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EL-19-282Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Issue Date: 02/25/2019 Location Address Parcel Number 448 NE 96 ST, Miami Shores, FL 33138-0000 1132060140575 Contacts Permit NO.: EL-02-19-282 Permit Type: Electrical - Residential Work Classification: Alteration Permit status: Approved Expiration: 08/26/2019 GEORGE SEMIEN Owner GEORGE SEMIEN Applicant 448 NE 96 ST, MIAMI SHORES, FL 33138 448 NE 96 ST, MIAMI SHORES, FL 33138 Other:3057937911 Other:3057937911 CAMAGUEY ELECTRICAL SERVICE Contractor SAMUEL JORGE GONZALEZ 6160 W 26 CT, MIAMI, FL 33016 Business: 3059841036 Inspection Requests: Description: RUN POWER FOR PERGOLA Valuation: $ 1,000.00 Inspec ion Re 49 TotalSq Feet: 112.00 Fees Amount Application Fee - Other $50.00 CCF $0.60 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.20 Permit Fee $50.00 Scanning Fee $3.00 Technology Fee $2.50 Total: $110.30 Building Department Copy Payments Date Paid Amt Paid Total Fees $110.30 Deposit 02/07/2019 $50.00 Credit Card 02/25/2019 $60.30 Amount Due: $0.00 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 accurKland�haAall work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above name co trac r to o the work stated. Authorized Signature: Owner ! Applicant / Contractor / Agent v Date February 25, 2019 Page 2 of 2• RECEIVED 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 v BUILDING PERMIT APPLICATION ❑BUILDING 0 ELECTRIC ❑ ROOFING EB q7 E B ° CD ;;��FB--t--C20 1`1 Master Permit No.V G -1 & -2-03 Sub Permit No.T -_- UZ (- I 2-8Z ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION [—]SHOP CONTRACTOR DRAWINGS JOB ADDRESS: `7 qg p l(� �� `5 t City: Miami Shores County: Miami Dade Zip: 33 i38 Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): (Sr—'016 F SI` M 1 t IV Phone#: Address: 4 `tk NC_ -! 04 S-f— City: pit kru-QwwreS State: Pl o r i did_ zip: 33/3 Tenant/Lessee Name: Phone#: 305- 7 93 Email: ti St1 an mAa i� f'e CONTRACTOR: Company Name: Camaguey Electrical Services Phone#: 305 984 1036 Address: 6160 West, 26th Ct J ' City: Hialeah state: Florida Zip: 33016 Qualifier Name: Samuel J. Gonzalez Phone#: 305 984 1036 State Certification or Registration #: ER 13014584 Certificate of Competency M 11 E000103 DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ /0 vv Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑Repair/Replace ❑ Demolition Description of Work: (>� lQ©�RV, -� -- 221 go � Specify color of color thru tile: Submittal Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ Permit Fee $ Radon Fee $ Training/Education Fee $ CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ (Revised02/24/2014) TOTAL FEE NOW DUE r C 60 , 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 certTled copy of the iecorded 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 uch posted notice, the inspection will not be approved and a reinspection fee will be charged. RSignature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this 1( day of 20 � 9 by who is personally known to e or who has produced FI- IT1> as identification and who did take an oath. NOTARY PUBLIC: The foregoing instrument was acknowledged before me this day of 20 % f , by Samuel J. Gonzalez , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: W Sign: Print: -1-11—AAJ4J12-4 -V/,4Z ek4-An/C0 Print: Seal: Seal: pry"' Notary Put�;ic state of Florida Lizandra Diaz Blanco ,fir Notary P#jt6 State or Fbride My Commission GG 243838 i LiZandra Dtaz BIanCO a Expires o7/3112022 My Commission GG 243 338 27ri112022 ######s#s# # ## # ########### s ss#s#######s#######sss#######ss##s##s#sssss##s##ssss#s#s##s#ss#s## APPROVED BY Z ZD Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) V01 CAMAGUEY ELEfTvw SERVI(ES CORP. Electrical Contractor (305)98A-1036 s,fRV,Lic:#ER13014584 Date: ` ,- & / � , -?o f y State of: t7 1a L- e`1512 C2L County of: �04�-De— Before me this day personally appeared `S0 W4v Q-C ' , � a (\- 4,who, being duly sworn, deposes and says: That he ill be the only person working on the project located at Contractor signature Sworn to (or affirmed) and subscribed before me this 4,12�'C day of 2018 By Personally know Or Produced Identification FL- ► D Type of Produced Identification L I Z,& #1 X*2. A !> I A ZZ r3 [--A-r1 Co Print, Type or Stamp Name of Notary Notary Public State FloridaLizandra Diaz Blanco g MY Commission GG 243938 @ate Expires 07/31/2022 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: LC4 764t1 Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this ( day of , 20-0—. By who is personally known to me or has produced ,_ 13> as identification. Notary: Notary Public Stets of FWda GPV My Lizandra Diaz Blanco • ' Comp !322 243938 SEAL: Expiroe /7(q L-� po C- e- 5� -�a 0,- qAt !e o(e C-c.c sv C 5 .2004 C- :�-/Z GFCI weather resistant Existent CKT# 12 general RECE�V ED propuse receptacle FEB 2 0 1019 PVC 12 0 0'.- Run cable #12 ) 1 black 1 white GFCI weather resistant 1 green Pergola Transformer SFiC �.i UI IP '7P'��w API-Ti ----'E!)_ 8Y __L_ DATE 7ON'l,\ 3 DEPT L" DG DEPT 1;'6JECT i'O CCA If'l if`NCE WI M ALL F— EC- Er pAL ,R' ATE ANC t;C INN f ril L"SD ELECTRICAL R ffE ./ . TE Z 12 inches I underground 141T Ila qwzlse