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EL-18-1412`sµOR, 14 , 10050 N.E. 2nd Avenue NE �— ... Miami Shores, FL 33138-0000 Phone: (305)795-2204 fiLOR1D4' Permit No. EL-48-1 412. 31 Awk, Permit Type: Electrical - Residential ' Wark Classification: Addition/Alteration Issue Date:7/11/2018 Expiration:01l0712019 rroject Aaoress Parcel Number Applicant 29 N E 98 Street 1132060131120 Miami Shores, FL 33138- Block: Lot: GLENN DAIDONE Owner Information Address Phone Cell GLENN DAIDONE 54 NE 97 Street (305)788-2711 MIAMI SHORES FL 33138-2331 54 NE 97 Street MIAMI SHORES FL 33138-2331 Contractor(s) Phone Cell Phone E & S ELECTRICAL SOLUTIONS INC (786)250-8836 Type of Work: INTERIOR ELECTRICAL REMODELING Additional Info: INTERIOR ELECTRICAL REMODELING Classification: Residential Scanning: 1 Fees Due Amount CCF $4.80 DBPR Fee $4.20 DCA Fee $2.80 Education Surcharge $1.60 Permit Fee - Additions/Alterations $280.00 Scanning Fee $3.00 Technology Fee $6.40 Total: $302.80 Valuation: $ 8,000.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # EL-5-18-67670 05/23/2018 Credit Card $ 50.00 $ 252.80 07/11/2018 Credit Card $ 252.80 $ 0.00 Avanaole inspections: Inspection Type: Final Meter Box Relocation Fire Alarm Service Change Review Electrical W. W. 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 contractor to do the work stated. `ZZ�Z, -r") — July 11, 2018 Au orized ignature:Owner / Applicant / Contractor / Agent Build epartment Copy July 11, 2018 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 FBC 20 BUILDING Master Permit No. I-c /6 - z PERMIT APPLICATION Sub Permit NO.:ff—j_( Ei - I `f.l Z ❑BUILDING %ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS P CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 21 A/(f7 16 A Sc City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 113 2060131120 Is the Building Historically Designated: Yes NO Occupancy Type: /lcst`6�� ad: Construction Type: Flood Zone: BFE: FIFE: OWNER: Name (Fee Simple Titleholder): G 1 Phone#: 3 �" j' 6S Address: City: State: Zip: 33 13� Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: e-�-< �EG�ticr-% 7D`��r""s c Phone#: 796 Address: gq/h/c • CitState: �`' Zip: Qualifier Name: Cc�� i • /loe/rrwCG Phone#: State Certification or Registration #: 0 �/ 1 Certificate of Competency #: 13 eo©C9 q6 54 DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 8�©� ' o Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: �� Ac /.-L0 We-l�k Arr� C -�^ s al S1S r'g' d tic✓ Specify color of color thru tile: Submittal Fee $ Scanning Fee $ Technology Fee $_ Structural Reviews $ Permit Fee $ 2 2C7 ; CX3 CCF $ CO/CC $ Radon Fee $ Z• ' 8 13 DBPR $ '4 • 26 Notary $ Training/Education Fee $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ Z S 2 �� (Revised02/24/2014) f Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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. Signatu Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this �) daay( off U 20 it � by day of �V �-`'L 20 � Zs by V DA lT)0 , who is personally known to �Q►J- opon (�`2—, who is personally known to me or who has produced` �� . IA_C�N5;s me or who has produced �� -- -�y r`^2— as identificationd who did take an oath. NOTARY PLll C: Sign: Print: identification and who did take an oath. NOTARY PUBLIC: Print: Seal: ,rvwwvtir�rvY I: °11 Notary Public State of Florida Sindie Alvarez ' My Commission FF 15t3750 h.Jk.,Alq , APPROVED BY Plans Examiner Structural Review Zoning Clerk (Revised02/24/2014) E & S ELECTRICAL SOLUTIONS INC Date:---� ( I 112Q 1 g State of ��2117L1 County of L^-'M t Before me this day personally appearedt?Cl, 7i `�G�� who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at: Z9 1 ST Sworn to (or affirmed) and subscribed before me this day of �UL .200, by 6��t � f a; NCB Ou NTk N(�- Notary Public State of Florida Sindia Alvarez { v My Commission FF 156750 . ofgdr Expires 0910312018 i� Personally know OR Produced Identification Type of Identification Produced Z2 u GC �) Print, Type or Stamp 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 11UL14;e 1<v owner — vvorKers- toompensation insurance txemption 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: _ Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this By GL'E;N N V -DAt V 0 t-C Notary: I I day of T V` , 20 ( 9 who is personally known to me or has produced 4ASY— as identification. SEAL: y �o0 P Notary Public State of Florida Sindia Alvamz My Commission FF 156750 A .A .h_..-