EL-18-1423Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
F�ORiDA
Permit No. EL-5-18-1423
Permit Type: Electrical - Residential
Permit work Classification: Addition/Alteration
Permit Status: APPROVED
Issue Date: 7/3/2018 1 Expiration: 12/30/2018
Project Address Parcel Number Applicant
1240 NE 91 Terrace 1132050010540
Miami Shores, FL 33138- Block: Lot: DAINEL OCARIZ
Owner Information Address Phone Cell
DAINEL OCARIZ 1240 NE 91 Terrace (305)487-3535
MIAMI SHORES FL 33138-
1240 NE 91 Terrace
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone
AMERICAN POWER ELECTRIC CORP (305)216-7491
/pe of Work: INTERIOR REMODELING, NEW ELECTRICAL
dditional Info: INTERIOR REMODELING, NEW ELECTRICAL
lassification: Residential
canning: 3
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
$6.60
$5.78
$3.85
$2.20
$385.00
$9.00
$8.80
$421.23
Valuation: $ 11,000.00
Total Sq Feet: 0
Pay Date Pay Type Amt Paid Amt Due
Invoice # EL-5-18-67686
07/03/2018 Credit Card $ 371.23 $ 50.00
05/24/2018 Credit Card $ 50.00 $ 0.00
Avaname
Inspection Type:
Final
Meter Box
Alteration
Relocation
Fire Alarm
Service Change
Review Electrical
nd
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 regulating
construction and zoning. Fljthermore, I authorize the above -named contractor to do the work stated.
July 03, 2018
wner / Applicant / Contractor / Agent uate
Building Department Copy
July 03, 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 jx ELECTRIC ❑ ROOFING
R E CL--- IVEZ 0
JUL 0 2 tJjB
�+i
ak
FBC 20r:
Master Permit No. � I — tU 2,-S 't—
Sub Permit No. 12c� vnr — I
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS 5E CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: / 2 ¢o �J L 9/5 i T&/�? 2,4c 6
City: Miami Shores County: Miami Dade Zip:
folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: �Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): a)( /l� ��d 1 ��•L,,` 1� Phone#:
Address: 7?A/.jIe/ 0cz/2.
City: I/LZ4GE State: FL- • Zip:
Tenant/Lessee Name:
Email:
Phone#:
CONTRACTOR: Company Name: �! I iLV�,-%Z /Gst",L/ rOV05%2. A-F4090 . CO/ZfJ. Phone#:
Address: 7 C—e—u&T
City: ,-aZ,=,Ad State: r—L Zip:
Qualifier Name: LO17-,'E47'F_ Phone#:%vp6-22�-%DCI%
State Certification or Registration #: Ec /-)oa 3 /Oa Certificate of Competency #:
DESIGNER: Architect/Engineer:
ne#:
Address: City: State: Zip:
Value of Work for this Permit: $ 11111200 Square/Linear Footage of Work:
Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: /ZELc c 7&-P gjrc,4/,e C! IZEG 6hJAGL�S , 1/)
�/A,Iu tZ£
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $_
Structural Reviews $
Permit Fee $ ,� 8J CCF $
Radon Fee $
Training/Education Fee $
DBPR $
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(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
Zip
City State 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 d a reinspection fee will be charged.
Signature / Signature ZU460
Or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
— li6v, day of , l>>1e 20 19 by
haole 1 C'QYI-Z who is personally known to
me or who has produced
The foregoing instrument was acknowledged before
me this
13-111", day of -JU%L 20 by
who CeZonally known to
as me or who has produced
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
as
Sign:` C Sign:
Print: Weig8o- L> t is vez. Print:
ADRIANA GIRARDI
Seal: ���' BRENDAL.RODRIGUEZ Seal: MYCOMMISSION #GG140466
:.; MY COMMISSION # GG 134318 EXPIRES September 04, 2021
rFo:° EXPIRES: December 13, 2021 I
Bonded Thru Notary Public Underwriterc
*************************************************************************
APPROVED BY , , Lam' Z ✓C/I. lg 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 txemnon
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:
Wner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this as day of 464, , 20 IT .
By (L,a(1 ?j who is personally known to me or has produced
as identification.
Notary:
tg�oi BRENDAL. RODRIGUEZ
SEAL: .. *- MY COMMISSION # GG 134318
''r Po EXPIRES: December 13,, 2�0�211
•iibro R•' Bondedjhru Notary Pubk Un@rvd"em