EL-18-1558Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit No. EL-6-18-1588
Permit Type: Electrical - Residential
er'i Work ClassificaSon: Addition
Permit Status: APPROVED
Parcel Number
Issue Date: 6/12/2018 + Expiration: 12/09/2018
Applicant
890 NE 92 Street 1132060050130
Miami Shores, FL Block: Lot: MIGUEL AND CARLINA ARROW
Owner Information Address Phone Cell
MIGUEL AND CARLINA ARRONTE 890 NE 92 Street
MIAMI SHORES FL 33138-
890 NE 92 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone
G3 ELECTRIC CORP (305)322-2489
ype of Work: ELECTRICAL WORK ON ADDITION
dditional Info:
lassification: Residential
canning: 1
Fees Due
Amount
CCF
$4.20
DBPR Fee
$3.41
DCA Fee
$2.28
Education Surcharge
$1.40
Notary Fee
$5.00
Permit Fee - Additions/Alterations
$227.50
Scanning Fee
$3.00
Technology Fee
$5.60
Total:
$252.39
Valuation: $ 6,500.00
Total Sq Feet: 0
Pay Date Pay Type Amt Paid Amt Due
Invoice # EL-6-18-67831
06/12/2018 Credit Card
06/06/2018 Credit Card
$ 202.39 $ 50.00
$ 50.00 $ 0.00
Available Inspections:
Inspection Type:
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 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
construction a4 zoning. Futhern/ore, PI
foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
prize the a ove-naa�meed contractor to do the work stated. j
Ca0 lvtQ__T, A r(-OrilT(_:D June 12, 2018
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
June 12. 2018
Miami Shores Village
Building Department Ju 062018
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY:
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 r
BUILDING
PERMIT APPLI ATION
BUILDING ELECTRIC ❑ ROOFING
FBC 20 is
Master Permit Noe-C. ( P
Sub Permit No. �U— k 60`
❑ REVISION ❑ EXTENSION RENEWAL
PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF
JOB ADDRESS: �90 ') E 9/2-1
CANCELLATION ❑ SHOP
DRAWINGS
Folio/Parcel#: Is the Building Historically Designated: Yes
Occupancy Type: •Load: / construction Type: I t Flood Zone: BFE: _
OWNER: Na
Address:
City: _,
Tenant/
Email: G
Lessee Name:
CONTRACTOR: Company Name:
Address: 9>01 rw .15W 12, 5
City
NO
hone#:' IPI(-) 5'*(0
State: t-L.- Zip: 233 (,-�
Phone#:
Qualifier Name: (*�VIWhA w �GIC./�•11'V�B�pZ Phone
State Certification or Registration #: 310 V&?— IKfificate of Competency #:
DESIGNER: Architect/Engineer: 0�1Phone
p: 3-3►73
Address: L,1� l e C -I L CyY i �tte
Value of Work for this Permit: $ — � i Square/Linear Footage of Work:
Type of Work: LJ Addition ❑ Alteration 1 j❑NewlI El Repair/Replace
� � ElDemolition
Description of Work: E'e ' U ca-� '0Q't4- ai'l lAC p" f
Specify color of
color thru tile:
Submittal Fee $ Permit Fee CCF $_
Scanning Fee $ Radon Fee $ DBPR $
Technology Fee $ Training/Education Fee $
Structural Reviews $ _
CO/CC $
Notary $ •yV
Double Fee $
Bond $ rJ 01
TOTAL FEE NOW DUE $ �U .
(Revised02/24/2014)
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. , I , I
MffiFIFAM 4W-AW MA
OWNER or AGENT
The oregoing instrument was acknowledged before me this
1 day of _ 20 by
It who is personally known to
me or who has produced �T! N�Q If 1 O�lh�g`P as
identificati
The foregoing instrument was ackr%wledged before me this
—? day of _ 1�/ / 20 /,_, by
�O n LO/a `,eI. s ., c/3t ,who is personally known to
me or who has produced/rf u� r �cQNs'e as
identification and who did take an oath. 6 $S - tp 5 -9 410 t U
NOTARY P BLIC: NOTARY PUBLIC:
L
Sign: • Sign: !*�—
Print: Print: /CUS
�% 7ANADY PRISeal: MYSeal:
SION d FF 214031
r a-` EXPIRES: March 25. 2019 �►.... ROSA CAMTERO )
Bonded Thu NotaryP i uSGcUndenvriters # My COMMISSION a! FFW5969 t
! O1
APPROVED BYU��_� Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
t�trtn�c
ER 13006290
Data,0.
State of_i-lp(AA
County ofM'C'Mt"�
Before me this day personally appeared L7s' T1ZG�Q_%`tr(� +� o, being duly sworn. deposes
and says:
That he or she will be the only person working on the project tocaigd a,.
2 %o,r� , SIn s 33 3 0
Contractor Si
Sworn to (or affirm ) and subscribed before me this
day of 20S
Personally know
OR Produced identification
Type of WPM
V/
Print,VTyp r Staih- l ire of Notary
A 7 AE8 M81ch 25, 2Q19
✓ tfuNot" pdk U000111111114
f
Notice to Owner — Workers' Corn
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
nsation Insurance Exemation
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 day of "E"1X1__ , 20) 'K.
BY (' a9,U n a A 24Z &4-T h— who is personally known to me or has produced
Notary:
16 2
SEAL:
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