EL-16-1888 fir. :'', �' •� Y°srz iii � �' �`
Miami Shores Village eltTt { WEal It�l
10050 N.E.2nd Avenue NW s W01*GIrS P( M �'.
Miami Shores,FL 33138-0000-
Phone: (305)795-2204
r.:
712017Iel 771,11M� Expiration: 01/0712017
Project Address Parcel Number Applicant
146 NW 92 Street 1131010160010
JUAN BLANCO
Miami Shores, FL 33150- Block: Lot:
Owner Information Address Phone Ceti
JUAN BLANCO 146 NW 92 Street
MIAMI shores FL 33150-2229
Contractor(s) Phone Cell Phone Valuation: $ 1,200.00
SUNSHINE ELECTRICAL CONTRACT( (305)268-4958 Total Sq Feet: p
Type of Work:POOL HOOK UP. Available Inspections:
Additional Info:
Coon Type:
Classification:Residential Final
Scanning:1
Light Niche
Bonding
Review Electrical
Alarms
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20 Invoice# EL-7-16-60474
DBPR Fee $4.50 07/11/2016 Credit Card $265.20 $50.00
DCA Fee $4.50
Education Surcharge $0.40 07/07/2016 Credit Card $50.00 $0.00
Permit Fee-Additions/Alterations $300.00
Scanning Fee $3.00
Technology Fee $1.60
Total: $315.20
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 assulpe responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, UMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVI : I ify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zo g. a re,I authorize the above-named contractor to do the work stated.
July 11, 2016
Authorizignature:owner / Applicant / Contractor / Agent Date
Buildin Department Copy
pY
July 11,2016 1
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-262701 Permit Number: EL-7-16-1888
Scheduled Inspection Date: September 14,2016 Permit Type: Electrical - Residential
Inspector: Devaney, Michael
Inspection Type: Final
Owner: BLANCO,JUAN Work Classification: Pool - Public
Job Address:146 NW 92 Street
Miami Shores, FL 33150- Phone Number
Parcel Number 1131010160010
Project: <NONE>
Contractor: SUNSHINE ELECTRICAL CONTRACTORS CO Phone: (305)268-4958
Building Department Comments
POOL HOOK UP. Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
September 13,2016 For Inspections please call: (305)762-4949 Page 14 of 44
Miami Shores Village
i 7 L 0 2016
Building Department -
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION UNE PHONE NUMBER:(305)762-4949
FBC 20 a��
BUILDING Master Permit No. Ib 'K �(0- �k S
PERMIT AP IC TION Sub Permit No. FL-- ( �- (9 Se
❑BUILDING LECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING [-] MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: I 0 �►1 I ���
City Miami Shores County: Miami Dade Zia: I ��
Folio/Parcel#: �- WA e rlu — iU Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): MIn Nun( n Phone#:
Address: `U'W " C{�`��
City: ISA mt Sri MS State: Zip:
Tenant/Lessee Name: Phone#:
Email: DD
CONTRACTOR:Company Name: trVA';rii'Al Phone#�':�'rj C;L.(0 qq''?
Address:
City: St-a-te �lam- Zip:3�✓f��
Qualifier Name: eva elAy-e., S ,r !AL3 Q �"'� Phone#:14LQS—2 o`Z 4 V- t4
State Certification or Registration#: �G�-����a'�Q7 Certificate of Competency M
DESIGNER:Architect/Engineer: Phone#:
Address• City: State: Zip:
Value of Work for this Permit:$ 00 Square/Unear Footage of Work:
Type of Work: ❑ Addition eAlteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: VO(h 1 � 112
Specify color of color thru tile:
Submittal Fee$ . C)�) Permit Fee$ J ®f ®47' CCF$ 1 ' 2—0 CO/CC s
Scanning Fee$� Radon Fee$ �V DBPR$ Notary$
Technology Fee$ I, C) Training/Education Fee$ G. 140 Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ 2G5 .
(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."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must
promise fn good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whproperty is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for-the j= inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
insperdom-will not be approved and a reinspection fee will be charged.
Signature R�)" Signature/�� �
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
2-^ day of 20—�by da f 20 by
who is personally known to L, " w personally kno n
me or who has produced as me or who has produced as
r
identification and who did take an o9th. identification and who did take an oath.
NOTARY PUBLI 3 NOTARY PUBLIC:
LA-
Sign: Sign
e4� MY C MISSION#FF126847 °�, `Aa
Print: Print: _ M COMMI N#FF126847
Bonded through 1 st State insurance Seal: �_0,
Seal: Bonded through 1st State Insurance
APPROVED BY , Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
1
Sunshine Electrical Contractors co.
Certified Electrical Contractors Lic# 13005807
Mariano Santiesteban
1300 SW 85th CT, Miami FL,33144
Cell: 786.273.6194 Office: 305.265.4958 Fax: 786.536.2804
April 26, 2016
State of Florida
County of Dade
Before me this day personally appeare ✓� , being duly
sworn, deposes and says:
That he or she will be the only person working on the project located at:
Swo to (or i m )anubscribed before me this 2,�day of 20� by
AA
Personally Know
OR Produces Identification 17
Type of Identification Produced
,:.. ...... �IPNdFb1e3 ry
int, Mthrcu�hi
MAY 28,2018
' Bo1st State Insurance
SttoREs
s� Miami shores Village
"' ""'�' Building Department
10050 N.E.2nd Avenue
IORIDp' 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:
Owner
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me this 2 day of 20_0V_-
By_ -.Tucm Naviczwho 's personally kno o me or has produced
1
as identification.
Notary:
�sY MICHELLE ESPI OSA-CLARK
SEAL: a°'" ''�n MY COMMISSION#FF1268$7
EXPIRES:MAY 28,2018
°'1' Bonded through 1 st State Insurance