ELC-19-1425Location Address
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date: 06/27/2019
Parcel Number
9705 NE 2ND AVE, Miami Shores, FL 33138 1132060134230
Contacts
Permit NO.: ELC-06-19-1426
Permit Type: Electrical - Commercial
Work Classification: Alteration
Permit Status: Approved
Expiration: 12/24/2019
Description: INSTALLING 2 EXIT SIGNS Valuation: $ 200.
00Ins pection Requests:
305 -*-4949
Total Sq Feet: 200.00
Fees
Application Fee - Other
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Work Without Permit 1st Offense
Work Without Permit 1st Offense
Total
Amount
50.00
0.60
2.00
2.00
0.20
50.00
3.00
2.50
100.00
100.00
310.30
Payments
COCHRAN MIAMI SHORES LLC c/o Owner
Fitzgerald Property Mgmt
1800 ELLER DR 212, FT. LAUDERDALE, FL 33316
Other: 9547604360
METPLANET ELECTRICAL Contractor
JEAN LESLIE TELEFORT
6231 GRANT CT, HOLLYWOOD, FL 33024
Business: 7542141695 JEANLTELFORT@AOL.COM
310.30
Check # 117 06/27/2019 $310.30
Amount Due:
Description: INSTALLING 2 EXIT SIGNS Valuation: $ 200.
00Ins pection Requests:
305 -*-4949
Total Sq Feet: 200.00
Fees
Application Fee - Other
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Work Without Permit 1st Offense
Work Without Permit 1st Offense
Total
Amount
50.00
0.60
2.00
2.00
0.20
50.00
3.00
2.50
100.00
100.00
310.30
Payments Date Paid Amt Paid
Total Fees 310.30
Check # 117 06/27/2019 $310.30
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: 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 authorize the above named co_gtyaq(o'r to do the wook ted. 7
6/Z
Authorized Signature: Owner / Applicant / Contractor / A ehi Date
June 27, 2019 Page 2 of 2
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
RECEIVED
FBC 20 14 -
BUILDING Master Permit No. GC '" /093
PERMIT APPLICATION Sub Permit NO.a-C- &" I q2—S
BUILDING RrELECTRIC ROOFING REVISION EXTENSION [-]RENEWAL
PLUMBING MECHANICAL PUBLIC WORKS [:]CHANGE OF CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 9 3 '41
City: Miami Shores County: Miami Dade Zip: 33
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 6464- 1" /y%/alyl r / oojeS ZLC Phone*
Address: l0pdy 67-G t- C -'-< r/1 • -5 7-eC_ Z/ Z
City: 0/7 (a %04e1A,A /e State: %- Zip: 33 3l
Tenant/Lessee Name: WIt O'C-/Al- &4 -*1 f rceL<,: Phone#:Cj-!d;-y7— S/,z
Email: "-blo'L,d/L4SnfevS j92!;74,q,4e-dam
CONTRACTOR: Company Name: .1I -
Address:
City:
f
Qualifier Name:• (
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Address:
Phone#: :Z 1
Zip: -2 z.
Phone#:ly% a1 a_ _4j_q
Certificate of Competency #: ` Ce 130 o 7-L3 9-] _
Phone#:
City: State: Zip:
Value of Work for this Permit: $( c_ Square/Linear Footage of Work:
Type of Work: Addition // Alteration New Repair/Replace Demolition
Description of Work: Zh S C^
Specify color of color thru tile:__
Submittal Fee $ ' Permit Fee $ CCFS, f 4 '0''2'00/CC $
Scanning Fee $ Radon Fee $ DBPR $ r> A;,Nli.r«;•<;,,,,,;Notary.$_
Technology Fee $
Structural Reviews $
Revised02/24/2014)
Training/Education Fee $ Double Fee $
Bond $
TOTAL FEE NOW DUE $ 3 10 ' U
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.ence of such posted notice, the
inspection will not be approve ;`11andareinspectionfeewillbecharged.
n
Si
ER or
The foregoingns ume((nt was acknowledged before me this
Q!
day of}c
r
t,
0
20 (4 by
V—fume G47-4 4!,r( who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: K r_
T
aSirw
Seal:
REGINA L. MASC1AltElrLI
Notary PUMIC • $we of FWM
my Comm. Expires Fab t0,.ZQZQ
RM ANdtiroughNftWNotaryAw.
Revised02/24/2014)
Sign
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of 20 /9/ by
who is personally known to
me or who has produced . as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
Seal: VALTY A RAYMORE
Notary Public - State of Florida
Commission # GG 123454
My Comm. Expires Jul 12, 2021
Plans Examiner Zoning
Structural Review Clerk
Notice to Owner — Workers' Com
Fa f? -i .
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:
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;
The officer is listed as an officer of the corporation in the records of the Florida
Department of State, Division of Corporations; and
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. /I /I
Signature:
State of FI
County of Miami -Dade
The foregoing was acknowledge before me this 1 day of tie- ' . , cj' , 20 1 5'_.
By 13Y'AW d,g ZCt t f;L' ( vAo.:is personally known to meor as produced
as identification.
Notary: /•_ ((meq c r/C
SEAL:
s. -s ir'. REGINA L. MASCIARELLI
Commission #F FF 928544
My Comm. Expires Feb 10, 2020
Banded throw National Notary Assn.