EL-18-607Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit
Permit NO. E L-3-18-607
Permit Type: Electrical -Residential
Work Classification: Addition/Alteration
Permit Status: APPROVED
IsSue Date: 3/15/2018
Expiration: 09/11/2018
Parcel Number
Applicant
1060 NE 105 Street
Miami Shores, FL 33138-2106
1122320280070
Block: Lot:
DUPLEX 900 LLC
Owner Information
Address
Phone
Cell
DUPLEX 900 LLC
44 W FLAGLER Street
MIAMI FL 33130-
44 W FLAGLER Street
MIAMI FL 33130-
Contractor(s)
ELECTRICIANS ON CALL, CORP
Phone Cell Phone
(954)284-5084
Valuation:
Total Sq Feet:
$ 3,100.00
0
Type of Work: INTERIOR BATHROOM REMODEL SEE ATTAC
Additional Info: INTERIOR BATHROOM REMODEL SEE ATTAC
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
$2.40
$3.38
$2.25
$0.80
$225.00
$3.00
$3.20
$240.03
Pay Date Pay Type Amt Paid Amt Due
Invoice # EL-3-18-66726
03/15/2018 Credit Card $ 240.03 $ 0.00
Available Inspections:
Inspection Type:
Final
Meter Box
Alteration
Relocation
Fire Alarm
Service Change
Review Electrical
W. W.
Underground
In consideration of the iss
pertaining thereto and in st
accepting this permit I as
required for ELECTRICAL
OWNERS AFFIDAVI
construction and
nce to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
e responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
UMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
ify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
hermore, I a.� • _ :..ve-named contractor to do the work stated.
ure: Owner / Applicant / Contractor / Agent
Building Department Copy
March 15, 2018
Date
March 15, 2018
1
JOB ADDRESS:
City:
Folio/Parcel#:
BUILDING
PERMIT APPLICATION
BUILDING
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
ELECTRIC ❑ ROOFING
MAR OS At
c 4-1
FBC 20Iq
Master Permit No. R l ` Cj - 1 7-, 13 q l
Sub Permit No.E1
❑ REVISION ❑ EXTENSION 0 RENEWAL
❑ PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF
CO TRACTOR
1o60 N O5 f
Miami Shores County:
'It9,,32o2 fool o
CANCELLATION ❑ SHOP
DRAWINGS
313.2
Is the Building Historically Designated: Yes NO C/
Miami Dade
Occupancy Type: Load: Construction Type: (Flood Zone:
OWNER: Name (Fee Simple Titleholder): l) PI q o o LC-
Address: l�li W I .R _sTRr 'r
City:
P M i State: L
Tenant/Lessee Name:
.Email: Cr(-3 )JC,e_P I a iioL. C
CONTRACTOR: Company Name: ) �) �S coo � all
Address: `1 i k) SG✓ /i q'l.5-7
City:"v,-��Ct.44-4a.Li State: —741-6:—
Qualifier Name: �c/i1 7 ,) G/Y /
State Certification or Registration #: C /)a O%L/ 5' E Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: n City: State: Zip:
BFE: FFE:
Phone#:
____46_30,tx:4_0
Phone#:
Zip:
Zip:331��
Phond#:9l
1,'L[Sd 4
---Value of Work for this Permit: $
Zip: 7)3 %`7
Phone#(5 0 y/4% 709
Square/Linear Footage,of Work:
Type of Work ❑ • Addition Alteration ❑New ❑Repair% eplace ❑ Demolition �/�)
Description of Work y I�JU } Lip- it-t)wt1 �-•" �=--Ql C�JL Sr, e C. N ct c. e c
Specify color of color thru tile:
7IA, cP
Submittal Fee $ Permit Fee $ i/ ' CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
' Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
(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 niade 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 b 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 attach ent. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which-occ swen (7) days after Vie ig pernut°is 1. sueci., In -the absence of such posted notice, the
inspection will not be approved anreinspection fee will be - • rged.
Signature
or AGENT
The foregoing i ."ent/was acknowledged before me this
L) day of 7 , 20 /? , by
who is personally known to
me or who has produced
as
identification and who did take an
NOTARY PUBLIC:
Sign:
Print:
Seal:
**************************
APPROVED BY
•
Signature
I �
CONTRACTOR
The foregoing instrumentwas acknowledged before me this
G) ,lday of i4la/✓ 140-1, " , 20 % , by
� :}: /C� ✓ .�,p , who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
as
********************************************************************************
(21210992 /6 Plans Examiner Zoning
Structural Review
Clerk
(Revised02/24/2014)
COMPANY LETTER HEAD
Date: 03/ ) A
State of •ficv I ciGt-\_
County of 0 \-04.4-4cVJ •
Before me this day personally appeared yt^irdS,./---0 who, being duly sworn,
Deposes and says:
YU n1 ! en.)
That he or she will be the only person working on the project located at :
iotCo OE. / 46- 5 l ate, i gta f( 3 39 3'
Contractor Signature
Sworn to (or affirmed) and subscribed before me this/i 3 day of , 2C/ ? ..
by:
Aitken
Not : of Florida
Comm
No
Commission #GG 82998
Expires 311 Cy enbtar,
Bonded through
Personally know
Or Produced Identification
Type of Identification Produced
Print, Type or Stamp Name of Notery
Miami Shores Village
Building Department
1.0060 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 is the construction industry who employs one or mo. 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 wo on your project. In these circumstances, Miami Shores Village does not require verification of
workers' compensation insuran ; • ' verage from the contractor's company for day labor, part-time employees or subcontractors.
BY SIGNING BELOW YOU Ii- CKNOWLEDGE THAT YOU HAVE READ THIS, NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
er
State of Flori
County of Miami -Dade /� /�� v
The foregoing was acknowledge before me this _ day of 1 `r 1�J11 Ch , 20_
18
ByQ \( Stm0 who is personally known to me or has produced
\C \ as identification.