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EL-15-1968 Miami Shores Village Buildi g Department L 2016 10050 N.E.2nd A enue,Miami Shores,Florida 33138 � 16Tel:(305) 5-2204 Fac(305)756-8972 INSPECTION LIN PHONE NUMBER:(305)7624849 FBC 20 BUILDING Roaster Permit No. ;?a-6- /5-43 3 PERMIT APPLICATION Sub Permit No. - BUILDING grELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION RENEWAL [-IPWMBING ❑MECHANICAL ❑PUBLIC WORKS M CHANGE OF ❑cANc£LLATION ❑SHOP CONTRACTOR DRAWINGS jos ADDRESS: l /6,5 5f City: Miami Shores County: Miami Dade Zip: �3 Folio/Parcel#: fl9:3!?i921f0 A9 is the Building Historically Designated:Yes _ NO Occupancy Type: Load: Construction Type: Flood Zone: SFE: f FFE: 4111 OWNER:Name(Feee Simple Titleholder): NQ40 J?e1f7� f'+i{/�G?l}t��� P#tone#:✓ ��(���>���%�12 Address:�/A�'m1'�' c��!(/� City: ln!/ / y LAS State: —Flalg1lipw Zip: j r Tenant/Lessee Name: I Phone# Email: CONTRACTOR:Company Name: �®1nA gaLQJ1PYJ71V1t91) Phone#: ��– Address: .9a.L) � �� City: State: Zap: 1�� Qualifier Name. v Phone#: State Certification or Registration#: /��6 � Certificate of Competency#: i DESIGNER:Architect/Engineer: Phone#: i Address: City: State Zip: Value of Work for this Permit:$ Squarre/linearof WortG Type of Worlc 13Addition Alteration ❑ New Repair Replace ❑Demolition Description of Work: I Specify color of color thru tile.- submittal ile:submittal Fee$ Permit Fee$ CCF$ co/cc$ Scanning fee$ ( Radon Fee$ DSPIR S Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ i Structural Reviews i Bond$ TOTAL FEE NOW DUE$ (Revised02/24,/2614) I I Bonding Company's Name(if applicable) Bonding Company's Address city State rip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zap 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$2500,the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment: Also,a certified copy of the recorded notice of commencement must be posted at the job site for the,first inspection which occurs seven (7) bays after the building permit is issued in the abjence of such posted notice, the inspection will not be approved and a reinspection fee will be charged Signature Signature OV11NER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this +s day of_ ' c�^� .i�'1 ,20 i W by da of t_�y '20 & by � t7YtG4�'�C {' 'YYYAVI- who is personally known to who is personally known to me or who has produced f'YPyy.h Pck'_t as me or who has produced r S!j as identification and who did take an oath. identification and o did to an h. NOTARY PUBLIC NOTARY PUBLIC Sig :_ Sign- Print i Y �.k��a IDA S RUI Print: oar Seal. EXPIRES:DEC 30,2018 Sea! LAkU�EP4lt t"��'+°`1 fl7i ,y 4 C.. ti :i ° Bonded through 1st State Insurance lam„" ar#}4_Lr}+k+p ssc�w .s$���iwwP+rbRe��Plc►7F.�!f°�7s�K?+d?��.arw_}�}MPM#}W k F##W#}+sisr�rF#W i W####W MP#F aPM##ilt+trf.#+Mf##W+k#M+k W W tBoc##s W W W+k#it#s APPROV ��/�� Plans Examiner Zoning Structural Review Clerk IReVLWd02/24/2024) r 1rilallll 011V1 GJ V 111agu Building Department g .. _ 90050 N.E.2nd Avenue,Miami Shores,Florida 33138 Fj 2 6 U16 Tel: (305)795.2204 Fax: (305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 BY: -ell FBC 20(1,4 BUILDING Permit No. l.4,� PERMIT APPLICATIO Permit Na��—, �I� CP M� Permit Type: EleetrieW JOB ADDRESS: 146 /"C7 !06, sT City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Flood Zone: OWNER••Name(Fee Simple Titleholder): W d 14e�1l� Phone# Address: 65®o dey 16® st _ �T City: /,�I e lAk Aa V State: Tenant/Lessee Name: Phone#: Email: t�JQCONTRACTOR:Compaq Name: Phone#: �,a-3 3" "3J- Address: G 1 ?U-) t A V —0 At City: 6 A-k S 1" L Zip1: 3 l Qualifier Name: n Phone#: State Certification or Registration#: 13 0®6 Certificate of Competency#: Contact Phone#: �ZJr� l ZAP Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit:$ ���t/®� Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ONew *pair/Replace ODemolition Description of Work: Submittal Fee$ Permit Fee$ '1"�/� CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ 5 - 63 Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ � o Bonding Company's Name(it 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. 1 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 abse7 f of such posted not' e, the inspection will not be approved and a reinspection fee will be charged Signature Signature 'f ,,,Owner or Agent Contractor The foregoing instrument was ackn®o�wledg �be/for me th/is�� The foregoing instrument was acknawl ed before day of ,20�,by/ U �G��6 day of 0 ,201,x,by Zufi,6�5 who is personally known to me or who has produced who is pet,onally known to me or who has produced a i 'on and who did take an oath. as identification and who did take an oath. NOTARY P "�''�. GLEYSIS IGLESIAS NOTARY Notary Public-State of Florida a oQc My Comm.Expires May 9,2016 Sign: k�o ��p:' Commission#EE 197151 , IS RUIZ Print: S r s Print: EC My Commission Expires: �y 9 ®,� My Commission APPROVED BY L/3 Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06f10/2009)(Revised 3/15/09) OREs Miami shores Village NINE Building Department R`IDA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N. Owner's Name (Fee Simple Title Holder): � � ���� 4®'� f�AY-Aone#: Owner's Address: //LJNC- �0 City: w*s-i e-1 State 'c4_ Zip Code: 0 946 Job Address (Of where work is being done): City: Miami Shores State:—Florida Zip Code: d �� Contractor's Company Name: �/"�Pa �r~il C h( Phone#: ��'-o�-LJ _9 /8 Address: � E6 14 SI City: LtF a t 6-H AGc f S' State: Zip Code: Qualifier's Name: 1/S'Ta✓i D3 CQ g Lic. Number: U 0 DL/ J: Architect/ Engineer of Record Name: Phone#: Address: City: State: Zip Code: Describe Work- 1 hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hold the Building Official and the i Shores harmless of all legal involvement! s Signature-4/ ��'�; � ��"��� nature `— .- Signature Owner d Agen Contractor or Architect The foregoing instrument was aknow414;JD for a The foregoing instrument was aknowledged before me this� .day of N f ,20/41 �.� �j• this 2.1 day of 02— ,2016 by-�LS-f0 r, 14 Who its personally known tome or w o has produced who is personally known to me or who has produced Olt-iVWS 11'deA 3P as indentification. R` tiPj kEy 0 tEt'4. as indentification. Notary hlic• Notary Pub Sign Elm I Sign: Seal: °• pie,,, Seal: rP �< GLEYSIS IGLESIAS god p�ey� Notary Puolic State of Florida Notary Public-State of Florida Sind P.Ivarez 'g, eQ My Commission FF 156750 My Comm.Expires May 9,2016 ''A ORF,o°� Expires 09103/0201 910 3/2 01 8 Commission#EE 197151 �v Inspection Worksheet _ Miami Shores VillageC 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-255628 Permit Number: EL-8-15-1968 Scheduled Inspection Date:April 01,2016 Permit Type: Electrical- Residential Inspector: Devaney, Michael Inspection Type• Final Owner: FERNANDEZ,STEPHANE Work Classification: Alteration Job Address: 1148 NE 105 Street Miami Shores, FL Phone Number Parcel Number 1122320280140 Project: <NONE> Contractor: CONTRACTORS ELECTRICAL SERVICES Phone: (786)252-1284 Building Department Comments ELECTRICAI REMODEL Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-255513. F P L notified to ET connect electric service for testing. Failed owl Correction Needed ❑ �� Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid March 31,2016 For Inspections please call: (305)762-4949 Page 15 of 32 ,gtto�,c h Miami Shores Village 10050 N.E.2nd Avenue NE � K " 18, Miami Shores,FL 33138-0000 tt/ Phone: (305)795-2204 Expiration: 03/27/2016 Project Address Parcel Number Applicant 1148 NE 105 Street 1122320280140 Miami Shores, FL Block: Lot: STEPHANE FERNANDEZ Owner Information Address Phone Cell STEPHANE FERNANDEZ 1148 NE 105 Street MIAMI SHORES FL 33138- 1148 NE 105 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 3,400.00 MIZPAH ELECTRICAL INC 305-620-2701 Total Sq Feet: 00 Type of Work:ELECTRICAI REMODEL Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $2.40 DBPR Fee Invoice# EL-8-15.56602 $3.38 08/05/2015 Cash $50.00 $422.16 DCA Fee $3.38 Education Surcharge $0.80 09/29/2015 Credit Card $422.16 $0.00 Permit Fee-Additions/Alterations $225.00 Scanning Fee $9.00 Technology Fee $3.20 Work without Permit Fee $225.00 Total: $472.16 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 AFFIDA T: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction an o ng. Futhe ore, authorize the above-named contractor to do the work stated. September 29, 2016 Autho nature: X(ent r ! Applicant / Contractor / Agent ate Buildin Depart Copy September 29,2015 1 7 t ° j Miami Shores Village SEWED Building Department auG 05 2015 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 BY: . Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 x4h FBC 20)9 BUILDING Master Permit No. r-C 6;-/-S —/S PERMIT APPLICATION Sub Permit No.�� ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP p P / < CONTRACTOR DRAWINGS /�C JOB ADDRESS: I r �-( �, L 10 ) ' City: Miami Shores County: Miami Dade Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: !&qA-1dlood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): ka Kg1 1 /52141 a P1 I)-'— Phone#: Address:_ &C-7:f & ' - City: 1Ml�4 y S 0-'r e, State: t'� Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: ////.2 h 141/�L 1F1ei I L ce—' Phone#:30 ` -g'16 `' Address: 'A J City: L,C-I-}1 (;-H t--u--4.& State: 1 Zip: 3`51� 7 �- Qualifier Name: Phone#: State Certification or Registration#: C—c-000A Certificate of Competency#: DESIGNER:Architect/Engineer: 6y, Phone#: Address: City: State: Zip: Value of Work for this Permit:'! �2 U Square/Linear Footage of Work: 1 Type of Work: ❑ Addition ❑ Alteration ❑ New nn Repair/Replace ❑ Demolition t ' Description of Work: Specify color of color thru tile: Submittal Fee$ 5 o Q ec) _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$ -4 2 (Revised02/24/2014) • 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." N,ltice 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 prochure 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 will no, ';e approved and a reinspection fee will be charged. Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of ' 20byday of ,20 by ersonally know to Mkon ll akij lir bn %M,who is personally known to me or who'has produced 4Z-L- dl_ as me or who has produced 'k ht y d'3 L.t C e Kca as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLI NOTARY PUBLIC: %%1111 0!1 j4' ``�����F /ygNy Sign: � .. ••. O �� Sign: Q * % r Prin Q. -A- �- Print: Seal: Seal: J a " v BARBARA A.ESTEP ZjJ•• fFE 2163 ;�`n+�%: *. „ MY COA4MISSION#FF 073975 •.'n,yt^ , ;e EXPIRES:March 29,2016 ���i9`',o• •.....••••Ck.: Bonded 71w Pbtwy Public Underwriters APPROVED BY 5 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) MIZPAH ELECTRIC INC. 512 Poinsettia Avenue Lehigh Acres, FL 33972 239-368-6783 (Business) mizpahelectric a*gmail.com State of Florida. County of Miami-Dade Before me this day personally appeared, f Sfi©n who, being duly sworn,deposes,and says: He is the President of Mizpah Electric Inc. and declares that ll the job addressed as l/ = �� v", 1O1 L be done solely by him. Sworp to"or affirmed"and subscribed before me this day of ,2015,by Personally known : Or produce identification: Type of ID produced: No Print, ,or stamp name of N ta'ry MIRYAN MARW GARCIA MY COMMISSION 9 FFI%058 '►� r EXPIRES February 08,2019 •e:t116N•Df croraan�r�-,Swvks.corr OR Miami shores Village Building Department rM 114 LpR�A 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. Signature: C—A r State of Florida County of Miami-Dade The foregoing was acknowledge before me this l day of 920 J S- By�` aPne �'�r'ru o ' �Ilkno�wntome has produced tie'Lfd�ld�j� entification. Ku rt �j�'�Y Notary: •.• ISSIpH'•.•O •.. tea` yd, s SE * ' �- ,,�Y��`'�1�111 jl T1� �,�t``�