EL-19-1418Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address Parcel Number
374 NE 104TH ST, Miami Shores, FL 33138 1121360130170
Contacts
Permit NO.: EL-06-19-14"
Permit Type: Electrical - Residential
Work Classification: Addition/Alteration
Permit Status: Applied
Issue Date: 1 Expiration: 12/17/2019
MARIE MYRTHA WROY Owner FARADAY ELECTRICAL CONTRACTOR INC Contractor
374 NE 104 ST, MIAMI SHORES, FL 331382018 JEAN CHARLES FRITZ MYTHO
10640 LAGO WELLEBY DR, SUNRISE, FL 33351
Business: 9549806128
Re
Description: UPGRADE ELECTRICAL PANEL ACCORDING TO Valuation: $ 4,000.00 Requests:
Inspection tion Re
APPROVED PLANS
TO REPLACE EL-2-18-372. Total Sq Feet: 0.00
Fees Amount
50% Renewal Fee $62.50
Application Fee - Other $50.00
Total: $112.50
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$112.50
Credit Card
09/03/2019 $62.50
Credit Card
06/20/2019 $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.
90
Owner / Applicant / Contractor / Agent
September 03, 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: (305) 762-4949
BUILDING
PERMIT APPL TION
❑BUILDING ELECTRIC ❑ ROOFING
❑PLUMBING ❑ MECHANICAL E]PUBLICWORKS
JOB ADDRESS:
-+ C-.
E.
JUN 0 20 9
IV:_ ,�'I.
FB�C 20
Master Permit No. Q
(/. �'05-Sub Permit No. -06-- H -
❑ REVISION qj /EXTENSION ❑RENEWAL
CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):! %�APhone#: O I/
Address: 4,1
City: 00 State: Zip: c� /r
Tenant/Lessee Name: Phone#-- r% o/E'?3
Email:
CONTRACTOR: Company Name: j, Phone#:� 21U
Address:[P 2
City: State- Zip: 7 S~
Qualifier Name: C` Phone#: Z
State Certification r Reg ration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City:' ��+� _ Stat
Value of Work for this Permit: $ Square/Loo ' e ine�r;Fof Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New - Rep if/Rep ce
Description of Work:
cicl�
Specify color of color thru tile:.
rnrn
Submittal Fee $ 1 Permit Fee $ OIa5l 0D CCF $_
Scanning Fee $ Radon Fee $ DBPR $
Technology Fee $ Training/Education Fee $
Structural Reviews $ _
Zip:
❑ Demolition
i nit TD r0v�FCl Uvs
CO/CC $
Notary $
Double Fee $
Bond $ /
TOTAL FEE NOW DUE $ (e
(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 I T 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 broch r will be deli red to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commence n mu a po ted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the b en of such posted notice, the
inspection will not be approved and a reinspection fee will be charged. A /1
Signature Signature Rlll�&/
OWNER or AGENT CO OR
The foregoing instrument w acknowledged before me this The foregoing inst fument was acknowledged before me this
l�JON nday of 20 J by �day of rhn' 220 J by
who is personally known to 1?— f - o ih` s personally known to
me 7s4�u o has produced �eyj V as me or who has produced �(_ �Jyer as
A . i._
a d w did take an oal����� Y PR/":.irl////
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Print: l (� *1� L �•••'q�Z�eOndeatt``o
Seal: ///aUC,•STA'���
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Sig
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:*****************•r***************************s**s****r**•********r*****************s***srr**•s**:•s****s
APPROVED BY O_9-uA-" Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Faraday Electrical Contractors, Inc
4952 NW 20 Avenue, # 8
Miami, FL 33127
Affidavit to Owner
Date: August 13, 2019
State: Florida
County: Miami Dade
Before me this day personally appeared Fritz M. Jean -Charles who, being duly sworn, deposes and says:
That he will be the onl person work' g on the project located at: 374 NE 104 Street, Miami Shores, Fl.
33] 38. I \
Sworn to (or affirmed) and subscribed Before me this 30 ILI
day of AU Su 2019.
Personally Know
Or Produced Identification
Type of Identification Produced
MARIE MYRTHA WROY
-' •'E MY COMMISSION A 00030325
EXPIRES September 14. 2020
Print, Type or Stamp Name of Notary
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:
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.
Sign
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this day of V h 20_�t.
By'' l i W o O v( who is personally known to me or has produced
LLt h S` I as identification. \111„111111//���
PRIETp v4z,�V
Notary: 4!11.� -Lz;°!pF
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SEAL:
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