EL-19-891Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
117 NW 103RD ST, Miami Shores, FL 33150
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Issue Date: 05/01/2019
Parcel Number
1121360131570
Permit NO.: EL-WI9-891
Permit Type: Electrical - Residential
Work Classification: Alteration
Permit Status: Approved
Expiration: 10/21/2019
VINCENT LEVROS Owner FARADAY ELECTRICAL CONTRACTOR INC Contractor
117 103 JEAN CHARLES FRITZ
10640 LAGO WELLEBY DR, SUNRISE, FL 33351
Business: 9549806128
Description: A/C CONNECT. POWER TO CONDENCING UNIT Valuation: $ 4,200.00 Inspection Renests:`s '_762 4949
Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$3.00
DBPR Fee
$2.21
DCA Fee
$2.00
Education Surcharge
$1.00
Permit Fee
$97.00
Scanning Fee
$3.00
Technology Fee
$3.68
Total:
$161.89
Payments
Date Paid Amt Paid
Total Fees
$161.89
Cash
05/01/2019 $111.89
Credit Card
04/24/2019 $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.
OWNERS AFFI
regulating
f: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
i and zoning. Futhermore, I authorize the above named contractor to do the work stated.
R � '//6 V,( V1 13 1� V1 AK2 -d
Owner / Applicant / Contractor / Agent Date
May 01, 2019 Page 2 of 2
Miami Shores Village
APR 2 4 % :3
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY:
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 2di
BUILDING Master Permit No. l" C 03` Jq —G14
PERMIT APPLICATION Sub Permit No. F-�L- 04 - J `f - gili
❑BUILDING �LECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS CHANGE OF CANCELLATION ❑ SHOP
7 , I 1 CONTRACTOR DRAWINGS
JOB ADDRESS: I rl !�1 «� I ��� S) ,(-e-6
City:-1 Miami Shores County: Miami Dade Zip:
Folio/Parcel#:' l I ' ;1 J V b 13-1 I5 a • • Is the Building Historically Designated: Yes NO
Occupancy Type: ''`a Load:
OWNER: Name (Fee Simple Titleh
Address: 1" 0 1-cvte-A
Construction Type: -flood Zone:
BFE: FFE:
ne#: CO- - �J '(p (P / 0
City: �I�i �� Stater Zip:
Tenant/Lessee Name: Phone#:
Email: /V I
CONTRACTOR: Company Name:tjg
Address: D
City:
Qualifier Name:
State Certification or Registration #:
ne#:
Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition erti ❑ New ❑ Repair/Replace
Description of Work: 'A k D,,,.,a
Zip:
❑ Demolition
Specify color of color t ru tile:., ,,. , `.
Submittal Fee $ i Permit Fee•$ CCF $ r• CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $
Structural Reviews $ _
Double Fee $
Bond $
TOTAL FEE NOW DUE $
L
(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.....
Y
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."
r'
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law br re will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of comme cem nt must b ted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued- In t abs nce such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signatu '
OWNER or AGENT
The foregoing instrument was acknowledged before me this
Z day of 1If'e l 120 /7 by
who is personally known to
me or who has produced as
CONTRA105TOR
The foregoing instrument was acknowledged before me this
Z' day of 20._—% by
is personal own to
me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: c Sign:
Print:,, - Print,,/
AYE
Seal: .MY OOmmISSIONN Seal: =' : p', MY COMMISSION # FF241814
(401) fta I EXPIRE # FF24�814 'e�►' :' EXPIRES June' 18, 2019
1,53 F aN 1$• 2019 401t3"-0,53 Flonaallota,
ota �Nkb Y orvice.00n
�
APPROVED BY `I Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014) y ! 106
Miami hores 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:
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,,M percent ownership;.
2. The officer is listed as an officer of the corporation in &' Tecbrds 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
CONTENT%
Signature: r
Owner
State of Florida
County of Miami -Dade
/6
The foregoing was acknowledge before me this day of , 20�.
By V I nCJ)=9=AL13 who is personally_ known to me or has produced
as identification.
N` `p�PpYPVei NANCY LEVROS
r° s State of Florida -Notary Publi
SEA *= Commission # FF 905910
My Commission Expires
August 03, 2019
FARADAY ELECTRICAL CONTRACTOR INC
10640 Lago Welleby Drive
Sunrise, Florida 33351
inchandrew@hotmaii.com
Date: April 25, 2019
State of Florida
County of Broward
Before me this day persbnNly appea�Fritz M. Jean -Charles who deposes and says:
That he or she ill,be th n erson working on the project located at 117 NW 103 Street, Miami Shores,
Florid"3150.A
Fritz M. Jean-Chbrl
Sworn to and Ascribed before me this -f-h day of April, 2019 by Fritz M. Jean -Charles who
is personally known to me or produced T-_'�, . ( _ . as identification.
Notary Public, State of Florida