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EL-18-2027Permit NO. EL-7-18-2027 Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address p is Permit Type:.Pools/Whirlpools/Hot Tubs Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 8/1/2018 Expiration: 01/28/2019 Parcel Number Applicant 150 NE 107 Street Miami Shores, FL 33161-7032 1121360070200 Block: Lot: PATRICK & SARAH SULLIVAN Owner Information Address Phone Cell PATRICK & SARAH SULLIVAN 150 NE 107 Street MIAMI SHORES FL 33161-7032 Contractor(s) KLEAN POWER ELECTRIC INC Phone Cell Phone Valuation: Total Sq Feet: $ 1,000.00 0 Approved: In ' Review Comments: Date Approved: : In Review Date Denied: Type of Work: Swimming Pool Additional Info: Classification: Residential Occupancy: Private Bond Return : Scanning: 1 Fees Due CCF DBPR Fee DBPR Fee DCA Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Amount $0.60 $4.50 $0.00 $0.00 $3.00 $0.20 $300.00 $3.00 $0.80 Total: $312.10 Pay Date Pay Type Amt Paid Amt Due Invoice # EL-7-18-68376 08/01/2018 Credit Card $ 262.10 $ 50.00 07/30/2018 Credit Card $ 50.00 $ 0.00 Available Inspections: Inspection Type: Review Electrical i 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 certi that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. utI rmore, I authorize the above -named contractor to do the work stated. August 01, 2018 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy August 01, 2018 Date 1 4 Miami Shores Village Building Department §8,za;s 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 PG BUILDING Master Permit No * k 9 v (0 2S PERMIT APPLICATION Sub Permit No7P\�9 — 0 BUILDING 12ILECTRIC 0 ROOFING 0 REVISION ❑ EXTENSION ❑ RENEWAL PLUMBING 0 MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF 0 CANCELLATION 0 SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 7r / t / 0'7 36- City: Miami Shores County: Miami Dade Zip: 3 3 /.d/ Folio/Parcel#: //--- 2 /3 6 — OO 7— 02 O 0 Is the Building Historically Designated: Yes NO Occupancy Type: Load: _ Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): 5 /4,--/ -/ S , LL,,V Phone# ��/ f// mo 7 / / 0 7 - Address: City: /'//Pi5W/' J P7Ar-e5 State: ' - I Zip:33 / d✓ Tenant/Lessee Name: 4 /,,Phone#: Email-��/� �L/% s U/� y �� i/✓%iil ��e L/�� CONTRACTOR: Company Name: /<'Z jt" �OaJL�%Z � �� ' Phone Address: ,S70 / 5 M O rea7 City: ..5-12 i'4 PL Zip: *3 Qualifier 3 / Qualifier Name: ,Gg /f/ S (O 6 / `/t " o Phone#: State Certification or Registration #: G /3 UOL 0 ( 5 Certificate of Competency #: DESIGNER: Architect/Engineer: \/G4!v/6: 04-rt/G12 Phone#: oY s—t5 3/ Address: /V % AAl/ gy / 9''vL5- ' City: /11// %/ State: Zip:3 3/2 ' Value of Work for this Permit: $ /0 9 f/ — Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace n Demolition Description of Work: 6.—/e c r 37,.�/9�° U /1 �. 5 / 1 & / f '• Specify color of color thru tile: Submittal Fee $ Scanning Fee $ l/L J 3 Technology Fee $ 0•56o Structural Reviews $ Permit Fee $ 3©t°'et, c.:0 mo Radon Fee $ �J CCF $ 0 •6 0 CO/CC $ DBPR $ 4 • SO Notary $ tSk Training/Education Fee $ 0 ' ZO Double Fee $ IN Bond $ / TOTAL FEE NOW DUE $ Z' Z • 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 approv-. and a reinspection fee will be charged. Signature 0 The foregoing in trument was acknowledged before me this The foregoing instrument was acknowledged before me this gj r+t- day of �f,---�/''C-4't , 20 �i , by day of /�i�,6-vim �- , 20 1 tt , by C who is personally�, _A r./1- n 42A-A-1-7.vbho is personally known to me or who has produced k-1_,. >L.- identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: as , Die or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: ******************sss*************************************************************************************** APPROVED BY i_ 3/ Tt'b YliPlans Examiner Zoning (Revised02/24/2014) Structural Review Clerk 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 SIGNING BELOW YOU CKNOWLEDGE 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 (..7- By 1 et, tag S"a r who is personally known to me or has produced • Notary: SEAL: as identification. ERRY P MZA N : Public S to Of • arida ,20 W Klean Power Electric Inc,. 5101 SW 160 Ave, South West Ranchos, FI 33331 Phone: 786 277 0217 Date: June 2018 State : Florida County : Dade Before me this day personally appeared Sarah Sullivan who, being duly sworn, deposes and say: That he will be the only person working on the project located at : 150 NE 107 St, Miami Shores, FI 33161 Contractor Signature Sworn to (or affirmed ) and subscribed before me this day of June , 2018 By Personally know Or produced Identification Type of identification Produced Print, type or stamp N