EL-12-20-2883Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address Parcel Number
9310 BISCAYNE BLVD, Miami Shores, FL 33138 1132060141610
Contacts
�m Inspection Requests:
Description: ELECTRICAL FOR RELOCATE EXISTING EQUIPMENT. Valuation: $ 500.00 y
Total Sq Feet: 0.00
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
12/15/2020 $50.00
Credit Card
04/22/2021 $60.30
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 Jisurate-.and that all work will be done in compliance with all applicable laws
regulating construction and zoning. Futhermore, I authorize the a e n d Ic; cto to do the work stated. 'j
,z\
Authorized Signature: Owner / Applicant / Contractor /I i Date
i
April 22, 2021 Page 2 of 2
Miami Shores Village1�EwE�
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 Q ELECTRIC ❑ ROOFING
FBC 20 t -t
Master Permit No w^ ! ZU `,
Sub Permit No. -�-'- 12
` cif Sub `��
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
5JOB ADDRESS: �� Q �"�5 CA e (/
City: Miami Shores County: Miami Dade Zip: 33/ 3 7
Folio/Parcel#: /t - 3{Z b 6 - ON - 1610 Is the Building Historically Designated: Yes NO h'
Occupancy Type: Sid Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 3 0 A, f�C Phone#: 6 Z - �Z
Address: S 4 /t d
City: ft eN Syw-y t State: Zip: 3 3 c/
Tenant/Lessee Name: Phone#:
r i r
Email
CONTRACTOR: Company Name: Dayron's Electric Inc. Phone#: 786-216-5679
Address: 16138 SW 154 CT
City: Miami State: FL Zip: 33187
Qualifier Name: Dayron Yanes Phone#: 786-216-5679
State Certification or Registration #: J^C Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: tt 1 J� City: State: Zip:
Value of Work for this Permit: $ 500 .0 ® Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: ?Lpqj �u k *kca ki 4 e�lSC�chhk. LQr oly I�CCO�iEr �C C9 �1�
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
(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.....
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 the n tice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to atto h ent. mo, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which cc rs s e (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approv a d a r i ection fee will be charged.
Signature Signature
WNER or AGENT CONTRACTOR
The foregoing instr ment was acknowledged before me this The foregoing instr ent was acknowledged before me this
day of Cnaaai-- 20 z� . by day of 20 �?.O, by
itG¢O�S Ae dM who is personally known to '' C who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOT^ov ei im ar.
Sign
Prini
Seal
NOTARY PUBLIC:
Sign:
Print:
Seal: 17-Z `e
**********s*******.**:**#•**«s**s****:*****:**s****ss********sr*m**r**sr*ss*****.***.**********•**■*********
APPROVED BY 41/ e �iJ �2Plans Examiner % '� Zoning
Structural Review Clerk
(Revised02/24/2014)
�DAYRON'S
L!JELECTRIC INC
Date l Z—`
State ofT�urtd C
County of�� ` � C16c
Before me on this day personally appeared D ion 'i o me S Who, being duly
sworn, deposes and says:
That he or she will be the only person working on this project located at q t` L' l'a LczA c
Sworn to (or affirm) and subscribed before meZ Q_ day of l _20_ZL
BybNal O �01►'Yl CS r
Personally Known k_
Or produced Identification
Type of Identification
q
OAIMARYS MOLINA
COMMISSION # HH 053223
EXPIRES: October 24, 2024
dad TMu Notary Pulft Uw wrkam
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 allow to wo k on your project. In these circumstances, Miami Shores Village does not require verification of
workers' compensation n$uran e coverage from the contractor's company for day labor, part-time employees or subcontractors.
BY SIGNING BELO YO ;ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS. j
Signature:
Owner
State of Florida
County of Miami -Dade
ei
The foregoing was acknowledge before me this day of l 20
By YC--C C �,' who is personally known to me or has produced?Val
as identification.
E:�
DAIMARYS MOLINA
My COMMISSION # HH 053223�V p�ww��Ew^XA�PIRES:Ocfter24,�2,0�2�4440P: W i RICV ThN NOf81y rub• UwW em