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EL-19-1499Location Address Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 • Issue Date: 09/07/2019 Parcel Number 10400 NE 4TH AVE, Miami Shores, FL 33138 1121360130150 Contacts Permit No.: EL -06-19-1499 Permit Type: Electrical - Residential Work Clossifacation. -Servke Change Permit Status: Approved Expiration: 02/03/2020 Description: UPGRADE AMPAGE FROM 125 TO 2Valuation: $ 3,500.00 Requests: 305-762-4949 Inspection nRe Re Total 5q Feet: 0.00 00 �j Fees EDELMAN LOPEZ JR Owner 10400 NE 4 AVE, MIAMI SHORES, FL 331382013 AMBER ELECTRIC CORP Contractor JORGE BERMUDEZ 527118 AVE SW, NAPLES, FL 34116 Business: 3055258322 $50.00 CCF $2.40 Description: UPGRADE AMPAGE FROM 125 TO 2Valuation: $ 3,500.00 Requests: 305-762-4949 Inspection nRe Re Total 5q Feet: 0.00 00 �j Fees Amount Application Fee - Other $50.00 CCF $2.40 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.80 Permit Fee $72.50 Scanning Fee $3.00 Technology Fee $3.06 Total: $135.76 Building Department Copy Payments Date Paid Amt Paid Total Fees $135.76 Credit Card 08/07/2019 $135.76 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 perrtNs are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws and moping. Futhermore, I authorize the above named contractor to do the work stated. Authjrijej(Sig%tt e: garner / Applicant/ Contractor 1 Agent August 07, 2019 Date Page 2 of 2 1 m Miami Shores Village RECEIVED Building Department JUL 2 2 10 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (30S) 795-2204 Fsx: (305) 756-8972 NEKTON UNE PHONE NUMM (305) 76 A90 FIX 2011 BUILDING Maaw Penwt No.F,-L- 6P -l1 -'14T° PERMIT APPLICATION Sub Peru* No• OBUiLOMIG ® ELECTRIC ROOFING 0 REVISION 0 EXTENSION ❑RENEWAL OPLUMBING 0 MECHANICAL (]PUBLIC WORKS� CHANGE OF 0 CANCELIAT" 0 SHOP CONTRACTOR DRAV41NO jos MOMS& 10400 NE 4th avenue city: Miami Shores County Miami faade Zip; 111-2136-013-0150 -bdwsuudft Dedwsatedt yes No X OCCupancy Type: 0� Load: Construction Type: Flood lone: M: FFE: OWNS Name (Fee Simple Titlehoiderr Edeman Lopez Phoned: 7864618854 x:10400 NE 4th ave ow. Miami Shores State: FL 33138 Tenant/Lessee Name: Emaw edelmaniopez@mac.com C-OY'NS' 0ONntACFOR: Conor Name: •J �6 1� Q e N( rJ'r� r' Z Phonef: 6Y — — 3xZ Address: — r7/ S.Z /7/ 1 6 AUK s • W _ :]i — �y?-�3"� � �' � Cay: Aj 14';:> i PS State: - iip: .3 / re Qualifier Name: _1'o Q F Zke 04!l')c E Z. Phonot: 23 9 - 943 —'9q if Sate Certification or aeIgistratic N: OF"C 436 0 (g j LA7 Certificate of Competency tt: DESIGNER: Architect/Ensineer. Phoned: Address: citir. State: Zip: VSW of ti w* for this f rm t: s 2� - Square/lines Footage of Work Type of work ❑ A&MM . ❑ Alteration ❑ New N Repalt/Replam 010. -a mm O"0101's of Vedly Cdw of CdOr tbru tie: Sn61011w f!e S ._.. rete roes CCF $_- COAX $ 5aanit4Fee: threatlees OMs NowV$ Tetfanotap foe s trtttttteyll[alucatlee we s Doable ftee s Sattcttwat Rorl.ws s Bad $ TWAL M 00w ows 13 S G ww.�oo<r�r Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage lender's Name (if applicable) Chase Mortgage Mortgage lenders Address PO BOX 78420 City Phoenix state AZ Zip 85082-8420 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 pnor 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 on estimoted value exceeding 525W, the applicant must promise in good forth that o copy of the notice of commencement and construction lien low 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 of the job site for the first -spertwn which occurs seven,q) days after the building permit is issued. in the absence of such posted notice, the irtspeason wav not be approved and g4rinspction fee will be charged. OwNEYrENTing instrument was wledged before me this day of J C I' l 20 ` by E,. j6rn' Va I®A-12eL-, who is personally known to me or who has produced as identification and who did take an oath. NOTARY Print: y1:.� j My ommrssion FF !96150 Seal: �i EXPOS 05125/2020 i 9 — Signature It NTRACTOR The foregoing in muni was acknowledged before me this day of��'�. 20 12 . by who is personally known to me or who has produced identification and who did take an oath. NOTARY PUJUC Sign: ;r`I:' Sergio Gongora Seal: My Comm;ss on FF 996150 V#. �.J Expires Ot/2512020 as •�a�s�sa�ss:�asst���ra�••�����frO••ir�iM��Yfa�rfaf��i���ft����••��t�••i•����r�rf/��•��r�ttrlt•�i�fa�l�aiM�����ti��• APPROVED BY 2C , t Plans Examiner Zoning 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 Notice to uwner — 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 AC�,NOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. ,I Signature: State of Florida County of Miami -Dade The foregoing was acknowledge before me this 219— day of Lt L' 20 By RC1 M V\ � oe z, who is personally known to me or has produced a �t as identification. Notary: `y n`� A*b+lx' Notary Public State of Flonda Sergi19 Gongora ,per My C Mrnission FF 998150 SEAL: J �o, , Expires 05/25/2020 AMBER ELECTRIC CORP. P.O BOX.2866 NAPLES FL 34106 Date: Z ema I: ibelectricall82@„gmaii com, phone: (305)525-8322 State of // County of Before me this day personally appearedJ Q �M q lo ( W� , being duly sworn, deposes and says: That he or she will be the only person working on the project located at: �C� 11.x."' dl✓I r S t�UC 3 313e Contractor ignature Sworn to (or affirmed) and subscribed before me this may of L 20 Personally Know LtFType ate Ot Fbnola a Or Produced identification FF 9961 S020 Type of Identification Produced e� �S-tom? ME an - Lq RFS � -�'' � ✓U Fi�F� �N1 Gt, l � aUtts 1w, y �1 1� ct vo*A . 6 0000 see ... ... . 0000.. .. 0 000000 0000. t 0000 .. ♦0900. •♦♦♦♦• •♦.. 0000• `00 Y • • • • . 09 0 •♦9•.• Q0 fyw ELECTRICAL REV 7 ra- y l APPROVE DATE ' ,?f Notary Pub6C State of I-Wa Sergio Gongora My Commission FF 996150 M Expires 05/25/2020 f" Notary Public State of Florxla Serio Gongors �'• •; n Ex. 05nS�2020 9981 i0 W:4,i ! .S� 1C4 A 1 3c)4 © v 6 All k UD 12 dbQ � U Al ZZ/ i yes/' r �y � fir} J•y,' �,% �«a • f" Notary Public State of Florxla Serio Gongors �'• •; n Ex. 05nS�2020 9981 i0 W:4,i ! .S� 3c)4 �0-0 k UD 12 dbQ � U • • TYPE: SERVICE: MOUNTING POLES: PANEL a � iMP MAIN BUS: NEUTRAL: MAINS: A.I.C.: K.V.A. TRIP POLE CON- DUIT WIRE REMARKS. CKT REMARKS NO. WIRE CON- DUff. 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