EL-12-755 Y �
p Miami Shores Village RECEIVES
Building Department APR 3 02012
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY:
Tel: (305)795.2204 Fax:(305)756.8972
l� INSPECTION'S PHONE NUMBER:(305)762.4949
�l(C) ,
BUILDING Permit No. FL q'-Iss
PERMIT APPLICATION Master Permit No.
FBC 20 IC-)
Permit Type: Electrical
OWNER:Na a(Fee Simple Titleholde ):�1 V ®�l���t Phone#:�
Address:
City: State: ' Zip:
Tenant/Lessee Name: Phone#:
Email:
JOB ADDRESS: 20 k) i I
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: - 10-00'
Is the Building Historically Designated: Yes N', '^ Flood Zone:
CONTRACTOR:Company Name: / 1` .. Phone#.-7 6-2`73-�Z�4)
Address: 8�2
City: o,wu �0.r�� v� State: t"L , �! Zip:33
Qualifier Name: s� �C LI C�-�tCJ� ¢Phone#: 6-2 7 3"t j 0
State Certification or Registration#: Ce/3 Q 12-7 Certificate of Coin ncy#: b 30%000 2 0
Contact Phone#:]?2r'2 73-/2 7® Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit:$ ` - Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ❑New epair/Replace ❑Demolition
Cl
Description of Work: SeAr-U( 0 106f-C&
4 (A S T) / 9�t.F'
Submittal Fee$ Perinit Flee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$ i
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
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 ELECTRICAL WORK,PLUMBING, SIGNS,
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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.
Signatures Signatlure`�V �—b
Owner or Age` Contractor
The foregoing insLwment was ackwled ed before meth's The foregoing instrument was acknowledged before me this
day of 20 ,by , � 1 , day of 3 20�,by [1 I,
who is person ly known to me or who has produced who is personally known to me or who has produced
Ute
j60
s identification and who did take an oath. '(V 4 -L CitLvias identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC-
Sign: ;Sign:
Print: E —LLY _ 6 D W(L).7 if LS ]Print: �l sal Gni ll e
` ••°B�% KETUEKDAM
My Commission Expires: l v MY CObBylISSION f EE 11Corrlmission Expires:
EXPIRES:October 17 2015
mr9�oF�pPv0P Botb¢dThN&dgetN�eryb :uY�� JEAN 0.ACHILLE
,.off', Bonded Thru Notary Pubk Urdarwrbm
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 07/10/O7)(Revised 06/10/2OO9)(Revised 3/15/09)
AC# STATE OF FLORIDA
DEAR O H S PSA S N RE TION
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f'
C,TQB
BUSINESS CERTIFICATE OF COMPETENCY f
03E000904
MK.WUD ELECTRICAL SERVICES INC
D.B.A.::
MICHAUD FITZROY
Is certified wider the provisions of Chapter 10 of nMertd-Darr Co�edSr
MIAMI-DADE COUNTY 2011 LOCAL BUSINESS TAX RECEIPT 2012 FIRST-CLASS
TAX COLLECTOR MIAMI-DADE COUNTY-STATE OF FLORIDA U.S.POSTAGE
140 W.FLAGLER ST. EXPIRES SEPT.30,2012 PAID
let FLOOR MUST BE DISPLAYED AT PLACE OF BUSINESS MIAMI,FL
MIAMI,FL 33130 .,
' PURSUANT TO COUNTY CODE CHAPTER.SA•ART:9 rk 10' PERMIT NO.231
506430-8 THIS Is HOT A DILL-Igo I'OT PAY RENEWAL
9UffESSAI�"�� '&AL SERVICES INC CC sRE`tE�'8o904 528945-9
3388F82 NW 207 ST RD
33055 UNIN DADE COUNTY
O8HAUD ELECTRICAL SERVICES INC
"tirfi t'MICAL CONTRACTOR WORKEl/S
,IS IS ONLY A LOCAL
ISWESS TAX RECEIPT.IT
)ES NOT PERMM T THE
)LDER TO VIOLATE ANY
ISTINO LATORY OR
MNG �AWWS OF TM DO NOT FORWARD
)LINTY OR CITIES. NOR
)ES IT EIIEYPT THE
)LDER FROM ANY OTHER MICHAUD ELECTRICAL SERVICES INC P
RMBT OR LICENSE FITZROY H MICHAUD PRES
.QUIREO eY LAW.Trus IS
)T A CERTIFICATION OF 3882 NW 207 ST RD
IE HOLDER'S QUAL(FICA-
)NIL MIAMI FL 33055
,YNENT RECEIVED
AMB-DADE COUNTY TAX
"09/27/2011
02220023001
000075.00 146
SEE OTHER SIDE
MIAMI-DADE COUNTY, 2011 MUNICIPAL CONTRACTOR'S 2012 FIRST-CLASS
TAX COLLECT& TAX RECEIPT U.S.POSTAGE
140 W.FLAGLER ST. MIAMI-DADE COUNTY-STATE OF FLORIDA PAID
1st FLOOR PURSUANT TO COUNTY CODE SEC. 10-24 MIAMI,FL
MIAMI,FL 33130 EXPIRES SEPT.30,2012 PERMIT NO.231
THIS IS NOT A BILL—DO NOT PAY
RECEIPT NO. 30-5289459 CC NO: 03E000904
BUSINESS NAME/LOCATION RECEIPT HOLDER MAY DO
BUSINESS AS A CONTRACTOR
MICHAUD ELECTRICAL SERVICES INC AS SPECIFIED HEREON.
3882 NW 207 ST RD
OWNER :MICHAUD ELECTRICAL SERVICES INC
I
SEE BACK OF RECEIPT FOR ELECTRICAL CONTRACTOR
A LIST OF NON-PARTICIPATING
MUNICIPALITIES
DO NOT FORWARD
Receipt holder must
-egister in the city
Nhere work is to be MICHAUD ELECTRICAL SERVICES INC
Jone. FITZROY H MICHAUD PRES
3882 NW 207 ST RD
PAYMENT RECEIVED MIAMI FL 33055
AIAMI-DADE COUNTY TAX
:OUECTOR:
09/27/2011
02220023002
000200.00 15
PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE
STATE OF FLORIDA IMPORTANT
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS'COMPENSATION Pursuant to Chapter 440.051141, F.S., an officer of a corporation who
CONSTRUCTION INDUSTRY elects exemption from this chapter by filing a certificate of election
CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA L under this section may not recover benefits or compensation under this
WORKERS'COMPENSATION LAW D chapter.
EFFECTIVE: 04/05/2011 EXPIRATION DATE: 04/04/2013 Pursuant to Chapter 440.051121, F.S., Certificates of election to be
PERSON: FITZROY H MICHAUD H exempt.. apply only within the scope of the business or trade listed on
FEIN: 043766387 E the notice of election to be exempt
R
BUSINESS NAME AND ADDRESS: E Pursuant to Chapter 440.051131, F.S., Notices of election to be exempt
MICHAUD ELECTRICAL SERVICES INC and certificates of election to be exempt shall be subject to revocation
3882 NW 207 STREET RD if, at any time after the filing of the notice or the issuance of the
OPA LOCKA, FL 33055 certificate, the person named an the notice or certificate no longer meets
the requirements of this section for issuance of a certificate. The
department shall revoke a certificate at any time for failure of the
SCOPE OF BUSINESS OR TRADE: person named on the certificate to meet the requirements of this
1- REGISTERED ELECTRICAL CONTRACT section.
QUESTIONS? (850) 413-1609
CUT HERE
* Carry bottom portion on the job, keep upper portion for your records.
OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11