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EL-18-889tee Miami Shores VillagesO1s 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 FCORIDp Phone: (305)795-2204 Permit No. BL -4-18-889 Permit Type: Electrical - Residential Work Classification: Pool - Primate Permit Status: APPROVED Issue Date: 5/4!2018 1 Expiration: 10/31/2018 Project Address Parcel Number Applicant 280 NE 91 Street 1132060190410 Miami Shores, FL 33138- Bloch: Lot: KIRSTIN INCELLI IRAAI IIIIIIA4 1 11 IRMRMIOIIIIgm ll KIRSTIN INCELLI 280 NE 91 Street MIAMI SHORES FL 33138- 280 NE 91 Street MIAMI SHORES FL Contractor(s) Phone Cell Phone R GOOD ELECTRIC INC (954)432-2232 ype of Work: POOL ELECTRIC dditional Info: lassification: Residential canning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount 0.60 4.50 3.00 0.20 300.00 3.00 0.80 312.10 Cell 786)801-8654 Valuation: $ 1,000.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # EL -4-18-67053 05/04/2018 Credit Card $ 262.10 $ 50.00 04/05/2018 Credit Card $ 50.00 $ 0.00 Avaiiame I Inspection Type: Final Light Niche Bonding Review Electrical Alarms 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 AFFID VIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constructiongtg ore, I authorize the above-named contractor to do the work stated. ck C;(,I e, 1Z0p -P May 04, 2018 Authoriz d Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy Mav 04. 2018 1 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 BUILDING PERMIT APPLICATION BUILDING 9ELECTRIC ROOFING F BC 20 k- Master Permit No.'67P 8 - GOfo Sub Permit No i—(o- e 6c7 REVISION EXTENSION RENEWAL F-1 PLUMBING 10 MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION SHOP CONTRACTOR DRAWINGS JOB ADDRESS: Zw ME, I ZA City: Miami Shores County: Miami Dade Zip: 3 r Folio/Parcel#:Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): KQ, 1 i Ad State: Tenant/Lessee Name: Phone#: Email: 111oC"1 0CM CONTRACTOR: Company Name: 6CO03 C- Phone#: Address: 1730 AVA/ V c-,3Dj City L Qualifier Name: (1000 Phone#: State Certification or Registration #: I-- C (3002 Z 70 Certificate of Competency #: _ DESIGNER: Architect/Engineer: Address: `` City: Value of Work for this Permit: $I1 l Square/Linear Footage of Work: Zip: Type of Work: Addition Alteration ® New Repair/Replace Demolition Description of Work: 2pD 6 `&i Vk- Specify color of color thru tile:, Submittal Fee $ Permit Fee $ 1©e0iOB CCF $ Scanning Fee $ Radon Fee $ 3 - a DBPR $ Technology Fee $ Structural Reviews $ Training/Education Fee $ CO/CC $ _ Notary $ Double Fee $ _ Bond $ TOTAL FEE NOW DUE $ 0^160P' (U Revised 02/24/2014) 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. in the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. OWNER or AGENT The foregoing instrument was acknowledged before me this Q_ day of Fh , 20 N by C5)yQsorl D ( IM, who is personally known to me or who has produced 2WIUA f C^-Cr,-2 as identification and who did take an oath. NOTARY PU Sign Print Seal: e, N Notary Public State of FloridaAdrianRojasPierrend x My Commission GG 183868 of a Expires 02/07!2022 re N0nI7_110ki The foregoing instrument was acknowledged before me this day of (Y" 20 TS by VS C-LOC,,O who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign:_ Print: Seal APPROVED BY Plans Examiner Structural Review Revised02/24/2014) 40 Notary Public State of Florida Add< ns Ras My Commisson GG Piexrend 183868 Expires 02/07/2022 as Zoning Clerk 0 1 • R. GOOD ELECTRIC, INC. 1730 NW 88th Way Pembroke Pines, FL 33024 March 5, 2018 Before me this day personally appeared Russell Good, who being duly sworn, deposes and says: That he will be the only person working on the project located at I si A)C I01 SJ' Miami Shores, FL 33 139 A",f'ta h v-C_ RUSELL GOOD EC13002270 Sworn to and subscribed before me this 900 day of 201$by, Vwd&t U U who is personally known to me. / a --QA OfAR/01` STATE OF FLORIDA AT LARGE of Florida 0, 101 9999e yes2 1730 NW 88th Way Pembroke Pines, FL 33024 Phone: 954-214-5899 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: "- I_ Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this _15,0 day of 494kf 1_, 20 By V_^ e-ka t ^D JCnceU; who is personally known to me or has produced 2k -, as identification. Notary: Notary Public State or Florida rY,. Adrian Rojas PierrendMyCommissionGG183888SEAL: Expires 02/07/2022