EL-19-657Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date: 05/09/2019
Location Address Parcel Number
278 NE 103RD ST, Miami Shores, FL 33138 1132060134860
Contacts
Permit No.: EL-03-19-657
Permit Type: Electrical - Residential
Work Classification: Pool
Permit status: Approved
Expiration: 11/05/2019
HB GROWTH PROPERTIES LLLP Owner KLEAN POWER ELECTRIC INC Contractor
HB GROWTH PROPERTIES LLLP GUILLERMO ALONSO
17071 W DIXIE HWY, NORHT MIAMI BEACH, FL 33160 6601 SW 80 ST, MIAMI, FL 33143
Inspection Requests:
Description: POOL 3/5 14X32 SPA 7X7 NEW POOL TO REPLACE Valuation: $ 1,800.00 Inspr-762-4949
EL17-2084
COMPLETE WORK ASSOCIATED WITH NEW POOL FOR EXPIRED Total Sq Feet: 448.00
PERMT BPP-8-17-2083
Fees
Amount
100% Permit Renewal Fee
$250.00
Application Fee - Other
$50.00
Total:
$300.00
Payments
Date Paid Amt Paid
Total Fees
$300.00
Credit Card
05/09/2019 $250.00
Credit Card
03/27/2019 $50.00
Amount Due:
$0.00
Building Department Copy
In consideration a issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining th/� to a in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. lry`acceptin �h p rrrlit assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
permits�ee required 4r L Cf CAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
AFFIDAV'I:� J�cei that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
,on struct�o z i g. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Si4flatire: Owner ' / Applicant / Contractor / Agent
May 09, 2019
Date
Page 2 of 2
Miami Shores Village RP'CLIVED
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 C(/
QF�BC 201�3� 1
BUILDING Master Permit No. [J
PERMIT APPLICATION Sub Permit No.Q�— a
❑BUILDING FE-1 ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 278 NE 103 St
City: Miami Shores County: Miami Dade Zip: 33138
Folio/Parcel#: 11-3206-013-4860 Is the Building Historically Designated: Yes NO x
Occupancy Type: Load: Construction Type: _ Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholde
Address: 17071 W Dixie Hwy
City: N Miami Beach
HB Growth Properties LLLP Phone#: 954-774-4616
Tenant/Lessee Name: na
Email: azorapropertymgt@gmail.com
State: FL
ne#:
33160
CONTRACTOR: Company Name: Ifi C-Aky' `OWtn Phone#: T96 IM2 dJ42
Addr
City:
Quall
State Certification or Registration #: E a l IW W 66 Certificate of Competency #:
DESIGNER: Architect/Engineer:
hone#:
Address: ,��� City: State: Zip:
Value of Work for this Permit: $ C/t Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of work: complete work associated with new pool as specified under expired permit #
BPP-8-17-2083
Specify color of color thru tile:
Submittal Fee $ % Permit Fee $CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary
Technology Fee $_
Structural Reviews $
Training/Education Fee $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ Z 50 • 0O
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable) na
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.
Signature 'Signature
or AGENT CONTRACTOR
The foregoing instrument was ac nowledged before me this The foregoing instrument was a knowledged before me this
day of 20 by 6* day of '20 , by
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Seal:
Seal:
APPROVED BY 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 txernwion
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:
l . 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.
Signatur
&4Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledg+efole me this � day off 20
W ,
as
Notary:
SEAL:��d90 tea,
who is personally known to me or has produced
04/02/2019
State of Miami Dade
Miami Shores Building Department
Before me this day appeared, Alonso Guillermo who being duly sworn, deposes and say:
That he will be the only person working on the project locates at 278 Ne 103 St.
/eanPower Electric Inc
Guillermo Alonso