EL-18-1409Miami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit
Permit NO. EL-5-18-1409
Permit Type: Electrical - Residential
rkClassification: Addition/Alteration
Permit Status: APPROVED
Issue. Date: 6/2 112018
Expiration: 12/18/2018
Parcel Number
Applicant
10 NW 100 Street
Miami Shores, FL 33150-
1131010180400
Block: Lot:
YNC INVESTMENT GROUP LLC
Owner Information
Address
Phone
Cell
YNC INVESTMENT GROUP LLC
1170 SEAGULL Terrace
HOLLYWOOD FL 33019-
(305)951-6724
1170 SEAGULL Terrace
HOLLYWOOD FL 33019-
Contractor(s) Phone Cell Phone
SUNSHINE ELECTRICAL CONTRACT( (305)268-4958
Valuation:
Total Sq Feet:
$ 3,500.00
0
Type of Work: ELECTRICAL WORK AS PER PLANS
Additional Info: ELECTRICAL WORK AS PER PLANS
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Penalty Fee
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Work without Permit Fee
Total:
Amount
$2.40
$3.38
$2.25
$0.80
$100.00
$225.00
$3.00
$3.20
$225.00
$565.03
Pay Date Pay Type
Invoice # EL-5-18-67667
06/21/2018 Check #: 135
05/23/2018 Check #: 134
Amt Paid Amt Due
$ 515.03 $ 50.00
$ 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 certify that all the foregoing information is accurate and that - ork will be
construction and zoning. Futhermore, I authorize the above -named contractor to do a ork-tated.
Authorized Signature: Owner / Applicant /
Contractor
Agent
pliance with all applicable laws regulating
ne 21, 2018
Date
Building Department Copy
June 21, 2018
1
Miami Shores Village
Building Department
f0050 N_E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
GILDING
PERMIT APPLICATION
El BUILDING 40fi ELECTRIC ❑ ROOFING
RECEIVED
MAY 2 3 2018
FBC 201'4
Master Permit No. 1Q C- `"i — / _ I / 2 I
Sub Permit No. C� l , - -loci
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
JOB ADDRESS: /b r" VI/ / D D 2 7-
City: Miami Shores
County:
Folio/Parcel#:
Occupancy Type: Load: Construction Type:
Miami Dade
❑ CANCELLATION ❑ SHOP
DRAWINGS
Zip:
Is the Building Historically Designated: Yes
Flood Zone:
NO
BFE: FFE:
OWNER: Name��yy(Fee Simple Titleholder): - 4 D(1C� %� / Phone#: -3aJ 9 S/ t 2;
Address: �"+( / i7 u S 4rtuu 7 /2A-c&
City: / 66/WOO ! State: -F-L Zip: 3.30)1
Tenant/Lessee Name: Phone#:
Email:
CONTRACTT/OJR: Company Name: 1)AJfll//./E `*&-k/C£dt COU TA Phone#:
Address:1�,1.300S A(r7
City: A/14 A41 State: r L
Qualifier Name: r 4 421 1Wk GAn776-/rElJ AX.) Phone#:
State Certification or Registration #: (✓ )3c .SS J1 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ s�� Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
6034-J1-. i-i /OPt. POW
V
Description of Work:
Zip: .3 3jq(l
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ ,,E757416 3/i" S CCF $ c CO/CC $
Scanning Fee $ Radon Fee $ 0.. 2 C DBPR $ 3. '3 v Notary $
Technology Fee $ Training/Education Fee $ Double Fee (9-5 • C)
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ ct S (S . C
ty�LT� (00 C7Z
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 e 3
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\ ` Signature J G(�LArJ
,aa/"--i-A21-4j----'
CONTRACTOR
The foregoing instrument was ac nowledged before me this The foregoing instrument was acknowledged before me this
` ' /�xdaay of 4 ,20 by
`.___41 404/ y who is plasioalb,LIcRown to /Tit/ wh is personally known to
me or who has produced as a or o asprod as
identification and who did take an oath.
NOTARY PUBLIC:
RY D. CAMARGO
MY COMMISSION #FF242221
EXPIRES: JUN 21, 2019
Bonded through 1st State Insurance
*********************Qi�srarr� *:__ *_ **.*******************************s
APPROVED BY( Z../A/)/ /& Plans Examiner
identification and who did take an oath.
NOTARY PUBLIC:
< 4' day of ! e/A , 20 _, by
Sign:
Print:
Seal:
MARY D. CAMARGO
MY COMMISSION #FF242221
EXPIRES: JUN 21, 2019
Bonded through 1st State Insurance
*************
Zoning
Structural Review Clerk
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 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.
akt
Signature: ;;*mnlF ,o
Si �^
g , ' Bonded Thru Notary Public Underwriters
Owner
MAHARAI K. GONZALEZ
MY COMMISSION # GG 044602
EXPIRES: November 2, 2020
State of Florida
County of Miami -Dade
The foregoingre�was j/acc(k\nro`wll'eddgge before me thishday of , 20
By C3 l v' t `Or 1 L cA) who is personally known to me or has produced
L-V‘. ( 2- as dentification.
Notary:
SEAL:
COMPANY LETTER HEAD
Date:
State of
County of
Before me this day personally appeared " who;l;'ng duly sworn,
deposes and says:
That he or she will be the only person worki
Contractor Signature
Sworn to (or affir
by
d) andsubs
'4
this day of . 20,
Personally know
OR Produced Identification
Type of Identification Produced
� r
Print, Type or Stamp Name of Notary