EL-16-2175Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit NO. EL-8-16-2175
Permit Type: Electrical - Residential
Work Classification: Alteration
Permit Status: APPROVED
Issue Date: 9123i2016
Expiration: 03/22/2017
Parcel Number
Applicant
10682 NE 11 Court
Miami Shores, FL 33138-2123
1122320280500
Block: Lot:
MARC ALBERT ILLOUZ
Owner Information
MARC ALBERT ILLOUZ
Address
7934 WEST Drive
NORTH BAY VILLAGE FL 33141-
1540 MERIDIAN Avenue
MIAMI BEACH FL 33139-
Contractor(s)
METPLANET ELECTRICAL
Phone Cell Phone
(754)214-1695
Phone
Cell
Valuation:
Total Sq Feet:
$ 1,600.00
400
Type of Work: ELECTRICAL OUTLETS SWITCHES, LIGHTS
Additional Info:
Classification: Residential
Scanning: 1
CANCELLED
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
$1.20
$2.25
$2.25
$0.40
$150.00
$3.00
$1.60
$160.70
Pay Date Pay Type
Invoice # EL-8-16-60843
09/23/2016 Credit Card
Amt Paid Amt Due
$ 160.70 $ 0.00
Available Inspections:
Inspection Type:
Review Electrical
I
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 zoninrnore 4authorize the above -named contractor to do the work stated.
September 23, 2016
Authorized Signature: Ow '-r / Applicant / Contractor / Agent
Date
Building Department Copy
September 23, 2016 1
BUILDING
PERMIT APPLICATION
❑BUILDING 'ELECTRIC ❑ ROOFING ❑ REVISION
IVIIdi I II al IUI CS V IIIdge
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
FBC 2Ot
Master Permit No.cA(0 ^9• 119
Sub Permit No. E' I 'Ul S
❑ EXTENSION RENEWAL
El PLUMBING ❑ MECHANICAL n PUBLIC WORKS CHANGE OF
CONTRACTOR
❑ CANCELLATION
❑ SHOP
DRAWINGS
JOB ADDRESS: `o p.! / Lf �/12{% 22 7
City: Miami Shores County: Miami Dade Zip: ,71 1, O
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone:
OWNER: Name (Fee Simple Titleholder): Ai C_, .001
Address: 19-t0 ffroli ,1n owe_ 2"5
City: P CLIAM CJ-I State: CiorioUA
Tenant/Lessee Name:
J ,oreJalln .
Email:
CONTRACTOR: Company Na
Address:4�3/
City:
BFE: FFE:
Phone#: 736— V J
Phone#:
Phone#:
Zip: 3 Nl 7 1
Zip: 3' O94,1,
Qualifier Name: / � Phone#: /57/
State Certification or Registration #: 0-Certificate of Competency #:
DESIGNER: Architect/Engineer:
Address: / City: State: Zip:
Value of Work for this Permit: $ 2 Square/Linear Footage of Work: kV)
Type of Work: ❑ Addition n Alteration
Description of Work:
Phone#:
❑ New ❑ Repair/Replace n Demolition
Specify color o
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
r thru tile:
Permit Fee $ I (27' CCF $ I ' 20
Radon Fee $ 2. . 2-DBPR $ 2 .
p
Training/Education Fee $ 0 %O
CO/CC $
Notary $
Double Fee $
Bond $
0
TOTAL FEE NOW DUES GO . r
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
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.
Signature
0 ' or AGENT
foregoing instrument was acknowledged before me this
day of
444.1
L
me or who has produced t `
identification and who did ta-
NOTARY PUBLIC:
Print:
�SE�I zit
ROUEZ
ry Public - St a : of Florida
M Commission Expires May 30, 2018
Commission # FF 10462.
Bonded Through National Notary Assn.
* * * * * * * * * * * * * * * * * * * * * *
APPROVED B
as
Signature
The for
CONTRACTOR
rument`was acknowledged before,me this
�JC)L 20 / 6 , by
rsonally known to
me or who has produced as
identification and who did take an
NOTARY PUBLIC:
Seal:
Notary Public - State of Florida
My Commission Expires May 30, 2018
(F�— oc Commission # FF 104626
Bonded Through National Notary Assn.
********************************************************************************
Plans Examiner
Structural Review
Zoning
.Clerk
Letter Head
Date 0-712//?0/B.
State of Florida
County of Dade
Before me this day personally appeared
I, Jean L. Telfort Who being sworn, deposes and says
That or she will be the only person working on the project located
or ffirmed and subscribed before me this 18th day of -July-2016 .. by
C- Ci -74fr-‘" Personally know
Metplanet Mee
NUMBER AREA CODE 754-214 1695
Or produced identification
Type of ident' ati� produced
-si ne•. / �`
�
,,• t JORGE MA
Notary Public - State of Mori
`sMY CemmiasloaErNres.Mey.30, 2018
�•
4 , `' Commission # FF 104626
94 �;°� Bonded Through National Notary Assn.
1 Grant Court Hollywood FL 3302PHONE
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 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 towork 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
day of Cb r.... , 20 lc.
y `\ `\H1p is personally known to me or has produced
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