EL-18-2347Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Permit NO.: EL-8-18-23+47 Permit IVR Number: 614884
rL Permit Type: Electrical - Residential
Work Classification: Addition/Alteration
Permit Status: Approved
Issue Date:10/15/2018 Expiration: 04/15/2019
Parcel Number
Project
122 NE 105 ST, Miami Shores, FL 33138-2033 1121360130680 <NONE>
Contacts
ROY AND MARGARET MEVERS Owner ROY AND MARGARET MEVERS Applicant
122 NE 105 ST, MIAMI SHORES, FL 331382033 122 NE 105 ST, MIAMI SHORES, FL 331382033
Other:3057560156 Other:3057560156
POWER POINT ELECTRIC, INC Contractor
LUIS DIEGO BARBOZA
6235 GRANT CT, HOLLYWOODS, FL 33024
Business: 9548822822
Description: RELOCATION OF EXTERIOR PANEL, AND Valuation: $ 12,Inspection Requests: 000.00 305 7b2 4949
ELECTRICAL FOR NEW MASTER BEDROOM, BEDROOM 4,
CLOSET AND MASTER BATHROOM. Total 5q Feet: 548.00
Fees
Amount
CCF
$7.20
DBPR Fee
$6.30
DCA Fee
$4.20
Education Surcharge
$2.40
Permit Fee
$420.00
Scanning Fee
$3.00
Technology Fee
$10.50
Total:
$453.60
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$453.60
Check # 206
10/15/2018 $453.60
Amount Due:
$0.00
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
re ati construction and zoning. Futhermore, I authorize the abovq�kamed contractor to do the work stated.
Signature: Owner / Applicant / Contractor A Agent Date
October 15, 2018 Page 2 of 4
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
BUILDING
PERMIT APPLICATION
BUILDING 0 ELECTRIC ❑ ROOFING
RF,CEIVED
1UG,
312018
B'Y
FBC 20 1--)-
Master Permit No. 2p-f ` (27 IL'
Sub Permit No. 1�L (� 2-5`7
❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 122 NE 105TH STREET
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11 -2136-013-0680 Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee simple Titleholder): Roy Mevers and Margaret Hood Mevers Phone#: 305 812-6522
Address:122 NE 105th Street
City: Miami Shores state: Florida Zip: 33138
Tenant/Lessee Name: N/A Phone#: N/A
Email: royatsea@gmail.com
CONTRACTOR: Company Name: Power Point Electric, Inc
Address: 6235 Grant Court
City: Hollywood State: Florid
Qualifier Name: Luis Diego Barboza
EC13005249
hone#: 954 882-2822
a Zip: 33024
Phone#: 954 882-2822
State Certification or Registration #: Certificate of Competency #: N/A
DESIGNER: Architect/Engineer: Mark A. Campbell Architect Phone#: 305 754-2318
Address:373 NE 92nd Street City. Miami Shores State: FL Zip: 33138
Value of Work for this Permit: $ �Z 0 0 U Square/Linear Footage of Work: 1017and 548s Qft
Type of Work: RE-1 Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: Relocation of Exterior panel, and electrical for new master bedroom, bedroom 4, closet and master bathroom
Specify color of color thru tile: 403 . 0�
Submittal Fee $ Permit Fee , J CCF $ CO/CC $
6 Scanning Fee $ Radon Fee $`7 DBPR $ ' Notary $
Technology Fee $
Structural Reviews $
Training/Education Fee $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 53 ' `F✓�
(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 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 01-'e
OWNER or AGENT
The foregoing instrument was acknowledged before me this
1 (0 day of f!1 V�-idV'i 120 f �, by
I -M who is personally known to
me or who has produced F-L 0 _ �, as
identification and who did ta'kke an o
NOTARY PUBLIC:
A2 CHASECAMPBELL
_,. ,s MY COMMISSION # FF 20M
rF EXPIRES: February 17, 2019
a �Z Bonded Thiu Notary PubNc Underwhters
Sign:
Print: C JA� l C . Oyot; El U11 -
Seal
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of .��,, r 20 by
Luis Barboza who is Berson a y Imana to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
Seal: -----_____
W""� WENDY NIIRANDA
MY COMMISSION # GG77029
��ed� EXPIItES: March 11, 2021
****************************************************************
APPROVED BY
Plans Examiner
r:11
****************
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
CONTRACTORS' REGISTRATION
IF CO,NTTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: " A. COPY OF QUALIFIER'S STATE LICENCES
B. / COPY OF LOCAL BUSINESS TAX RECEIPT
C. +� COPY OF LIABILITY INSURANCE*
D. '� COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL
CONTRACTOR'S TAX RECEIPT.
D. COPY OF LIABILITY INSURACE*
E. COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit)
*YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW:
Certificate Holder:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
Certificate must specify the description of operations or contractor license number.
BUSINESS NAME: MW(-
BUSINESS ADDRESS:
h� CITY4/9��STATECZIP
BUSINESS PHONE: FAX NUMBER ( )
CELL PHONE ( ) QUALIFIER'S NAME: t �'b®
QUALIFIER'S LIC NUMBER: fc 1 P
>. STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
a� 7-6
ELECTRICAL CONTRACTORS LICENSING BOARD
`F 2601 BLAIR STONE ROAD
TALLAHASSEE FL 32399-0783
BARBOZA, LUIS DIEGO
POWER POINT ELECTRIC, INC
6235 GRANT COURT
HOLLYWOOD FL 33024
Congratulations! With this license you hecome one of the nearly
one million Floridians licensed by the Department of Business and
Professional Regulation. Our professionals and businesses range
from architects to yacht brokers, from boxers to barbeque
restaurants, and they keep Florida's economy strong.
Every day we work to improve the way we do business in order
to serve you better. For information about our services, please
log onto www.myfloridalicense.com There you can find more
information about our divisions and the regulations that impact
you, subscribe to department newsletters and learn more about
the Department's initiatives.
(850) 487-1395
STATE OF FLORIDA
y DEPARTMENT OF BUSINESS AND
PROFESSIONAL REGULATION
EC 13005249 ISSUED: 08/ 11 /2016
CERTIFIED ELECTRICAL CONTRACTOR
BARBOZA, LUIS DIEGO
POWER POINT ELECTRIC, INC
Our mission at the Department is: License Efficiently, Regulate
Fairly. We constantly strive to serve you better so that you can
serve your customers. Thank you for doing business in Florida, IS CERTIFIED under the provisions of Ch.489 FS.
and congratulations on your new license! Expirationdate AUG 31, 2018 L1608110002920
DETACH HERE
RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD
LICENSE NUMBER
11 •• .
The ELECTRICAL CONTRACTOR
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2018
BARBOZA, LUIS DIEGO
POWER POINT ELECTRIC, INC
p +.. 13
�j Z
115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000
VALID OCTOBER 1, 2017 THROUGH SEPTEMBER 30, 2018
DBA:
Business Name: POWER POINT ELECTRIC INC
Owner Name: LUIS DIEGO BA.RBOZA
Business Location: 6235 GRANT COURT
HOLLYWOOD
Business Phone:
Receipt #:181-25 CAL5
Business Type:
Business Opened:01/25/2013
State/County/Ceft/Reg:EC13 0 0524 9
Exemption Code:
Rooms Seats Employees Machines Professionals
1
For Vending Business only
Number of Machined
Tax Amount
Transfer Fee
NSF Fee
Penalty
Prior Years
Collection Cost
Total Paid
27.00
0.00
0.00
0.00
0.00
0.00
27.00
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is
non -regulatory in nature. You must meet all County and/or Municipality planning
WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when
the business is sold, business name has changed or you have moved the
business location. This receipt does not indicate that the business is legal or that
it is in compliance with State or local laws and regulations. '
Mailing Address:
LUIS DIEGO BARBOZA Receipt #OIA-16-00007767
6235 GRANT COURT Paid 09/21/2017 27.00
HOLLYWOOD, FL 33024
VWMS
JIMMY PATRONIS
CHIEF FINANICAL OFFICER STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * *
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE DATE: 1/16/2018
PERSON: BARBOZA
FEIN: 371709829
BUSINESS NAME AND ADDRESS:
POWER POINT ELECTRIC, INC
6235 GRANT COURT
HOLLYWOOD FL
SCOPE OF BUSINESS OR TRADE:
Licensed Electrical Contractor
33024
EXPIRATION DATE: 1/16/2020
LUIS
A
IMPORTANT: Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under
this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply
only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be
exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the
person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a
certificate at any time for failure of the person named on the certificate to meet the requirements of this section.
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609
Power Point Electric, Inc
6235 Grant Court
Hollywood, FI 33024
Phone: (954)882-2822
Fax: (954)674-9742
Luis@mypowerpointelectric.com
Www. mypowerpointelectric.com
Date: June 6, 2018
State of Florida
County of Miami -Dade
(b
Power PoN Electric
Before me this day personally appeared Luis Barboza who, being duly sworn, deposes and says:
That he will be the only person working on the project located at:
122 NE 105th Street, Miami shores, FL 33138
Contractor Signature
Sworn to (or affirmed) and subscribed before me this day of r i .2011
by %t . 5 t-60 2.01
Personally know
OR Produced Identification
1% wENDY mpANDA
'�7�►TV MY COMMISSION # OG77029
%ENFIRES: March 11, 2021
Print, Type or Stamp NamVof Notary
Notice to Owner - Workers' Com
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
nsation 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:
17— Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this 1 �5 day of
A-U�,V.S
,20 GCi'
By �G {'� ¢�/ cs who is personally known to me or has produced
L as identification.
Notary: tiwr:PY4p, CHpSECAMPBELL
MY COMMISSION It FF 200055
EXPIRES: February 17, 2019
SEAL: ` � ��r "'ko�Fq$ Bonded Thru t4otary Public Underwritem