EL-17-495Miami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Parcel Number
Permit NO. EL-2-17-495
Permit Type: Electrical - Residential
Work Classification: Addition/Alteration
Permit Status: APPROVED
Expiration: 09/17/2017
Applicant
94 NW 94 Street
Miami Shores, FL
1131010340230
Block: Lot:
SANTIAGO JIMENEZ ANTONELI
Owner Information
Address
Phone
Cell
SANTIAGO JIMENEZ ANTONELA
94 NE 94 Street
MIAMI SHORES FL 33150-
(561)596-7146
94 NE 94 Street
MIAMI SHORES FL 33150-
Contractor(s) Phone
MAJESTY ELECTRIC SERVICES CORI (786)402-9150
CeII Phone
Valuation:
Total Sq Feet:
$ 4,500.00
0
Type of Work: ELECTRICAL WORK MOVE SERVICE FOR UN
Additional Info: ELECTRICAL WORK MOVE SERVICE FOR UN
Classification: Residential
Scanning: 3
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Notary Fee
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Amount
$3.00
$3.38
$3.38
$1.00
$5.00
$225.00
$9.00
$4.00
Total: $253.76
Pay Date Pay Type
Invoice # EL-2-17-63076
03/21/2017 Credit Card
02/24/2017 Credit Card
Amt Paid Amt Due
$ 203.76 $ 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 ELECTRICALPLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS A
construction
IDAVIT:
d zonin
at all th
ore, I a
g information is accurate and that all work will be done in compliance with all applicable laws regulating
e above -named contractor to do the work stated.
March 21, 2017
Authorized Signature: Owner / Applicant / Contractor / Agent Date
Building Department Copy
March 21, 2017
1
BUILDING
PERMIT APPLICATION
❑ BUILDING
❑PLUMBING
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
❑ MECHANICAL ❑ PUBLIC WORKS
JOB ADDRESS: V/ t ktir'7/`l &J[ea-
24P017
BY:
FBC 20
Master Permit Nok L — fl S
-U0i5
Sub Permit No.
❑ REVISION ❑ EXTENSION
❑ CHANGE OF
CONTRACTOR
City: Miami Shores County: Miami Dade
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone:
❑ CANCELLATION
❑RENEWAL
❑ SHOP
DRAWINGS
Zip: 33/5V
BFE: FFE:
OWNER: Name (Fee Simple Titleholder): yt/1/ aJF lea- �T 1-+ND Phone#:
Address: ! ivI 414 K
city: 0- (t-rAA;i Pke ram '
State:
Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: /y,)Q D--.oc, J 7 2-2.e• c ill i ( Si P AU/ e-Phone#: 7 r - `7'o 9 /,s'(]
Address: f 1 iQ r� % 2c c / I1 C. C '--'i7 w %/ 8 7D /�/.t!24 A/
City: U/If/r fl / %—/22 State: ".Z Zip: `7G/1C�'.
Qualifier Name:
6 Ac- / ,_lJ /
Phone#:
State Certification or Registration #: Certificate of Competency #: a/eTa a a /‘ i
DESIGNER: Architect/Engineer: Phone#:
Address: A r',,V� City: State: Zip:
Value of Work for this Permit: S. 4-tJ �, 00 Square/Linear Footage of Work:
Type of Work: ❑ Addition rr ❑ Alteration ❑ New XRepair/Replace ❑ Demolition
Description of Work:X tfeCW' � t410r k r M-ott:� Sex t/V (e- P ^ ( u/;elet q �' ,_. ^, /:.
` J /� tl/i C
`,-d! b 1,4l n ftiota C%rr?P./t 45 of o4-( eh gill G AI1I1 Al su ibia 4A- If ......,. Z,
gt c,c r KS.
Specify colpr of colorthru tile:
t. 5 k 1. d 6 1 n•. r
Submittal Fee $"""'"" ' . '�"''' • "Permit Fee $ -2•, ma ✓c�CC $
Scanning Fee $ Radon Fee $ E -33
Technology Fee $ Training/Education Fee $
Structural Reviews $
DBPR $ • j Notary $
Double Fee $
Bond $
Q Cv
TOTAL FEE NOW DUE $ qGJ a
(Revised02/24/2014)
2d3 '�
Bonding Company's Name (if applicable)
Bonding Company's Address
A '
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 reinspecl'ion fee will be charged.
Signature
OWNER or AGENT
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
2 ( day of �bwq`y 20 I?• by � F\ day of ,bvIrc , 20 17 , by
4vriortena , who is personally known to ec f4B( Gje.T Gl , who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take anoath.
NOTARY PUBLIC:
Pr'
NOTARY PUBLIC:
didliWillir
/441111111
• • eir/- .-V-a.
"Se •;r+l!"•a DANIELMONTOYA "Seal:
?•.�.. i MY COMMISSION # GG 011304
•pr VJ
—...,�.:or EXPIRES: July 13. 2020
•,;0=?.i Bonded Thru Notary Public Underwriters
*
APPROVED BY
DANIELMONTOYA,
MY COMMISSION # GG 011304
EXPIRES: July 13, 2020
Bonded Thru Notary Public Undervrritars
*s**************************.****
*******************************
: g / Plans Examiner Zoning
Structural Review
Clerk
(Revised02/24/2014)
M
iami Shores Wage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice t_ o Owner — Workers' Compensation Insurance Exemption wei
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 euiploys 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 BEOW OU AO/VLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENT
Signature:
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this %, \ day of ' ` t_.t\ l� ' , 20 ,4 .
By ) ' U u' l c GT 000 who is personally known to me or has produced
C (:)1 `/ _ "�O " 5(QZ as identification. Y ` d G tiUr
SEAL:
111.
'"F,%;Ji
MAHARAI K. GONZALEZ
MY COMMISSION # GG 044602
EXPIRES: November 2, 2020
Bonded Thru Notary Public Underwriters
_aw�rlb.
Majesty Electric
Service Corp.
Date: 3-21-2017
State of 4-1-0-ri c�G
County of
Before me this day personally ap
sworn, deposes and says:
eared RA4e( cOift who, being duly
That he or she will be the only person working on the project located at
94 N.W. 94 Street Miami Shores , Fl 33150
Sworn to (or affirmed) and subscribed before me this 2 i day of
DANIEL MONTOYA
MY COMMISSION # GG 011304
EXPIRES: July 13.2020
Bonded Thru Notary Public Underwriters
tam
Phone 786-402-9150
License No. CCO1E000164
Personally Know
Or Produced Identification
Type of Identification Produced l 9
11870 Hialeah Gardens Blvd Unit 129-122
Hialeah Gardens FI 33018