EL-19-2581Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
�1'��IUiIiJ.li�
Issue Date:11/07/2019
Location Address Parcel Number
155 NW 91ST ST, Miami Shores, FL 33150 1131010000220
Contacts
Permit NO.: L-10-19-2581
Permit Type: Electrical - Residential
Work Classification: Pool
Permit Status: Approved
Expiration: 05/05/2020
JESSICA SIRMANS Owner ON CALL ELECTRICAL CONTRACTORS INC Contractor
155 NW 91 ST KEVIN GILLIS
Business: 7863885880 JORGE@ONCALLELECTRIC.NET
Mobile: 7863458001
Description: NEW POOL Valuation: $ 2,000.00 Inspection Requests:
305-762-4949
Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$1.20
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.40
Permit Fee
$50.00
Scanning Fee
$12.00
Technology Fee
$2.50
Total:
$120.10
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$120.10
Check # 5995
11/07/2019 $120.10
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. I /
Authorized Signature: Owner
/ Applicant / Contractor / Agent
November 07, 2019 Page 2 of 2
Miami Shores Village ENTERED
g OCT 2 9 z»
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
FBC 20L1
BUILDING Master Permit No. Wp— lc)--n-2S �13
PERMIT APPLICATION Sub Permit No. EL-10—l9 --Z5Y1
BUILDING XELECTRIC ROOFING REVISION EXTENSION RENEWAL
F-JPLUMBING ❑ MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION ❑ SHOP
nn C� CONTRACTOR DRAWINGS
JOB ADDRESS: I SS NW "1 I a -
City: Miami Shores County: Miami Dade Zip: MIV)
Folio/Parcel#: I1 • ?A01 • CM - O220 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE:
OWNER: Name (Fee Simple Titleholder): ` 5:S CG Si Y i'Y am Phone#:
Address: all
City: State: L . Zip: ) o
Tenant/Lessee Name: Phone#:
Email
CONTRACTOR: Company Name: On Coil EV'Y I Phone#: -Ali • �.FS �(�j
Address: _—ILM W �}�h <zd ' 111
City: RictrVll State: Fi.. Zip: ?r31`LCD
Qualifier Name: id& 1 n C1- 16 Phone#: —'M(D • 164S•4001
State Certification or Registration #: ey-ow0 a-1 Certificate of Competency #:
DESIGNER: Architect/Engineer:
Address:
Phone#:
City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: 4�v Addition,," ❑ Alteration ❑ 1New ❑ Repair/Replace ❑ Demolition
Description of Work: (;1► I (%Dj ky pkw goo t
Specify color color iI ru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $ CO/CC $
DBPR $ Notary $
Double Fee $
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $
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�f such posted notice, the
inspection will not be approved and a reinspection fee will be charged. //
�l Signature , 49�Signature �/
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
15+— day of 0-[L16f,-- 20 �, by
—SSti C_ S) !9 ,Q , who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Print:
Seal: ;, *!"N.,' GLADYSBORGES
MY COMMISSION I GG 2717119
p: EXPIRES:: December 17, 2022
: �IFOF �Qt r Bonded Thm NotNy Pd* UndWffl to
The foregoing instrument was acknowledged before me this
1 '- day of G 20 1 '�( by
I&We / C71 Il; who is personally known to
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: a 6A
R` GLADYS BORGES
Seal: MY COMMISSION # GG 271M
EXPIRES: December 17, 2M
odFo.•' g« NotW Public Undemkm
#############p#########################################
APPROVED BY ,5�A -310 l/ Plans Examiner
as
#############
Zoning
Structural Review
(Revised02/24/2014)
Clerk
Miami hores illage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795,2204
Fax: (305) 756.8972
Notice to owner -- worKers, Lompensation 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 1.0 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
1 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. Constntction 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. J
Signature:
ner
State of Florida
County of Miami -Dade
The foregonlg was acknowledge before me this
By /e&s�CCi_,./y`�,a�
Notary:
SEAL:
�— day of /y�y2Gh �Qv' , 20 !`?.
who is personally known to me or has produced
as identification.
MYD%#M10N / GG 2717W
8atded TWO