EL-19-868Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date: 06/12/2019
Location Address Parcel Number
145 NE 91ST ST, Miami Shores, FL 33138 1132060133330
Contacts
Permit NO.: 44-19-868
Permit Type: fileCtrlC81 - Residential
Work Classification: Pool
Permit Status: Approved
Expiration: 12/09/2019
ANTAR VAUGHAN Owner ON CALL ELECTRICAL CONTRACTORS INC Contractor
145 NE 91 ST, MIAMI SHORES, FL 33138 KEVIN GILLIS
Business: 7863885880
Description: NEW POOL Valuation: $ 2,000.00 Inspection Requests:
305-762-400
Total Sq Feet: 0.00 11 1
Fees
Amount
Application Fee - Other
$50.00
CCF
$1.20
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.40
Permit Fee
$50.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$111.10
Payments
Date Paid Amt Paid
Total Fees
$111.10
Check # 5451
06/12/2019 $61.10
Check # 5377
04/19/2019 $50.00
Amount Due:
$0.00
Building Department Copy
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: jidertify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating constructi an zoning. Futhermore, I authorize the above named contractor to do the work stated.
Owner �� Applicant / Contractor ! Agent
2019
Date
Page 2 of 2
VED
-Z
✓
Miami Shores Village '0 9 019
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 20
BUILDING; Master Permit NoRp—p —SG-�
I
PERMIT APPLICATION Sub Permit No. M-790
F-JBUILDING ELECTRIC ROOFING REVISION ❑EXTENSION ❑RENEWAL
nPLUMBING MECHANICAL (PUBLIC WORKS n CHANGE OF n CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: WIT VAff Cl I lli&f
City: Miami Shores County' Miami Dade Zip:
i
Folio/Parcel#: U=1001 Is the Building Historically Designated: Yes NO
Occupancy Type:.'— Load: Construction Type: Flood Zone: BFE: — FEE:
OWNER: Name
Address:,
City: Miami-
Tenant/Lessee
Email:
Simple Titleholder): Ayfty-Aamy) Phone#:
U
State: f L Zip: 73I31
Phone#:
CONTRACTOR: Co I mpany Name, Phone#:
Address: -k Im
City: Miami State: Zip:
Qualifier Name: lftwn—�3&s Phone#;—
State Certification I or Registration #. Certificate of Competency M
I
DESIGNER: Architect/Engineer: Phone#:—
Address: City: State:
I ]. 0(0 ()
Value of Work fob' this Permit: $- Square/Linear Footage of Work:
Type of Work: W, Addition D Alte
Description of
Specify color of color thru tile:
Submittal Fee
Scanning Fee
Technology Fee
Structural Revic
(Revised02/24/2014
Permit Fee $
Radon Fee $
Zip:
F1 New E] Repair/Replace ❑ Demolition
Training/Education Fee $
CCF $—
DBPR $
CO/CC $
Notary
Double Fee
Bond $
TOTAL FEE NOW DUE
Bonding Company'$ Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's'iName (if applicable)
Mortgage Lender's? Address
i
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 priorto the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. 1 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 f `bith 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 inspeiction which occurs seven (7) days after the building permit is issued. 1n the absence of such posted notice, the
inspection will noebe approved and a reinspection fee will be charged. n
1 /1
OWNER or AGENT
The foregoing instrument was acknowledged before me this
dav'of n I 20 j. by
who Is personally known to
me or who has
identification and who did take an oath.
NOTARY PU
Sign:_
Print:
Seal: *: MY COMMISSION 0 GG 271799
a: A EXPIRES: December 17, 2022
''•F R, B nded Thr Nawy PUbrc Underwbn&
Signatu
The foregoing instrument w/as acVnowledged before me this
day of — 20 �, by
Gt rLa5 r7_ , who is personally known to
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
Seal: "*_ My COMMISSION # GG 271799
EXPIRES: Deoember 17.2D22
bonded Thr Notary PUft Uiderwritem
##########!##►######!##!i##!###!##############tk+i.+t########�►####�R####�Y##iM iMl�i##k#�R########ii###ik rM �M##M##ik##4#M###
#i
APPROVED €iY Plans Examiner Zoning
{
E
i Structural Review Clerk
JRevised02124J20I4)
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:
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this t t day of 1 !�Ns 20�.
By _ `moo Qua? of who is personally known to or has produced
as identification.
Notary:
MY commissioN 9 GG 271799
EXPIRES; December 17, 2022
Bonded Thru Notary PW* tlnee1Wft