EL-18-236 (2)�` SyIORE L,
F�ORtDp'
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit
Permit No. EL-1-18-236
Permit Type: Electrical - Residential
Work Classification: Addition/Alteration
Permit Status: APPROVED
issue Date:1/31/2018 1 Expiration: U"Mi2018
Project Address Parcel Number Applicant
7 NE 91 Street 1132060130080
Miami Shores, FL 33138- Block: Lot: ANCAR GLOBAL COMPANY
Owner Information Address Phone Cell
ANCAR GLOBAL COMPANY 7 NE 91 Street (786)484-9143
MIAMI SHORES FL 33138-
7 N E 91 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone
TOWER ELECTRIC OF PALM BEACH (561)718-1816
e of Work: CHANGE LIGHT SWITCHES AND RECEPTACL
itional Info: CHANGE LIGHT SWITCHES AND RECEPTACL
>sification: Residential
nning: 1
Fees Due
Amount
CCF
$1.80
DBPR Fee
$2.25
DCA Fee
$2.00
Education Surcharge
$0.60
Permit Fee - Additions/Alterations
$150.00
Scanning Fee
$3.00
Technology Fee
$2.40
Total:
$162.05
Valuation: $ 3,000.00
Total Sq Feet: 0
Pay Date Pay Type Amt Paid Amt Due
Invoice # EL-1-18-66277
01/30/2018 Check#: 1490 $ 50.00 $ 112.05
01/31/2018 Check #: 1493 $ 112.05 $ 0.00
,avauaoie inspections:
Inspection Type:
Final
Meter Box
nge
W. W.
Underground
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, PSrt
BING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFID#VIL I cethat all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and n. q. Fuore, I authorize the above -named contractor to do the work stated.
January 31, 2018
5t6 djIzed Sign-40Gre: Owner / Applicant / Contractor / Agent
Building Department Copy
January 31, 2018
Miami Shores Village RECEIVED
Building Department 0 2018
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 S
FBC �21q
1 r ,
BUILDING Master Permit No. �C 1, 1 W Z(o
�-
PERMIT APPLICATION Sub Permit No._ I 18 " 23
❑BUILDING 0 ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
,, I� ! g CONTRACTOR DRAWINGS
N
JOB ADDRESS: / S-�-
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: %Flood Zone: �BFE: FFE:
Q
OWNER: Name (Fee Simple Titleholder): T / 1nG�r � /% d � Gam-/ nm� orie#:
Address: /
City: �� ,r Ft(Y1 I State:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: (OWe--4- I IC P&I I1-CsPhone#:,
Address: Z Z O
City: al // -, S '/C5 r Sta/te: ��a i ,G+C.� Zip: .�3 `// `/
r
Qualifier Name: ��' ( � �1r,��! Phone#: ($142
State Certification or Registration #: 51jyG Certificate of Competency #:
DESIGNER: Architect/Engineer:
Address:
City:
Phone#:
Value of Work for this Permit: $1 • d Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New El Repair/Replace
of Work:
Zip:
❑ Demolition
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ //d�U CCF $ CO/CC $
Scanning Fee $ Radon Fee $ 2-W DBPR $ ` �3 Notary $
Technology Fee $
Structural Reviews $
Training/Education Fee $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(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
t
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 subjec- to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection wh ch 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 Signature i A J r k i
OWNER or AGENT / CONTRACT
Th fo��rl1egoing instrument was acknowledged before me this
V day of e, sd1\,, 42 20 J y
Vl . J 0- S who is rsonally kn to
me or who has produced
identification and who did take an oath.
NOTARY PU
Sign:
Print:
Seal:
***********
The foregoing instrument was acknowledged beforemethis
�0 day of ��Q(� 120 �!, by
CV4 Oft who is personally known to
as me or who has produced
identification and who did take an oath.
NOTARY PUB
Sign:
Print: (Lrno
MA)(SERNAL_
MY COMMISSION # GG 091737 Seal: iLY •a MAX BERNAL
EXPIRES: Pnl96192021 ' t ; MY COMMISSION O GG 091737
Bonded Thru Notar! r; = EXPIRES: Ap6 9.2021
•:e.:' c: ThN PubkUnderwdters
APPROVED BY o�cTl���� Plans Examiner
as
Structural Review
Zoning
Clerk
(Revised02/24/2014)
0
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 txernwion
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:
l . 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. . - -.•-•,_-
Signatur
Owner
State of Florida
County of Miami -Dade Q
The foregoing was acknowledge before me this 11 0 day of :No ^`"'! y 20 9 .
By ! J n J C Q 5 U � " *%� who is personally known to me or has produced
Y P •• MAX BERM
Notary: _ MY COMMISSION # GG 091737
EXPIRES: April 9, 2�0�2�1,.,�
SEAL: a•rf Oi F„e ThrU Way Pubk UIRwmlen
Tower Electric of Palm Beach, Inc
2222 Balsan Way Wellington, FL 33414
Date: l_2
State of ? �
County of /(4144 I� de
Before me this day personally appeared 0 C (who being duly sworn, deposes
and says:
That he or she will be the only person workmi on the project located at:
Sworn to (or affirmed) and subscribed before me this
By LO
I -
day of aeeAmb e /—.20h.
Personally Know
OR Produced Identification
Type of Identification Produced _
MAX BERNAL
MY COMMISSION # GG 091737
amded ih, Notary koic Under~