EL-15-653 Ao � EL- -'1
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Miami Shores Village W't
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10050 N.E.2nd Avenue NE !jn,
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Miami Shores,FL 33138-0000 �
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peftt PROVE #
Phone: (305)795-2204
tonic � �
IseExpiration: 08128/2016
Project Address Parcel Number Applicant
1094 NE 91 Terrace 1132050010380
WATERSEDGE SHORES LLC
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
WATERSEDGE SHORES LLC 1094 NE 91 Terrace (305)336-7100
MIAMI SHORES FL 33160-3313
72 GOLDEN BEACH Drive
GOLDEN BEACH FL 33160-
Contractor(s) Phone Cell Phone Valuation: $ 1,900.00
B.L.F ELECTRICAL INC (786)380-2509
__...... _. Total Sq Feet: 0
Type of Work:SERVICE REPAIR Available Inspections:
Additional Info: Inspection Type:
Classification:Residential Review Electrical
Scanning: 1
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20
DBPR Fee Invoice# EL-2-16-58842
$2.25 03/01/2016 Credit Card $ 110.70 $50.00
DCA Fee $2.25
Education Surcharge $0.40 02/29/2016 Credit Card $50.00 $0.00
Permit Fee-Additions/Alterations $150.00
Scanning Fee $3.00
Technology Fee $1.60
Total: $160.70
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,ME HANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all t e regoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futherm r the above-named contractor to do the work stated.
March 01, 2016
Authorized Signature:, / Applicant / Contractor / Agent ate
Building DepaWr e/ nt Copy
March 01,2016 1
Miami Shores Village CE.� D
Building Department FEB 29 2pl6j
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 I Icy
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 S
FBC 20 j y
BUILDING Master Permit No. I (ei —
PERMIT APPLICATION Sub Permit No.
❑BUILDINGLECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
�
— CONTRACTOR DRAWINGS
JOB ADDRESS: l D qy 111 'E- q1 l P(Z&d
City: Miami Shores County: Miami Dade zip: -,?73/3 1?
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): e f A,�,q 4)0/ ZI C Phone#: 3 US-
Address: 172 delviy 1y/4C DR,
City: State: ! l Zip: 33/e 4)
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: /" ��(�!G_ _ Phone#: 7W 71p `ff3 5
Address: /7.50 W Y_(o ST_
City: / r State:
�
• 4 zip:_ _33Qlz
Qualifier Name: 1� ��'t�� L�A4Ah — Phone#:
State Certification or Registration#: `'�/3 00 5465 Certificate of Competency#: �-
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$_/ '� b� Square/LinearrFF000tage of Work:
Type of Work: ❑ Addition ❑ Alteration 1:1New [ Repair/Replace ❑ Demolition
Description of Work: vsyic-e 12�,
1— IS — 18 2 �`a
1
Specify co
4e-- '3"M 0 T 4ldy 14,0,v�
, a
Submittal Fee sog aat iyF + `"` %���Ol� CCF$ e ; -CojCi $ v
*,�s3 -nme to . s
Scanning Fee
,.zwon 6e�e a ¢¢' �� DBPR
Technology F dation Fee$ Double Fee$
Structural Reviews$ Bond$ pp HH�
TOTAL FEE NOW DUE$ 0 Il C
(Revised02/24/2014)
' is;
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 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 o condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien low brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. in the absence of such posted notice, the
inspection will not be appy ed and a 'nspection fee will be charged.
Signature Signature
OWNER or CONTRACTOR
The foregoing instr ent was acknowledged before me this The foregoing instrument as acknowledged before me this
day of Lae/2 0 20 by Z 17 day of 20 C � by
Qldr 0,/-, who is personally known to (0 hiuQ,I,'nu'[f/ tlAAP-4 6-.a ,who is personally known to
me or who has produced�LU� _j��"S-(� as me or who has produced /'L ( J/°�f�2 l��a5f as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC-)
Sign: Sign:
Print: I,$ Print:,V 7
Seal: Seal:
YINET CAMPBELL
= NOWY Public-State of Florida ,.; '�, VOW CAMPBELL
%.Fos F�.•� GOMMISSIOD#FF 173169 ,n My Comm.Eq"Oet 30.2416
APPROVED BY ®® Plans Examiner .4;.�t••••� Commisaio 0 FF 173169 Zoning
Structural Review Clerk
(Revised02/24/2014)
BLF ELECTRIC INC
Date
State ofd
County of -���L' -----
Before me this day personally appeared �Ll �if2�`� �` Who,being duly swom,deposes and says
That he or she will be the only person working on the project located
Sworm to or affirmed and subscribed before me this day of .20 ,b Vig Ldtl�W6
Personally Know ------------
Or produced identification------ ------ ---
Type of identification produced
Print, mp NaWW&MC
s, a MY CNN.Esq Oct3114 M
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• 5H01
y9� Dr
,,?, Miami shores Village
-- -d-* Building Department
�OR1Up 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 ACKNOW EDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
Owner
State of Florida
County of Miami-Dade /
The foregoing was acknowledge before me this-day of Fp-ku',cU ,2016
Byryt�« 1<41i77 who is personally known to me or has produced
� C,_e C, as identification.
Notary: r !
S Notuy l -State of Florida
SEAL: :s,,r c My Comm.Fxpkes tkt 30,2018
FOF Ftp Commission#FF 173169