Loading...
EL-17-102Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit Permit NO. EL-1 -1 7-1 02 Permit Type: Electrical - Residential WorkClassiftcation: Addition/Alteration Permit Status: APPROVED Issue Date: 1/30/2017 Expiration: 07/29/2017 Parcel Number Applicant 444 NE 93 Street Miami Shores, FL 33138- 1132060140200 Block: Lot: SETH & LYNETTE LONG Owner Information Address Phone Cell SETH & LYNETTE LONG 650 W Avenue MIAMI BEACH FL 33139- (305)325-6976 650 W Avenue MIAMI BEACH FL 33139- Contractor(s) B.L.F ELECTRICAL INC Phone (786)380-2509 Cell Phone Valuation: Total Sq Feet: $ 11,000.00 0 Type of Work: INSTALL NEW OUTLETS AND SWITCHES RE Additional Info: INSTALL NEW OUTLETS AND SWITCHES RE Classification: Residential Scanning: 3 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $6.60 $5.78 $5.78 $2.20 $385.00 $9.00 $8.80 $423.16 Pay Date Pay Type Invoice # EL-1-17-62614 01/30/2017 Credit Card 01/13/2017 Credit Card Amt Paid Amt Due $ 373.16 $ 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 all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated. January 30, 2017 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy January 30, 2017 1 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 BUILDING PERMIT APPLICATION ❑ BUILDING g- ELECTRIC ❑ ROOFING ❑PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS JOB ADDRESS: City: yy y /6 9 3 s / Miami Shores County: Master Permit No. Sub Permit No. ❑ REVISION ❑ CHANGE OF CONTRACTOR Miami Dade 5 FBC2010 El P - I o 2 mask-CY 1(.0"Z35(() ❑ EXTENSION ❑RENEWAL ❑ CANCELLATION ❑ SHOP DRAWINGS Zip: Folio/Parcel#: Is the Building Historically Designated: Yes Occupancy Type: Load: Construction Type: OWNER: Name (Fee Simple Titleholder): Address: .' 3 7 'YE C 1-4 City: 201 ciThf-ei State: Flood Zone: NO BFE: FFE: y ARM(cone#: 30)- .? RS-33 Pj Tenant/Lessee Name: Phone#: Email: Zip: 33/3' CONTRACTOR: Company Name: L t_/ £(. Address:F75 c% rr City: s,.-- Qualifier Name: V N uJ /?3 5 State: / Phone#: �/�Adl�-c� L4 LZ Phone#: 766,- 300-2_501 _ Zip: 330 /S State Certification or Registration #: g'G/300 d:' 56 Certificate of Competency #: G /300 5.esSc DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ / / / D d U Square/Linear Footage of Work: Type of Work: ❑ Alteration,.,. ❑ New Description of Work: J)i (�///V 2-©0) 4215 r.rt _ . it , 5..11.1y" u [Repair/Replace 42, s ❑ Qemolition S l(1/ e"46. / e ,-. . Specify color of color thru tile: 0." may+'.. :""'.. /� co 0 Submittal Fee $ Permit Fee $ 3B�re e-) CCF $ (a• CO/CC $ Scanning Fee $ 4:1Radon Fee $ 5 • -a- 8 DBPR $ Notary $ 0 Technology Fee $ • &�- Training/Education Fee $ 2. 2 0 Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ 3"" J 1 (0 (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 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. Signatur The foregoing instrument was acknowledged before me this 3 day of SA -. , 20 sv / once , who is personally known to C i NTRACTOR.,, The foregoing instrument was acknowledged before me this by ) 3 day of ,) /9 NeiY , 20 / 1 , by 54d;f/2 `L c//eea ,who is personally known to me or who has produced FL 1.)R/L,e' 2/6-4,5c as me or who has produced P2 bRiiiei2 Li c.o SPS as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: • State o Florida it ',,„ a 'ommission i FF 173169 identification and who did take an oath. NOTARY PUBLIC: Seal: **************************** tit**** **4.****************** R******** R****+R***************************ski******** APPROVED BY / )' Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) BLF Electric Inc. Date: 002/7 Stare of County of it-fcw, -(l3akr Before me this day personally appeared /3/ac.c/vtAX L A1.Qo . who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at: W'IVJ5 13 5 T 6--tut, S /005 3 3/ 32 Sworn to (or affirmed) and subscribed before me this 1 Z day of ) lq nVu4 R/ , 2Q , by I J/C�.442//2 Personally known OR Produced Identification Type of Identification Produced FL b a.i„"-2 2 i i c -p Sc-K 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 SIGN G BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONT Signature: Own State of Florida County of Miami -Dade The forego' was acknowledge before me this / 3 day of /; It 'V , A/77 , 20 / . By -C / �'1 z tI who is personally known to me or has produced p Y tification. Notary: SEAL. xpires Oct 30, 2018 Commission # ff 173169