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EL-19-2558Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 ��:,�I11fJJl li? Issue Date:10/30/2019 Location Address Parcel Number 1158 NE 99TH ST, Miami Shores, FL 33138 1132050180130 Contacts Permit NO.: EL-10-19-2558 Permit Type: Electrical - Residential Work Classification: Pool Permit Status: Approved Expiration: 04/27/2020 I SUSAN PINNAS Owner MAS ELECTRICAL CONCRACTORS INC Contractor 1158 NE 99 ST, MIAMI SHORES, FL 331382641 MANUEL SANCHEZ Business: 7863900035 Description: NEW SWIMMING POOL FOR ELECTRICAL Valuation: $ 1,500.00 Inspection Requests: 305-762-4949 TotalSq Feet: 400.00 ==j �.--1 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 $3.00 Technology Fee $2.50 Total: $111.10 Building Department Copy Payments Date Paid Amt Paid Total Fees $111.10 Check # 1509 10/30/2019 $61.10 Check # 1504 10/28/2019 $50.00 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 / gent Date October 30, 2019 11� 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: (305) 762-4949 BUILDING PERMIT APPLICATION ❑ BUILDING Xf ELECTRIC ❑ ROOFING CTI2 S li"!3 [ME F��QQBC 20 Master Permit No. �pp-d`�In i9 a�afG� Sub Permit No. L-10-19 —zsS's ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP / )j� [� CONTRACTOR DRAWINGS JOB ADDRESS: lI 6-g NTT J✓ City: Miami Shores /�� %�County: Miami Dade Zip: 3-0/3� Folio/Parcel#: %1,91 501 YOL 36 Is the Building Historically Designated: Yes NO Occupancy Type: sr— Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder) Address: Address: J/ - A -, City: State: ► L Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: /"lf'1�/ 6C;rXW 6'477tAGTM/t- Phone#: 6 3ra—�3 - Address: � 33 5;LV /3.5 City Qualifier Name: State Certification or Registration #: j5 %z 130140 jq Certificate of Competency #: o e 6©DOo25;4 16( Zip: 5,7)016 hone#: DESIGNER: Architect/Engineer: Phone#: Address Value of Work for this Permit: $ X&AW Square/Linear Footage of Work: State: Zip: Type of Work: ❑ Addition >> ❑ Alteration New ❑ Repair/Replace ❑ Demolition Description of Work: NEG✓ ��O Specify color of color thru tile: Submittal Fee $�� I Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Technology Fee $ Training/Education Fee $ Notary $ Double Fee $ Structural Reviews $ (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE $ (j I• I O 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 and a reinspection fee will be charged. Signature Signature = OWNER or AGENT ONTRACTOR The foregoing instrument was acknowledged before me this d y 20 �_, by w o is personally kn n to me or who has produced identification and who NOTARY PUBLIC: Sign: Print: �r� 1 ✓ Seal: an oath. COAMI�OII;R 6 t�1� "= Expku: Mwch 20.2023 c BMW Thin As= Nq as The � foregoing instrument was acknowledged before me this 101 day of 2 by "UALPvho is Csonallyn to me or who has produced as identification and who did take an oath. NOTARY PUBrk _ IV � Sign:_ Print: Seal: s**s*s**************ss***�*«***sus*s***s*s*****�*****s*****�******s**s**�***�****�•s�*#*****:ss**s********** n ^Y I ns Examiner Zoning APPROVED BY r'lo^H� �( g 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 Owner -Workers' Compensation 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 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. Signature: weer State of Florida County of Miami -Dade 10) ta The foregoing was VIAVW nowledge before me this day of / , 20�1 By &0�-who i per onally know to me or has produced \ as identification. N cmMi lmoons" SEAL: ?+� EOW 111" 20, 2M BOW01 ft AN= Nolatry MAS ELECTRICAL CONTRACTOR INC 14337 SW 135T" AVE MIAMI, FL 33183 Date: State of County of _Mlaoti dxk Before me this day personally appeared dow who, being duly sworn, deposes and says: That he or she will be the only erson working on the project located at: //0 AJr ip- Contractor Signature Sworn X (or affirmed) and subscribed before me this ,mday of �/Vtl/I .201q by Personally know OR Produced Identification Type of Identific 4 n Produced Pri T pe or Stf Notary _+� * Expires: Ml,Kch Z#'2023 NobrY 8WW -MM Aaron n�a