Loading...
ELC-20-306Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Issue Date: 02/20/2020 Location Address Parcel Number 9723 NE 2ND AVE, Miami Shores, FL 33138 1132060134210 'ontacts Permit NO.: ELC-02-20-306 Permit Type: Electrical - Commercial Work Classification: Alteration Permit Status: Approved Expiration: 08/18/2020 Gator 9723 NE 2 Avenue, LLC Owner GOLDEN ELECTRICAL CONTRACTOR LLC Contractor 9723 NE 2 AVE, Miami Shores, FL GLAUBERT REGALADO 19407 NW 82 CT, MIAMI, FL 33015 Business: 9545123848 glaubertregalado@yahoo.com Inspection Description: INSTALLATION OF NEW OUTLETS AND SWITCHES Valuation: $ 5,500.00 Inspection Requests: 4949 RELOCATE POWER BRAKERS Total Sq Feet: 48.00 Fees Amount Application Fee - Other $50.00 CCF $3.60 DBPR Fee $2.48 DCA Fee $2.00 Education Surcharge $1.20 Permit Fee $115.00 Scanning Fee $3.00 Technology Fee $4.13 Total: $181.41 Payments Date Paid Amt Paid Total Fees $181.41 Credit Card 02/10/2020 $50.00 Credit Card 02/20/2020 $131.41 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 a, d-t#aat all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above named co, ractor`,lo do the work stated. Authorized Signature: Owner / Applicant / Contractor / Agent ` Date February 20, 2020 1 Page 2 of 2 Vb REC=, ivED 2 Miami Shores Village E� 10 1020 p BuildingDepartment B 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 p_C 201 Q05- +� BUILDING Master Permit No.. PERMIT APPLICATION Sub Permit No. ❑BUILDING O/ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: _���� Ale- 2 A -ye - City: Miami Shores County: Miami Dade Zip: 3 2 / .32 Folio/Parcel#: 40 t2l 3 1542-/ O Is the Building Historically Designated: Yes NO Occupancy Type: Load: ((Construction Type: ,�,Flood Zone:: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Va q"�a3 WE Y�( Ave, (.C-C, Phone#: 305- ` L(0,— ct 0 '4-2) Address: `7 $5;*C7 N w I -4(oSk a F L City: gian+, Lo,6 i, IF State: 3301 (n Zip: Tenant/Lessee Name: Phone#: Email: A q CONTRACTOR: Company Name: 6c) lde.� F—ho-II raAA Phone#: 305 Address: _/9SLfJ� �✓� ��' all, City: State, �rL Zip: 330 )r Qualifier Name: 1p (C-y �: ,, A) /�'��1 � ( � Phone#:361)�� Dl'_T-� `W fl p 7�,ByP State Certification or Registration #: 6e 130 00PZ,61 Certificate of Competency #: DESIGNER: Architect/Engineer: Address: hone#: City: State: Zip: Value of Work for this -Permit: $ 00 Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration , �� ❑ New ❑ Repair/Replace ❑ Demolition Description of%�i /L Specify color of color thru tile: Submittal Fee $ • 613 Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ I3i I (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 attEa ment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which ors ven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved reinspection fee will be charged. Signature OWNER or AGENT The foregoing instrum`eent as acknowledged before me this iO day of—Y- rL - 20, by � a CAL *+G , who is EEEn wn me or who has produced identification and who did take an oath. as Signature CONTRACTOR The foregoing instrument was acknowledged before me this 6——day-of �✓J �0._.. 'Q'_"bY �o (Gw h,&,t tAttJy who is personally known to me or who has produced as NOTARY PUBLIC: NOTARY P .: MY COMMISSION # GG 252 92 EXPIRES: September 1, 20 D°loin Bonded Thru Notary Pubic UnderwlMers Sign: Print- ' Print: co hc" Seal: Notary Public State of Florida Leslye Chirino Seal: �j My Commission GG 1357 pia Expires 06/13/2020 ************************************************************************************************************ APPROVED B moans Examiner Zoning Structural Review Clerk (Revised02/24/2014) RICK SCOTT, GOVERNOR JONATHAN ZACHEM, SECRETARY STATE OPFLORIDA d�pr DEPARTMENT OF bUSIN-FESSIONAL REGULATIOW . rjp:,P "I ELECTRICA NG BOARD THE ELECTRI E is C T-41d UNDER THE PROVI F, 4$9 , Ri 1 Tl UTES 4 WD IWV , '0 64- e j t , , 1940flf �,82�q. OU T, FL�3 FXPIRA'1110NO Always verify licenset online at.MyFlortcIpLicensexorn Do notalter this document in any form. This is your license. It is unlawful for anyone other than the licensee to use this document. 008012 Local Business Tax Receipt Miami -Dade County, State offlorida -THIS S NOT A BILL - DO NOT PAY '6 ti 7258955 BUSINESS NAMEACCATION GOLDEN ELECTRICAL CONTRATOR LLC I OPERATING IN DADE COUNTY RECEIPT NO. EXPIRES RENEWAL SEPTEMBER 30, 2020 7645559 Must be displayed at place of business Pursuant to County Code 1 Chapter 8A -Art. 9 & 10 OWNER �, r �� SEC. TYPE Of BUSINES I PAYMENT diT RECEIVED I GOWEN ELECTRICAL CONTRATOR LLC 196 LEC7RICAL CCINTRACTOR �--� — 9Y T COLLECTO# C/O GLAUBERT REGALDO Rt QUALIFIER ��'' 1 87500`05/,09J2O19 CkDIT�I D-19 b72371 .This Local. Bush on Tax Racal pt only confirms paym kof thii lecal Business Tax. The Receipt is aoC a iiceise, I permit or a con ficatlan of the Helder s quaiifiestions, to do.lwsiaess. Holder eruct comply with enjr paverna►ental % or nongovernmental regulatory,laws and requirdam is which apply to the business. _ ,"-A. RECENT NO. ebawe rust be,displayed on all commercial vehicle - Miemi-Dodo We Soe Ba-M f �� mar more irtformatiod J sR www. iemidad .gev3axeeliactor JIMMY PATRONIS CHIEF FINANICAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 6/6/2018 PERSON: GLAUBERT REGALADO JR FEIN: 823086218 BUSINESS NAME AND ADDRESS: GOLDEN ELECTRICAL CONTRACTOR LLC 19407 NW 82ND COURT HIALEAH, FL 33015 SCOPE OF BUSINESS OR TRADE: Licensed Electrical Contractor EXPIRATION DATE: 6/5/2020 EMAIL: GLAUBERTREGALADO@GMAIL.COM IMPORTANT: Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 COMPANY LETTER HEAD Date: State of F /0 rrtoA County of Ph6r, Before me this day personally appeared 0 U0,ut Qe f who, being duly sworn, deposes and says: That he os she will be the only person working on the project located at: Contractor signature Sworn to (or affirmed) and subscribed before me this —� day of 4 -" 20 y0 By Personally know OR produce Identification Type of Identification Produced GELKA LGG2 MY COMMISSIOa EXPIRESSeptgp 7MyNotary r6 Print, Type or Stamp Name of N 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 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 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; The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 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 o work on your project. In these circumstances, Miami Shores Village does not require verification of workers' compensation ins rance c rage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING BELOW O 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 10� day of F 20 o10 . By �cw�. A . ►(�s �..; who i ersonally known me or has produced Notary; aV0r 04. Notary Public State of Florida + Leslye Chinno c • My Commission GG 1357 Expires 06/13/2020 as identification.