EL-11-20-2529Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address Parcel Number
730 NE 94TH ST, Miami Shores, FL 33138 1132060141690
Contacts
MARTA GIERCZYK Owner Marta Gierczyk Applicant
730 NE 94 ST 730 94th ST NE 730, Miami Shores, FL 33138
Mobile: 305-639-0194 MARTAGIERCZYK@GMAIL.COM martagierczyk@gmail.com
SUNSHINE ELECTRICAL CONTRACTORS Contractor
CORP
MARIANO SANTIESTEBAN
1300 SW 85 CT, MIAMI , FL 33144
Business: 3052654958
Home: 7864439590
Other:7862736194
Inspection Requests
Description: KITCHEN REMODEL REPLACE CABINETS COUNTER Valuation: $ 1,000.00 30S 49�I9
TOPS, ADD TILE Total Sq Feet: 116.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$0.60
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.20
Permit Fee
$50.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$110.30
Payments
Date Paid Amt Paid
Total Fees
$110.30
Credit Card
11/20/2020 $110.30
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 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.
Authorized A nature: Owner / Applicant / Contractor / Agent Date
November 20, 2020 Page 2 of 2
BUILDING
PERMIT APPLICATION
❑BUILDING -S] ELECTRIC
Miami Shores Village PIE: EIVEID
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 Gj
FBC 201
Master Permit No. _t. — 7 2 C7
Sub Permit No.
ROOFING REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:'
Folio/Parcel#:
Miami Shores
iami Dade
Is the Building Historically Designated: Yes NO_
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): ��+(�� v1�C-� )� Phone#:
Address: �� Ci
City: )('V\\ ��kl� �� , State: Zip: 'T�j1-!) V
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:
Address:! <_y ,D .r-3 j L
e#:
City: rV C: State: Zip: 915 1 ` "—A
Qualifier Name Phone#: az;� so +A 35 f 5 0
State Certification or Registration #: Q--- (�� �� Cy"�} Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ -.VO10 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
j �-
Description of Work:'• K '4 r� a S cci�1 ��
Specify color of color thru tile:,
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $_
DBPR $
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ ''O •3
(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
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.
Signatur t
a
WNER or AGENT
The foregoing instrument was acknowledged before me this
day of n�J , 2 ? , by
�{ L2' ho is personall_ v known to
Signatur C GrYiic
CONTRACTOR
The foregoing instrument was acknowledged before me this
day ofYVIJ 20 C" by
�,y G
1 1P2( Cfl� J��1 b� ^� who is personally known to
me or who has produced as me or who has produced _ak
identification and who did take an oath. identification and who did take an oath ry Public Sate of Roma tl,
NOTARY PUBLIC: NOTARY PUBLIC: r tUn GG 962953
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Print: Print:
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APPROVED B z� Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Local Business Tax Receipt
Miami —Dade County, State of Florida
-THIS IS NOT A BILL - DO NOT PAY
4860764
BUSINESS NAME/LOCATION
SUNSHINE ELECTRICAL
CONTRACTORS CORP
1300 SW 85TH CT
MIAMI, FL 33144
OWNER
SUNSHINE ELECTRICAL CONTRS
CORP
rin MARIANn RANTIPATPRAN
Worker(s) 1
RECEIPT NO.
RENEWAL
5073093
SEC. TYPE OF BUSINESS
196 ELECTRICAL
CONTRACTOR
EC13005807
LBT
EXPIRES
SEPTEMBER 30, 2021
Must be displayed at place of business
Pursuant to County Code
Chapter 8A - Art. 9 €i 19
PAYMENT RECEIVED
BY TAX COLLECTOR
75.00 09/2212020
ECHECK-20-247919
This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license,
permit or a certification of the holder's qualifications, to do business. Voider must comply with any governmental
or nongovemmentaf regulatory laws and requirements which apply to the business.
Muft The RECEfPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sac ga-276.
MI�AM� For more information, visit www raiamidade.ggvttexcolleetor
SUNSHINE ELECTRICAL CONTRACTORS
License #13005807
Phone # 7864439590
Date:
State Of Florida
County:
Before me this day personally appeared ��1 `mac, n� Who being duly
sworn, deposes and says:
That he or she will be the only rson working in the project located at
()�� 11� IDN 5T
Contractor Signature
Sworn to (or affirm) and subscribed before me this�� --
By r V\A C/l-C>
v u
a''
Notary Public State of Florida
f�rsuiNa , to
G 562853
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con,,;, Ran
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day of ri.'lj 20
Personally Know
J
/ .
Or produced identification
Type identification Produced
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.
s
Signatu �.1..:W ,, w i
O 4er
114
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this day of nQ0 , 20-2-7 .
/
By 00 t G � t-� �r (�2'1 (� who is personally known to me or has produced
as identificatio,,� �.
Nit / Pubii . S ate of Flora
Notary:
.yn GG 962853
c G.i/20/s:024
SEAL: