The URL can be used to link to this page

EL-18-615�` ytyonfs L�t� Fro ioA Project Address Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit No, EL-3-18-615 Permit Type: Electrical - Residential Per i t Work Classification: Addition/Alteration Permit Status: APPROVED Parcel Number Issue Date: 3/15/2018 1 Expiration: 09/11/2018 AoDlicant 85 NW 103 Street 1121360131080 Miami Shores, FL 33150-1233 Block: Lot: DM INVESTMENT SERVICES LLI RMONOMMMMMM Owner Information Address Phone Cell DM INVESTMENT SERVICES LLC 85 NW 103 Street (786)473-5959 MIAMI SHORES FL 33150- 85 NW 103 Street MIAMI SHORES FL 33150- Contractor(s) Phone Cell Phone FREEMAN'S CONSTRUCTION & ENGI (786)337-0665 of Work: NEW OUTLETS SWITCHES AND ALL DISTRI itional Info: NEW OUTLETS SWITCHES AND ALL DISTRI ,sification: Residential nning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Penalty Fee Permit Fee - Additions/Alterations Scanning Fee Technology Fee Work without Permit Fee Total: Amount $2.40 $3.38 $2.25 $0.80 $100.00 $225.00 $3.00 $3.20 $225.00 $565.03 Valuation: L 0.00 Total Sq Feet: Pay Date Pay Type Amt Paid Amt Due Invoice # EL-3-18-66733 03/15/2018 Check #: 251 $ 515.03 $ 50.00 03/09/2018 Check #: 5469 $ 50.00 $ 0.00 Avartame Inspection Type: Final Meter Box Alteration 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 ELECTRIC! PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AVI : I c at all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construct g. Fythe ore, I authorize the above -named contractor to do the work stated. March 15, 2018 Owner / Applicant / Contractor / Agent Building Department Copy March 15, 2018 1 BUILDING PERMIT APPLICATION ❑BUILDING XELECTRIC ❑ PLUMBING ❑ MECHANICAL Miami Shores Village RECEIVED Building Department MAR 09201 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 201"A Master Permit No. '. \0 — —� 3 Sub Permit No. El � � " (r 1,5 ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 65 n City: Miami Shores County: Miami Dade zip:✓ % Folio/Parcel#: Is the Building Historically Designated: Yes NO 7 Occupancy Type: Load: Construction Type: L� Flood Zone: BFE: FFE: A , / / i --I / OWNER: Name (Fee Simple Titleholder): ��%�tit`ff/-IoerJ�s Address: . (_%1 —<3A3 % ?0 e-t v,,e City: Tenant/I Email: CONTRA Address: City: Ir Name: //MDanv Name: State: L ne#: A" _Zip: .3 c%.J ne#: -Lo he#:: � 33?-0 G5 Qualifier Name: lJ1d(MSP Phone#: State Certification or Registration #:C "JO�� Certificate of Competency #: _ F DESIGNER: Architect/Engineer: Phone#: Address: City: Value of Work for this Permit: $ Lk am Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Re lace Description of Work: NQ.W ��0 � Specify color of©br fhru•t�le. -'-�! .m �0 7 �'3-o,av I'oj-g-� Submittal Fee $ Permit Fee $ Zhu` iob Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ IXFACCF $- DBPR $ Zip: 1p 0 Zip: ❑ Demolition ^� CO/CC $ Notary $ Double Fee $ , Bond $ 4 TOTAL FEE NOW DUE $ (Revised02/24/2014) W 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 Zi 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" a reinspection fee will be charged. 11 / Signature Signature ,'1107 j� L OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this l� n day of` � 1T 20 (- by l�y (llo Ji(rL.n v�o who is personally known to me or who has produced •�-iVL �sSa- 3�-?n�S�� identification and who did take an oath. NOTARY PUBLIC: ttIIIIIII/l Sign: Print;�JTA Y/v�• �� The foregoing instrument was acknowledged before me this 13_ day of AA 20 by who is person known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: C j Print: 1 7 I - as NaUry Pubk • start of Raft Seal: -*My Comm. Expires-. � Seal: Juty 27, 2018 ` My Comm. Expires Juno 21 2019 No FF 145596 �RoAi Comm�sron/1�9011�7 ,.` OFF 4e� APPROVED BY �11 /��i,�lZ fZ6 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 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 ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: caner State of Florida County of Miami -Dade The fjojregoin/gf was acknowledge before me this (� day of Leo+- , 20 By 1 rt^( Z who is personally` i�'iLd�iprk s produced as identification. J '� Notary: MY Comm. Expires r - • JuIY 27, 2018 i N No. FF 145596 SEAL: J, ; .00///lilllll! FREEMAN'S CONSTRUCTION & ENGINEERING GROUP INC. Professional Engineering PE # 66341 CA #31040 General Contractor License # CGC 1513699 Electrical Contractor License # EC 13007927 Plumbing Contractor License # CFC 1429863 Mechanical Contractor License # CAC 1819129 10610 SW 146 PL Miami FI 33186 Phone:786-337-0665 Fax: 786-472-8810 constructionfreeman@Yahoo.com Date: State of / County of Before me this day personally appeared �1, ' who, being duly sworn, Deposes and says. That he or she will be the onlyperson (working on the project located at: Contractor Signature Sworn r affirmed) and subscribed before me this by or't day of� .20 Personally know OR Produced Identification Type of Identification Produced !*4 YANETMARTINEZ s Commission # GG 12M * t ,y '�'at�� Expires July 11, 2021 rnre�aa�c►�ns�aoes Print, Type or Stamp Name of Notary