REV-19-481RECEIVED
Miami Shores Village M i Zo»`
Building Department BY.
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�-
BUILDING Master Permit No. imi-o �� - �Uop
PERMIT APPLICATION Sub Permit No. MU-63- 19 '41 U I
❑BUILDING X
ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR
DRAWINGS
�\�
I aq(o
�j
99
JOB ADDRESS: I Vl:
City: Shores
County:
Miami Dade Zip:
``Miami
Folio/Parcel#: I 2. Li 3bb!3o
14�
Is the Building Historically Designated: Yes
`/
NO 1l
Occupancy Type: Load:
Construction Type:
Flood Zone: BFE:
FIFE:
OWNER: Name (Fee Simple Titleholder): I _ I I,00 i- —oner � es, ; L\�C Phone#: 9 I (I - —71 `f — 08 7
Address: I o� —I (o \N� --Lr P -Y '
City: � t C� � � `� 1 Zi�� S State: c),r-, A G, Zip: -35 1 3 S-
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Co .-R pit Company Name: �.
Address: ( t 6 D bi
C LiJ Cis Phone#: 3�
City: rya / State: zip:d (:J
Qualifier Name: SGt -'l v C'-t 'ej ^I Q Phone#:
State Certification or Registration #: 4&130 / V S $' Certificate of Competency #: 0 D d
DESIGNER: Architect/Engineer: Phone#:
Address:
Value of Work for this Permit: $
Type of Work: ❑ Addition
of Work:
1nrl1
❑ Alteration
EKt4
Specify color of color thru tile:
City:
Square/Linear Footage of Work:
❑ New ❑ Repair/Replace
- 1 I 1. ., r
W]
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $_
DBPR $
State: Zip:
❑ Demol
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 431 Qb
(Revised02/24/2014)
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 ins ction which occurs seven (7) days after the building permit is issued. j�tf abg�sence'of�such posted notice, the
inspection will n be approved and a reinspection fee will be charged. � t �-_�
N NO I
110 1 W., I
Y�MSignature— �4
OWNER or AGENT ` CONTRACTOR
The foregoing instrument was acknowledged before me this
day of MMO& 20 16 by
who is personally known to hN p v
me or who has produced,��-; as
The foregoing instrument was acknowledged before me this
—day of 20 by
SQ oor ve- `- , 0 who is personally known to
me or who has produced
as
identification and who did take an oath.
identification and who did take an oath.
NOTARY UBLIC:
NOTARY PUBLIC:
e_c�
Sign:
Sign:
Print:
Print:
Seal:`
'':. SINDIAALVAREZ
EMMQUIROS
al:,: MYCOMMISSIONG(i174376
MY COMMISSION # GG 238273t;
"'• EXPIRES: January 10, 2022
'•OF Fl�: EXPIRES::September312022
IRlni 'yta(y PiNK
BadWThruNotary PuatkWwwrIlles
EBo.Jed
Underwriters
'
APPROVED BY
Plans Examiner Zoning
Structural Review
Clerk
(Revised02/24/2014)
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Federal Employer ID Number Information
1 records found for federal employer id number 274283178.
Click the links below the Employer Name column for more detailed information.
Record Employer Name Employer Address
1 ! CAMAGUEY ELECTRICAL SERVICES CORP 16160 W 26TH CT, HIALEAH, FL 33016 Exem
1 records found for federal employer id number 274283178.
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Elec
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Carrier Location Information
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Employer Information
Employer Name Employer Type NAICS Code
ICAMAGUEY ELECTRICAL SERVICES CORP (CORPORATION IN/A
Coverage History
INo Coverage History
Exemption Listings
Exemption Holder Name - Click on the name(s) below to view more detailed information
JOSE A SARASIA
IPEDRO A GONZALEZ
SAMUEL J GONZALEZ
Owner Election Listings
No Owner Election of Coverage Listings
Employer Name History
Employer Name Name Type Change Date
�CAMAGUEY ELECTRICAL SERVICES CORP I Legal Icurrent
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Exemption Details
Name
Title j
Effective Date ''Termination Date
Exemption Type Business Activities 'Employer Name
��_.._....___..................__.......__.......................__...______.,
SAMUEL J
..............................__...... _......_.........................._
........,
Click Here to View CAMAGUEY
GONZALEZ
Mar 9 2019 Mar 8 2021
Construction Activities Listed on ELECTRICAL
Exemption SERVICES CORP
SAMUEL J
Click Here to View CAMAGUEY
GONZALEZ
PR
Mar 9 2017
Mar 9 2019
Construction Activities Listed on ELECTRICAL
Exemption I SERVICES CORP
SAMU
Click Here to View CAMAGUEY
GONZALEZ
PR
Mar 10 2015
Mar 9 2017
Construction Activities Listed on ELECTRICAL
Exemption SERVICES CORP
SAMUEL J
Click Here to View i CAMAGUEY
GONZALEZ
PR
Mar 10 2013
Mar 10 2015
Construction Activities Listed on ELECTRICAL
Exemption SERVICES CORP
SAMUEL J
Click Here to View CAMAGUEY
GONZALEZ
PR
Mar 11 2011
Mar 10 2013
Construction Activities Listed on j ELECTRICAL
Exemption SERVICES CORP
'Termination may be through the revocation of the exemption; or expiration of the exemption.
"The exemption only applies to the business activities listed on the exemption.
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