EL-18-996y
FLORiDp`
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit No. EL -4-18-996
Permit Type: Electrical - Residential
Worts Classification: Addition/Alteration
Petmit Status: APPROVED
Issue Date. 4/23/2018 1 Expiration: 10/20/2018
Project Address Parcel Number Applicant
187 NE 100 Street 1132060132071
Miami Shores, FL Block: Lot: JESSICA WADE PFEFFER
Owner Information Address Phone Cell
JESSICA WADE PFEFFER 187 NE 100 Street (305)804-8424
MIAMI SHORES FL 33138-
187 NE 100 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone
RAY OF LIGHT ELECTRIC, INC (954)240-1262
e of Work: REPLACE EXISTING OUTLETS AND SWITCH
itional Info: REPLACE EXISTING OUTLETS AND SWITCH
>sification: Residential
nning: 1
Fees Due
Amount
CCF
$1.20
DBPR Fee
$3.38
DCA Fee
$2.25
Education Surcharge
$0.40
Permit Fee - Additions/Alterations
$225.00
Scanning Fee
$3.00
Technology Fee
$1.60
Total:
$236.83
Valuation: $ 1,500.00
Total Sq Feet: 0
Pay Date Pay Type Amt Paid Amt Due
Invoice # EL -4-18-67175
04/13/2018 Check #: 115 $ 50.00 $ 186.83
04/23/2018 Check #: 117 $ 186.83 $ 0.00
Avanaoie i
Inspection Type:
Final
Meter Box
Alteration
nge
and
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 authgeize,ttp above-named contractor to do the work stated.
April 23, 2018
Authorized Signature: Owner / App- ant ntractor / Agent Date
Building Department Copy (�
April 23, 2018 1
Miami Shores Village RECEIVEi
Building Department APR 13 71111
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 (✓\
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (30S) 762-4949
FBC 1I201`
BUILDING Master Permit No��
PERMIT APPL ATION Sub Permit No. l 0 CPU❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ PLUMBING ❑ MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION [:]SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores ' n County: Miami Dade Zip:
Folio/Parcel#A 1—a76S1 C11 — O" 1 ' Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:: p(e 7
OWNER: Name (Fee Simple Titleholder): CS�" CSS Ck WC -U() Phone#: 31)530ZA 8( C.'1
Add
City: �)
Tenant/Lessee Name: _
Email:
CONTRACTOR: Company Name:
Address: %
S.
State: 7,4— Zip:
591
City:
City: 110-7�4 State:
Qualifier Name:
State Certification or Registration #: /-/
gISIA LLA a I Z(o 2 -
_Zip:
ne#:
rtificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City:
Value of Work for this Permit: $ t( Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration CEl New , n (^❑p �R�e�ai�r/ eplace
Description of Work: d�E� C`1.C� X �l5,'6\ " Vli"T"1J�
Specify -color of color thru tile: J'
Submittal Fee $ Permit Fee $ ^ 4qd/F $ CO/CC $
Scanning Fee $ Radon Fee $02 • o�� DBPR $ J • >9 Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $ J
(Revised02/24/2014)
Zip:
Demo
TOTAL FEE NOW DUE $ 18b. @ :3
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.
Q,.fjr-
Signature DSignature ^`�' ��•y�
OWNER or AGENT V CONTRACTOR
The foregoing instrument was acknowledged before a this The foregoing instrument was acknowledged befor me this
day of 4\91 11 20 A, by day of
1 20 by
9 luvh Is rsonally known to N i xp i�'� I �rti ho is p�er�so}n-ally known to
LS(i1 1
me or who has produced -%u� p�_ as me or who has produced '1� 1 `t as
identification and who did take an oath.
NOTARY PUBLIC:
Sign. "Yo
* *, MY COMMISSION # GG 044602
Print:
•r•° Bonded Thru Notary Public Underwriters
Seal:
identification and who did take an oath.
NOTARY PUBLIC:
Print:
Seal:
MAHARAI K. GONZALEZ
EXPIRES: November 2, 2020
Bonded Thru Notary Public Underwriters
************************************************************************************************************
APPROVED BY(�/e A�Wlz%& Plans Examiner
Structural Review
(Revised02/24/2014)
Zoning
Clerk
t
Ak
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: r
fw�14rg
State of Florida
County of Miami -Dade r
The foregoing was acknowledge before me this day of 1 20
By ' rl w who is personally known tome or has produced
l U/) YA,-, as identification.
Y PU • MAHARAI K. GONZALEZ
Notary:
MY COMMISSION # GG 044602
'* EXPIRES: November 2, 2020
SEAL: Bonded Thru Notary Public Underwriters
t.
n
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M W ��HT
El EC`t'R1C
INC.
1320 Brae Burn Tel 954-240-1262 rayoflightelectricinc@gmail.com
North Lauderdale FL, 33068 EC13007035
Date:
State of Fle;
County of
Before me this day personally appeared — who, being duty sworn,
Deposes and says:
That he or she will be the only erson working on the project located at:
AA -4 �x io)a �NAoGNv\\ ��r,ore5� 33k66 -
Contractor signature
Sworn to (or affirmed) and subscribed before me this 13- day of 4�r, ' ' 2018,
By 0 k -< 0 n e Q
Personally known_
Or produced identification
Type of identification produced—
Print,
roducedPrint, type or stamp name of notary
FiMY G. SgtC AR
* My COMMISSION i FF 244583
* EXPIRES: June 25, 2019
... "OF Bended Thru Budget Notary Serriw