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ELC-18-155Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address 1521 NE 105 Street Number: 1-1 Miami Shores, FL Owner Information 1015 NE 105 ST CORP Address Parcel Number 1122300530490 Block: Lot: Permit NO. ELC-1-18-155 Permit Type: Electrical - Commercial Work Classification: Addition/Aiteem Permit Status: APPt Phone Expiration: 07/22/2018 Applicant 1015 NE 105 ST CORP 1390 BRICKELL Avenue MIAMI FL 33131- Contractor(s) Phone UNLIMITED ELECTRICAL TECHNOLO (786)299-9500 Cell Phone (305)771-2423 C Valuation: Total Sq Feet: Type of Work: INSTALLATION OF SMOKE DETECTORS Additional Info: Classification: Commercial Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $0.60 $2.25 $2.00 $0.20 $150.00 $3.00 $0.80 $158.85 Pay Date Invoice # 01/19/2018 01/23/2018 Pay Type ELC-1-18-66182 Check #: 1673 Check* 1677 Amt Paid Amt Due $ 50.00 $ 108.85 $ 108.85 $ 0.00 Cell $ 800.00 0 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 ELECT AL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFF constructj6ri a IT, I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating i- g. F hermore, I authorize the above -named contractor to do the work stated. January 23, 2018 Au or ed Signa ' re: Owner / Applicant / Contractor / Agent Buildin ment Copy Date January 23, 2018 1 BUILDING PERMIT APPLICATION BUILDING [ELECTRIC 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 ROOFING FBC20 iAC) Master Permit No. QI (L9 l Sub Permit No. -F1 j — 'S`j REVISION EXTENSION RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION SHOP JOB ADDRESS: (5(0 I t<I € /0514 City: / Miami Shores Countv: Folio/Parcel#: / 1- j--c 3 6 4-/.9 U Occupancy Type: CONTRACTOR Miami Dade Is the Building Historically Designated: Yes Load: Construction Type: Flood Zone: DRAWINGS Zip: -2)3) NO X BFE: FFE: OWNER: Name (Fee Simple Titleholder)): /01/: ! v 6 /v 9rf Phone#: Address: W City: t-el, ete.tki- ��w �� Stater Tenant/Lessee Name: Phone#: Email: Ei') In burv, rvi (7176) . L`.�%►� CONTRACTOR: Company Name: V n 1 I / 4 1 "red C'1.1 -1 HC� Address: City: Phone#: Zip: ' �c3 - / 0 LS Qualifier Name: State: t)Pf ). Zip: T33 Phone#:, ,c).5 - 9)03— jOi/s`" State Certification or Registration #: L - 000 21.1 '( Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition n Alteration n New Description of Work: 7vts r"oLvZ- ❑ Repair/Replace ❑ Demolition Specify color of color thru tile: ( Submittal Fee $ � Permit Fee $ 450` rmC' CCF $ CO/CC $ Scanning Fee $ Radon Fee $ 2. DBPR $ 2. • 25 Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ pp TOTAL FEE NOW DUE$ ( 9 • 9S (Revised02/24/2014) 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 t attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection wh,ch occurs seven ,) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved anrein ection fee will be charged. Signature Signature OWNER or AGENT ,CONTRACTO The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this ['/ t 5 day o )- f , 20 / , by kO day of ...Act, f1.1.44 , 20 / b , by '? who is personally known to 71 �� , who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. NOTARY PUBLIC* ttttttititNe identification and who did take an oath. NOTARY PUBL C: . Sign: ,ii�, :� ��" Sign: tt Print: ! .O �.ls.'_#, Print: • :07 GG142714 t:. .. •• ,MISS, .•.Fr;'.. Seal: s Seal: 4 V.• O O Z *' o EXPIRES * S . 0 Number 'lr/ '. sort to 2021 $ •: cp G0142714 , e ? EXPIRES ********* 401*Alitt.! **********************************. i1L1*****t*4e t ************************* i+ S. tf ��. APPROVED BY rt�J—1 Tans Examiner ,^burSillik"`` Zoning Structural Review Clerk (Revised02/24/2014) 7360 West 20th Ave. • Suite # 135 Hialeah, FL 33016 Phone: 786-299-9500 Fax: 305-456-2683 olvillarl @comcastnet LIC. # EC-0002054 Date: (I ci /9 State of rj,-- County of .1 ( IQ-M Gti l r Before me this day personally appeared C'11`'0- -ft Deposes and says: That he or she will be the only working on the project located at: I ; Z1 tiL JI7 ,� who being duly sworn, Contractor Signature Sworn to ( or affirmed ) and subscribed before me this By VIAA �''-- • day of -C 1 L`t' f-s 20 t i, Personally Know OR Produced Identification Type of Identification Produced Prin`��T+lipe'orstamp name of Notary y N mbe . ▪ : • m GG142774 `. o ExPIRE ' * .: $ed 1J 2021 "• %�fhff! Asia • 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' Com • ensation Insurance Exem • tion 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 emp oyees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will be the only person alloweto work on your project. In these circumstances, Miami Shores Village does not require verification of workers' compensation ins: rance overage fr• the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING BELOW OU CKN• LEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: 0 ner State of Florida County of Miami -Dade The foregoing was acknowledge before me this / q day of °,t.4 , 20 1 -. By / v, (>A-1 who is personally known to me or has produced as identification. Notary: F a- YLl.i3 - •%`%w1..VEL,�sS, %e V.`oa,N►ISS/ . ,S �t SEAL: .• ' G % ' EXPIRES' I,i. s het 13 202� 1.11 'a�hfh Astdc'�t�. it1- 41,110.611110 Still • Inspection History Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores FL 33138-0000 Phone: (305)795-2204 Fax: (305)756-8972 ELC'-1-1$-155 Electrical - Commercial Project: <NONE> Owner: Phone: (305)771-2423 Job Address: 1521 NE 105 Street 1-1 Miami Shores, FL Parcel: Block: 1122300530490 Lot: Scheduled Insp # Inspection Type 01/01/2999 INSP-295754 Underground 01/01/2999 I N S P-295760 01/01/2999 I N S P-295757 01/01/2999 I N S P-295753 Final Meter Box Alteration 01/01/2999 INSP-295755 W. W. 01/01/2999 I N S P-295756 01/01/2999 INSP-295758 Service Change Fire Alarm 01/01/2999 INSP-295759 Relocation 01/19/2018 I NS P-295761 01/30/2018 I N S P-296196 Review Electrical Rough Inspection Status NONE NONE NONE NONE NONE NONE NONE NONE APPROVED PARTIAL APPROVED Check that bathroom receptacles are on 20 amp circuit and G. F. I, protected. Smoke detectors are O. K. 03/02/2018 INSP-296394 Final APPROVED Inspector Date Completed Default Inspector Not Complete Default Inspector Not Complete Default Inspector Not Complete Default Inspector Not Complete Default Inspector Not Complete Default Inspector Not Complete Default Inspector Not Complete Default Inspector Not Complete Michael Devaney 1/22/2018 Michael Devaney 1/30/2018 Michael Devaney 3/2/2018 CREATED AS REINSPECTION FOR INSP-296196. Check that bathroom receptacles are on 20 amp circuit and G. F. I, protected. Smoke detectors are O. K. Friday, June 29, 2018 Page 1 of 2 01/01/2999 INSP-298327 Rough NONE Michael Devaney Not Complete CREATED AS REINSPECTION FOR INSP-296196. Check that bathroom receptacles are on 20 amp circuit and .�. F. I, protected. Smoke detectors are O. K. Friday, June 29, 2018 Page 2 of 2