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EL-18-2169yIiORES L'! 6 tiyEN 0RtDp' Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Parcel Number Permit NO. EL -8-18-2169 Permit Type: Electrical - Residential Worts Classification: Alteration Permit status: APPROVED issue oate:8123/20'18 1 Expiration: 02/19/2019 Applicant 1481 NE 104 Street 1122320320090 Miami Shores, FL 33138-2663 Block: Lot: JAMES & MAR BREEN Dwner Information JAMES & MAR BREEN Address 1481 NE 104 Street MIAMI SHORES FL 33138- 1481 NE 104 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone APA ELECTRIC INC (305)225-8964 (786)256-9093 Type of Work: POWER BOATLIFT Additional Info: POWER BOATLIFT Classification: Residential Scanning: 1 Fees Due Amount CCF 0.60 DBPR Fee 2.25 DCA Fee 2.00 Education Surcharge 0.20 Permit Fee - Additions/Alterations 150.00 Scanning Fee 3.00 Technology Fee 0.80 Total: 158.85 Phone Cell 786)617-3500 Valuation: $ 800.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # EL -8-18-68557 08/15/2018 Credit Card $ 50.00 $ 108.85 08/23/2018 Check #: 39258 $ 108.85 $ 0.00 Available Inspections: Inspection Type.- Review ype: Review Electrical 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 st rictthe pl s, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this perm asil' for work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELEC ICAL, CHA AL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFI AVIT: I e egoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction an zoning. Frize the above-named contractor to do the work stated. L August 23. 2018 Authorized Building [ August 23, 2018 nature: Zent er / Applicant / Contractor / Agent P4, pCopy Miami Shores Village rQ 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 BUILDING PERMIT APPLICATION BUILDING 4 ELECTRIC ROOFING RECEIVED AUG 15 018 rn 6 FBC 201 Master Permit No. Doc 1k, 7d__1 Sub Permit Noel I C9- 21(- 1 v REVISION EXTENSION RENEWAL PLUMBING MECHANICAL [:]PUBLICWORKS CHANGE OF CANCELLATION SHOP 9 CONTRACTOR DRAWINGS JOB ADDRESS: st City: Miami Shores County: Miami Dade Zipk 33 3 1 Folio/Parcel#: Is the Building Historically Designated: Yes y NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fe^e Simple /Titleholder): rq r°,5 Phone#: k ZU -417 ' 35—d 6 Address: l y!(FI /V 6: /r0 y City: Al trc-7 i _S 11 o -e State: L Zip: 3 Tenant/Lessee Name: Email CONTRACTOR: Company Name: ../ f2i L1 Phone#: zo i7y 1 Address: /6 J 3 % !2W S-2 Z /V City: "11 (`A Al ! nn State: L Zip: 3 31 e Qualifier Name: ,f> -9 Q-- UC -4',4 Phone#: _3 ®J ` 3 Z " S X State Certification or Registration #: C° /3 04 s'_q 0 ( Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Value of Work for this Permit: $ gd90. ©D Square/Linear Footage of Work: Type of Work: Addition Description of Work: Zip: Alteration New ARepair/Replace Demolition Specify color of color thru the: Submittal Fee $ Permit Fee $ /-5`! D CCF $ Scanning Fee $ Radon Fee $ 2 ' rA DBPR $ 2 ZS Technology Fee $ Training/Education Fee $ Structural Reviews $ Revised02/24/2014) CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 109 • R5 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 w ch occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be apved and q*inspection fee will be charged. Signatu OWNER or AGENT Signature N ACTOR The foregoing instrumet was acknowledged before me this ; The foregoing instrument was acknowledged before me this 5 th day of o - 201, . J by S day of 20 by who is personally known to,anis personally known to e or who has produced irlyg,( U ansi as me or who as produced \ 1 ' as N TARY UBLIC: Sign: Print: Seal: J APPROVED BY Revised02/24/2014) who did take.an oath. r, YANADY PRIETO MY COMMISSION # FF 214031 EXPIRES: March 25, 2019 e,4 Tk- NMAN Public Underwiters identification and who did take an oath. NOTARY PUBLIC: Print:' Seal: GONZALEZ EXPIRES: November 2, 2020 Bonded Thru Notary public Underwriters Plans Examiner Structural Review Zoning Clerk B-21c Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Nouce io 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 i urance coverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING BELOYOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. //// Signature: i A"°' MAHA A,4') W.RAI K. GONZALEZOwnerMYCOMMISSION # GG 044602 EXPIRES: November 2, 2020 State of rich FyR ;4"•' Bonded Thru Notary public Underwriters County of Miami -Dade The foregoing was acknowledge before me this day of 1 , v '20 who is personally known tome or has produced as identification. Notary: SEAL: