EL-18-1312Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Permit NO.: EL-5-18-1312 Permit IVR Number: 613803
-� Permit Type: Electrical - Residential
Work Classification: Addition Alteration
Parcel Number
Permit status: Applied
Issue Date: I Expiration:
Project
138 NE 109 ST, Miami Shores, FL 33161-7042 1121360090130 <NONE>
Contacts
EAL INVESTMENT INC Owner EAL INVESTMENT INC Applicant
138 NE 109 ST, MIAMI SHORES, FL 33161 138 NE 109 ST, MIAMI SHORES, FL 33161
Other:7863160828 Other:7863160828
SUNSHINE ELECTRICAL CONTRACTORS Contractor
CORP
MARIANO SANTIESTEBAN
1300 SW 85 CT, MIAMI, FL 33144
Business: 3052654958
Other:7862736194
Description: CHANGE 4 GFI IN THE KITCHEN AND 3 IN THE Valuation: $ 3,000.00 Inspection Requests:
BATHROOM. INSTALL 4 NEW SMOKE DETECTOR NEW r-712-4949
ELECTRICAL LINES FOR THE A/C CONDENSER 240V- CABLE #8 - Total Sq Feet: 0.00
30 AMP CIRCUIT AND NEW ELECTRICAL LINES FOR THE A/C
COMPRESSOR 240 V CABLE #8 15 AMP CIRCUIT
Fees
Amount
CC F
$1.80
DBPR Fee
$3.35
DCA Fee
$2.25
Education Surcharge
$0.60
Permit Fee - Additions/Alterations
$225.00
Scanning Fee
$3.03
Technology Fee
$2.40
Total:
$238.43
Building Department Copy
Payments
Amt Paid
Total Fees
$238.43
Deposit
$50.00
Check # 584
$188.43
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 accurate and that all work will be done in compliance with all applicable laws
regulating construction and zoning. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Signature: Owner
/ Applicant / Contractor / Agent
Date
October 02, 2018 Page 2 of 4
htV►- �.
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 0 ELECTRIC ❑ ROOFING
MAY 162018
(:4��
FBC 201'_:� rr,,
Master Permit No. PIC k f? — (?) 10
Sub Permit No.(" A 12> — 13 12
z.--o
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 138 NE 109th St, North Miami, FL 33161
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-2136-009-0130 Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): EAL INVESTMENT INC Phone#:786 316 0828
Address:13499 BISCAYNE BLVD # TS3
City: MIAMI State: FL Zip: 33181
Tenant/Lessee Name: Phone#:
Email: israelcamposdeleon@hotmail.com
CONTRACTOR: Company Name: Sunshine Electrical Contractor Corp
Address: 1300 SW 85 COURT
City: M IAM
Qualifier Name: Mariano J Santiesteban
State Certification or Registration #: EC13005807
DESIGNER: Architect/Engineer:
Phone#: 305 761 7937
FL Zip: 33144
Phone#: 305 761 7937
Certificate of Competency #:
Phone#:
Address: City: State:
Value of Work for this Permit: $ 3,000.00 Square/Linear Footage of Work:
Zip:
Type of Work: ❑ Addition ❑ Alteration ❑ New N Repair/Replace ❑ Demolition
Description of work: Change 4 GFI in the kitchen and 3 in the bathroom. Install 4 new smoke detector
New electric lines for the A/C Condenser 240v - Cable #8 - 30 amp - circuit and
New electric lines for the A/C Compressor 240v - Cable #8 - 15 amp ciruit.
Specify color of color thru tile:
Submittal Fee $ Permit Fee $,•ZS l 3 � CCF $ CO/CC $
Scanning Fee $ Radon Fee $ ZS DBPR $ 3 - 3 G Notary $
Technology Fee $ Training/Education Fee $
Structural Reviews $
Double Fee $
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $ 12J9 - '� 3
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 approved ank a reinspection fee will be charged.
Signature Signature4y—,A��'�
le
WNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
A dt�-" day of I �) 20 LpO by
who is personally known to
me or who has producedas
identification and who did take an oath.
NOTARY PUBLIC:
The foregoing instrument was acknowledged before me this
day of -i ' 20 �7 ' , by
rf2l�r')O ,)75� , who is personally known to
me or who has produce
identification and who did take an oath.
NOTARY
Sign:y��+'�t�"^`"'c.r�' Sign:
Print: C*Y-.e Print: 't
V's,
Seal: Seal: NOTARY PUBLI
VANESSA FUNDORAsTATEOFFLORIDA
MY COMMISSION # GG 17000I Cornet# GG11904C
EXPIRES: December 20,2021 Expires 6/26/2WI
APPROVED BY
,,.�-4Yl9 Plans Examiner
Zoning
(Revised02/24/2014)
Structural Review
Clerk
Notice to Owner - Workers'
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
ation 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
I . 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 ACK WLEDGE 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 01 day of <JntO, 20L.
By who is personally known to me or has produced
as identification.
Notary:
' LILLIAM LANDAZABA.
SEAL: 'r`Z�11.
Notary Public - State ofFt&da
' Commission # GG 138SS9
My Comm. Expires Aug 28.2C21
SUNSHINE ELECTRICAL CONTRACTORS CORP
1300 SW 85 Cr
MIAMI FL 33144
LICENSE EC13005807
Jun 01/2918
State of Florida
County of Dade
1 get
Before me this day personally appeared Mariano J Santiesteban who, being duly sworn, deposes and says:
That he will be the only person working as an electrician on the project located at:
138 NE 109 Street, Miami Shores, Fl 33161
Contractor Signature
Personally Know
OR Produced Identification
Type of Identification Produce
�pRY Christy M. Cruz
NOTARY PUBLIC
o STATE OF FLORIDA
Z ` ? Comm# GG119046
-CE 19�0 Expires 6/26/2021
Name of Notary