EL-18-1401Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit
Permit NO. EL-5-18-1401
Permit Type: Electrical Residential
Work Classification: Pool - Private
Permit Status: APPROVED
Issue Date: 7/10/2018
Expiration: 01/06/2019
Parcel Number
Applicant
1263 NE 92 Street
Miami Shores, FL 33138-
1132050270270
Block: Lot:
MARTA J PACHECO BOBONIS
Owner Information
Address
1263 NE 92 Street
MIAMI SHORES FL 33138-
1263 NE 92 Street
MIAMI SHORES FL 33138-
Contractor(s)
ONLY ELECTRIC CO INC
Phone
305-785-6059
CeII Phone
Phone
Cell
Valuation:
Total Sq Feet:
$ 1,000.00
0
Type of Work: ELECTRICAL BONDING ON SWIMMING POOL
Additional Info: ELECTRICAL BONDING ON SWIMMING POOL
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
$0.60
$3.38
$2.25
$0.20
$225.00
$3.00
$0.80
$235.23
Pay Date
Invoice #
05/22/2018
07/10/2018
Pay Type
EL-5-18-67654
Check #: 315447
Check #: 315740
Amt Paid Amt Due
$ 50.00 $ 185.23
$ 185.23 $ 0.00
Available Inspections:
Inspection Type:
Final
Light Niche
Bonding
Review Electrical
Alarms
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 c ntractor to do the work stated.
July 10, 2018
Authorized Signature: Owner / Applicant / Contractor / Agent
Date
Building Department Copy
July 10, 2018
1
BUILDING
PERMIT APPLICATION
BUILDING ✓ELECTRIC
❑PLUMBING ❑ MECHANICAL
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
PUBLIC WORKS
JOB ADDRESS: ID lco S NA. 12
City: Miami Shores County:
Folio/Parcel#:
Occupancy Type: Load:
II
FBC 20 f 14%1
Master Permit No. 7JP p Y6- Z 6 b
Sub Permit No.-B.A C;b— 1 41)
REVISION I I EXTENSION RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
Miami Dade
Zip: 35/38
Is the Building Historically Designated: Yes NO
Construction Type: Flood Zone:
OWNER: Name (Fee Simple Titleholder): fV ►O.r\,A l ►ieco
Address: , ( NC- 5 )--
City: tit .,%\w re.4 State: •
Tenant/Lessee Name: ulf-
Email:
BFE: FFE:
Phone#:
Phone#:
Zip:
CONTRACTOR: Company Name: ec'r�c
Phone#:
Address: 3y (' 1 " r" 1 0 2 '9/RR
City: PLA-N417/4 t0// FL State:
YofiV ,-Doc/3-
Qualifier Name: 2
State Certification or Registration #: GT (390
DESIGNER: Architect/Engineer:
Address: City:
Value of Work for this Permit: $
Type of Work:
II
Addition ❑ Alteration
Description of Work: �CCirlcArl b*AdO ► e -
Zip: �Zy
Phone#: \s y) 4-7 6 s 6 17-
Certificate of Competency #:
Phone#:
State: Zip:
Square/Linear Footage of Work:
New Repair/Replace
.n.,M•M,81
Demolition
Specify color of color thru tile:
So9q►d
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
(Revised02/24/2014)
;VA, 9P
Permit Fee $ CCF $ CO/CC $
n
Radon Fee $ O- • DBPR $ ' 3E Notary $
Training/Education Fee $ Double Fee $
Bond $
TOTAL FEE NOW DUE $ 19 H • Z3
Bonding Company's Name (if applicable) N1f�
Bonding Company's Address
City State \\ Zip
Mortgage Lender's Name (if applicable) VlI4
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
Signature
ER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of MA�.E , 20 It , by 1 day of MAI
Nair iACHew boo jt 1 , who isqersonally known o Tx 4.6.1 Ao, WI , who i Personally known
,20 by ,by
me or who has produced as me or who has produced as
identification and w
NOTARY PUB
id take an oath.
identification an. 'o did take an oath.
NOTARY P • : LIC:
Sign: EN Sig :
Print: _ -•�StON E21 P
Sal: �
�p 'eaTto
Bud9atN°ta�Y ea I : aua�,�1bSSt#1 4Cg5
, ." m ed1
E.
APPROVED BY
"-Zdi/tr�� tl Plans Examiner
Zoning
Structural Review Clerk
(Revised02/24/2014)
ONLY
ELECTRIC CO, INC.
Florida State Certified Licensed Electrical Contractor
Residential, Commercial, Industrial
EC13002313
onlvelectriccompanv@gmail.com
348 NW 102 Terrace Plantation, FL 33324
Tel: (954) 476-5617 Fax: (954) 476-6189 CeII: (305) 785-6059
Date: MA`1 15, �18
State of -ti) A
County of DAnL
Before me this day personally appeared 36 l `-lo)tA who, being duly sworn, deposes and
says:
That he or she will be the only person working on the project located at:
a(S tJL `i. �} M►mot 5‘ttA,e. , . 3)138
Contractor Signature
Sworn to (or affirmed) and subscribed before me this 2K'- day of MAi , 206.- .
Personally know `/
Or Produced Identification
Type of identification Produced
COkkal
�on
�sS 0
Dom"
fOFF`-
Let
amp Name of Notary
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
k 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 BELOWA1411
KNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
OL.OrKEW
Signature:
State State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this }5 day of An41 , 20 IY .
By PAAri44 Porc,tn hobo..„,
Notary:
SEAL:
who i(ersonally knowl)to me or has produced
as identification.
'c' ofl364
tr vu"1010N 3'
June seems
nn o liotaiY
?turfBo�� '
Ztw Budge