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EL-19-71 (2)Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 lr vLrnai 61,t Issue Date: 02/26/2019 Location Address Parcel Number 1055 NE 96TH ST, Miami Shores, FL 33138 1132060143710 Contacts Permit No.: EL-01-19-71 Permit Type: Electrical - Residential Work Classification. Alteration Permit Status. Approved Expiration: 07/10/2019 PATRICE ROBINET Owner ONLY ELECTRIC CO INC Contractor 1055 NE 96 ST, MIAMI SHORES, FL 331382551 YOAV ADIKA 348 NW 102 TERR Business:3057856059 onlyelectriccompany@gmail.com Description: UPDATE LOWER OUTLET AND DOWN LIGHTS IN Valuation: $ 5,400.00 Inspection Requests: TWO BATHROOMS AND KITCHEN, PER PLAN . Total Sq Feet: 300.00 Fees Amount Application Fee - Other $50.00 CCF $3.60 DBPR Fee $2.84 DCA Fee $2.00 Education Surcharge $1.20 Permit Fee $139.00 Scanning Fee $33.00 Technology Fee $4.72 Total: $236.36 Payments Date Paid Amt Paid Total Fees $236.36 Credit Card 02/26/2019 $186.36 Check # 2308 01/11/2019 $50.00 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. AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws ;onstructioAand zoning. Futhermore, I authorize the above named contractor to do the work stated. Owner / / ('-4 V(Y / Contractor / Agent Date February 26, 2019 Page 2 of 2 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: (30S) 762-4949 FBC 120 Master Permit No. l.n'f1\\— BUILDING PERMIT APPLI TION Sub Permit No. ', L BUILDING ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION ©RENEWAL PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: cl) la .4, City: Miami Shores County: 2 Miami Dade Zia: �3 r; Folio/PameW � � �,�/ l 3C.s- C- I� `t ' -7 '"_7 / Is the Building Historically Designated: Yes NO Z. Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: City: zi (in & skkC f State: _� c Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: 0 '�\+ �� celp/ �. Phone#: Address: U1.7 1624, may; GI t�1 State: E �( Zip:�ZY Qualifier Name: Phone#: OpS - State Certification or Registration #: �5—•r �i�Certificate of Competency # DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: Square/Linear footage of Work: Type of Work: ❑ Addition d Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of work: 1)pGA.-e &LC-V OA w I/Vj D=vt t L'�6 i Two. Specify color of color thru tile: Submittal Fee $ � i'- ' Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Technology Fee $ Structural Reviews $ Radon Fee $ Training/Education Fee $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 12 G . 1 (Reviseeo2/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address En State Zip Tip 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 - 6) OWNER o GENT The foregoing instrument was acknowledged before me this 2>,O day of (2)(`�rJ20 � J by � who is personally known to me or w as produce W — as identification and who did take an oath. NOTARY PUBLIC: Sign: 1. Print: c \<< Seal: ^-------- LUZ P. ERLICH MY COMMISSION # GGI"7 EXPIRES Mav 30 m22 APPROVED BY Signature CONTRACTOR The foregoing instrument was acknowledged before me this day of r �K.( . 20by Ynci V AX,who is rsona kno to me or who has produced identification and who did take an oath. NOTARY PUBLIC: as Sign: Print: Seal: '"° LUZ P. ERLICH MY COMMISSION # GG199267 EXPIRESMay 30. 2022 sssssssssssssssssssssss s ssssss Plans Examiner Zoning (Revised 24/2014) Structural Review Clerk ONLY ELECTRIC COMPANY, INC. 348 NW 102°"d TER PLANTATION, FL 33324 305-785-6059 Date: ,D t to � 1 °, State of `f xri` County of M ( <c U,�Z-P Before me this day personally appeared �2_Qz &1(� who, being duly sworn, deposes and says: That he or she will be the only person on the project located at: Contractor Signature Sworn to (or affirmed) and subscribed before me this day of . 20 (9 , Personally know OR Produced Identification Type of Identification Produced Print, Type or Stamp Name of Notary "'� LUZ P. ERLICH MY COMMISSION N OG199267 ���v, EXPIRES May 30, 2022 by ��iv MC�q 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' Comaensation Insurance Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. StaL § 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. State of Florida County of Miami -Dade The foregoing was acknowledge before me this ?O day of , 20—Q-.. ByIa sprodu �� U'�^rf�l`(�'�' who is personally known to me o ced as identification. Notary: - LUZ P. ERLICH MY C0MI►NSiM r 0Gl9M7 SEAL: E EX?MN: MW lo, 2W