EL-18-1463Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
P
mit
Parcel Number
Permit NO. EL-5-18-1463
Permit Type: Electrical - Residential
Work Classification: Pool - Public
Permit Status: APPROVED
Issue Date:0/25/2018 Expiration: 12/22/2018
Applicant
1700 NE 105 Street
Miami Shores, FL
1122300500001
Block: Lot:
SHORES CONDO INC
Owner Information
Address
Phone
Cell
SHORES CONDOMINIUM
1700 NE 105 ST
MIAMI SHORES FL 33138
Contractor(s)
ONLY ELECTRIC CO INC
Phone
305-785-6059
Cell Phone
Valuation:
Total Sq Feet:
$ 5,800.00
0
Type of Work: BONDING 5, POOL REPLACING 2 POOL LI
Additional Info: BONDING 5, POOL REPLACING 2 POOL LI
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
$3.60
$4.50
$3.00
$1.20
$300.00
$3.00
$4.80
$320.10
Pay Date
Invoice #
05/29/2018
06/25/2018
Pay Type
EL-5-18-67728
Check #: 315550
Check #: 315687
Amt Paid Amt Due
$ 50.00 $ 270.10
$ 270.10 $ 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 s. - ifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either mysel ' agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, : • •FING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accur
construction and zoning. Futhermore, I authorize the above -named contrac
Authorized Signature: Owner / Applicant / Contractor /. :ent
t all work will be done in compliance with all applicable laws regulating
stated.
June 25, 2018
Date
Building Department Copy
June 25, 2018 1
Address: '.. ITV 10 --Q,4
City: P yi ` N T6- \ 0 /i State: FL.
Qualifier Name: J 41)
State Certification or Registration #: E(- \ 300 2-3 13 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: �^ (, City: State:
Value of Work for this Permit: $. j Jcb • CO Square/Linear Footage of Work: I�I
Type of Work: ❑ Addition ❑ Alteration o ❑l New Repair/Replace I I Demolition
Description of Work: `� N ' n 5 ( 7 p0 L l��cc)l) (ik /I 2- 1 OOL I )3 h
County:
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
BY:
REC
MAY 292018w
4I
(-C 1
FBC 20I�
Master Permit No. i ' .4 /d �/
Sub Permit No. (� 16 —Nt (OS
❑ ROOFING ❑ REVISION
❑PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
JOB ADDRESS: 1 / 00 — /fE 1 05 S-r
City: Miami Shores
Folio/Parcel#:
Occupancy Type: Load:
OWNER: Name (Fee Simple Titleholder):
Construction Type:
Address: ,',,//-1 ?c A4• /OS
City: //4:1,17' "d%'ck State: Zip:
Tenant/Lessee Name: Phone#:
Email:
❑ EXTENSION ❑ RENEWAL
❑ CANCELLATION ❑ SHOP
DRAWINGS
Miami Dade Zip: 33) 3 �{
Is the Building Historically Designated: Yes NO
aAa
Flood Zone:
BFE: FFE:
Phone#:206-J • li74/J
33/38
CONTRACTOR: Company Name: 014 �.li ec r\ C c 0
Phone#: 305 9- 5 60 51
Zip: 3332 7
—�� �0 /�I i�� Phone#: IPI Y7-'G 5'6 17'
Zip:
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ lOetOe,-- CCF $ CO/CC $
Scanning Fee $ Radon Fee $ 3 • CO DBPR $ `'(' S—O Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ Z'.C) ' 10
(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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
OWNER or AGENT
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
)S day of MAi , 20 , by day of , 20 , by
, who is Esonally knoW)to
kn14r1eN SAnnmaki5 , who isCersonally knoww to 3;c 1o44/ API k.iir
me or who has produced as me or who has produced
identification and who did take an oath.
NOTARY PUB
identification and who did take an oath.
NOTARY PUBLIC: Ap
Sign:
Print:
Seal.
OF
E P S:June7$,202
sodeed B
Sign:
Sea
140F,'
***********************************************************************************
as
Plans Examiner
Structural Review
pN#GG6n354
ergES: June 25,Sa`
Ices
oaP` sorT vu B�dDe1llv�Y
Zoning
Clerk
(Revised02/24/2014)
Notice to Owner — Workers' Com
p
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
ensation 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.
Signature:
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this 1') day of MA 1 , 20 / l .
By CLIVIt4 SArwt who is personally known to me or has produced
as idertcation.
aoe-CCU#�,,o'f13'4
Not • �i Bl, •: OS 26� ,1
4 ' ucA
SE.. t °`u�p`. a �r0
ONLY
ELECTRIC CO, INC.
Florida State Certified Licensed Electrical Contractor
Residential, Commercial, Industrial
EC13002313
onlyelectriccompany@gmail.com
348 NW 102 Terrace Plantation, FL 33324
Tel: (954) 476-5617 Fax: (954) 476-6189 CeII: (305) 785-6059
Date: 2S_ /0
State of A20.9e;Goe
County of d :4" ' jE
Before me this day personally appeared V4E �� f4T who, being duly sworn,'deposes and
says:
That he or she will be the only person working on the project located at:
/ 76) 4-/ . /OSA.
Contractor Signature
Sworn to (or affirmed) and subscribed before me this al day of M ' , 20 ISr .
co0o Personally know
04,1.11,14' NRA s Or Produced Identification
�A►tott°° Type of identificati gg odu
Print
Yae-e
tamp Name of Notary