entity submits this statement for the purpose of changing its registered office or registered agent, or both, in the State of Florida.
SIGNATURE:
Electronic Signature of Registered Agent
Officer/Director Detail :
Title
Name
Address
City -State -Zip:
Title
Name
Address
City -State -Zip:
Title
Name
Address
City -State -Zip:
PD
DE ROJAS, JORGE
9140 NE 8TH AVE, APT 4H
MIAMI SHORES FL 33138
TD
ZARAGOZA, OSCAR
726 NE 92ND ST, APT 1L
MIAMI SHORES FL 33138
D
OCAMPO, DAVID
755 NE 91 ST
4F
MIAMI SHORES FL 33138
Title
Name
Address
VD
<TALAVERA, CARL=
726 NE 92ND ST, APT 7L
City -State -Zip: MIAMI SHORES FL 33138
Title
Name
Address
City -State -Zip:
SD
WARD, DAVID
488 NE 90 ST
EL PORTAL FL 33138
Date
I hereby certify that the information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the same legal effect as if made under
oath; that I am an officer or director of the corporation or the receiver or trustee empowered to execute this report as required by Chapter 617, Florida Statutes; and that my name appears
above, or on an attachment with all other like empowered.
SIGNATURE: OSCAR ZARAGOZA
TD 04/27/2018
Electronic Signature of Signing Officer/Director Detail Date
(LOCATION
Miami Shores Plaza
736 NE 92nd Street
Miami Shores, FI 33138
I
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