EL-19-351Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Permit NO.: EL-02-19-351
Permit Type: Electrical - Residential
Work Classification: Addition/Alteration
Permit Status: Approved
Issue Date. 02/26/2019 F Expiration: 08/26/2019
Location Address Parcel Number
1181 NE 92ND ST, Miami Shores, FL 33138 1132050270340
Contacts
ANDREW & DANIELLE BEYDA Owner MIA ELECTRICAL SERVICE INC Contractor
1181 NE 92 ST, MIAMI SHORES, FL 33138 RONY MENDEZ
8567 CORAL WAY 310, MIAMI, FL 33155
Home: 7862386641
Inspection Requests:
Description: NEW OUTLETS ELECTRICAL BOX SWITCHES Valuation: $ 12,243.00 Inspec i 4949
TotalSq Feet: 700.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$7.80
DBPR Fee
$6.43
DCA Fee
$4.29
Education Surcharge
$2.60
Permit Fee
$378.51
Scanning Fee
$3.00
Technology Fee
$10.71
Total:
$463.34
Payments
Date Paid
Amt Paid
Total Fees
$463.34
Cash
02/26/2019
$234.81
Credit Card
02/14/2019
$50.00
Credit Card
02/26/2019
$178.53
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
reaulatina construst+on4%-n2hzoning. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Signature
/ Applicant / Contractor / Agent
Date
February 26, 2019 Page 2 of 2
Miami Shores Village RECEIVED
Building Department FEB 14 2019
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 (24
INSPECTION LINE PHONE NUMBER: (305) 762-4949
C 20 c-0 I Zi-o
BUILDING Master Permit NoXVQW_____r -
PERMIT APPLICATION Sub Permit No.� I I `"I — Is l
❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
i i i CONTRACTOR DRAWINGS
�/
JOB ADDRESS: 1 l G ( 0.J -
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Type:
Flood Zone:
BFE: FFE:
)Construction
l
�GjQ_,NAQ'-,--
OWNER: Name (Fee Simple Titleholder):
Phone#:
Address:
City: _up0'--'
State: `t L
Zip:
Tenant/Lessee Name:
Phone#:
Email:
/
CONTRACTOR: Company Name: A C/C'
r
L,, C AL_ Sean-%w
� oc ,
Q /
Phone#: `71G - 2 33-C? 61
4
Address: 66 7 C-o/L,-Z_ w ja
e)
City: ff / A. k
State: �
Zip:
i
Qualifier Name: &kjy et E' 2-Phone#:
/
71 3 Sr0 /
State Certification or Registration #: "F` / 300 57 2 I Certificate of Competency #:
DESIGNER: Architect/Engineer:
Address:
City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: W1 Addition ❑ �Allte�ration (� ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: 'yOLO Out-�D't S Q%C l[ S_y� i •� C,% Q_f
Specify color of color thru tile:
Submittal Fee $� Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
DBPR $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 43.
(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 approveNand a reinspection fee will be charged.
Signature //F /// Sign
or AGENT
The foregoing instrur t was acknowledged before me this
�_ day of 0J) 1 20 19 , by
Ar"1Clrew 5P_Aq who is personally known to
me or who has produced —Pnkxor as
CONTRACTOR
The foregoing instrument was acknowledged before me this
l O day of 20 by
V�o I
M1. Uend P2 who is personally known to
me or who has produced. �d07- L)e."k-a-A- as
identification and who did take an oath. 63coo (2 b4-?-OTdentification and who did take an oath. H 1"5> 2. --*-ZO T+ Z3 ( p
NOTARY PUBLIC:
Sign:
Pri nt: I
NOTARY PUBLIC:
Sign:
Print: i
Seal: Seal: rt�. BAtiBAfiIIGARCU
sv "•'r+�, BARBARA GARCIA �'`:�' ��' C ffd"b on R GG 187164
• ,v ioe #i GG 1871U
Expires February 42022
e` was Febnrary 1b, 2022
'7
APPROVED BY S q Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
notice to uwner — worKers, compensation Insurance txemptlon
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 rk on your project. In these circumstances, Miami Shores Village does not require verification of
workers' compensation insura a coverage from the contractor's company for day labor, part-time employees or subcontractors.
BY SIGNING BELOW Y tA)1��WLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this l+h day of ��c n 20.
By J4`14, O'er" who is personally known to me or has produced
.l rro.w (4u,,,_x. 1 '3an p t2 as identification.
Notary: ` +��`�j CpwNee(on ae (i(31� 6d
MMWGWIA
SEAL:Eqkft FOnwy 18, 2022
�
e""Ift"s.Loe.
Mia Electrical Service In.c.
8567 Coral Way # 310 Miami FL, 33155
Ph: 786-2.38-6641
Email: miae'ectricai@yaho.com
yaho.com
Date:
State of t
Countryof
Before me this day personally appeared �f kle k) dIC-) 2- who,
being duly sworn, deposes and says:
That he or she will be the only person working on the project locate at: 1 ►�� C
_�
Cont cttoor Signature.
Sworn to (or irmed) ands cribe before me this kh day of U
20 �, by
"MARAGARCIA
* •C0MMISWffl#GGI87i64
•ofn�t�� EVkn Febru" IS, 2W
1n*dftnbAW"0`"$MMO, Personally know
Or Produced Identification
nN S3Z g120 w V 2_ t �
Type of Identification Produced-�'�u.e� `� MAX LA.