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EL-16-1810 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL l� I Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-273220 Permit Number: EL-6-16-1810 Scheduled Inspection Date: December 19,2016 Permit Type•. Electrical- Residential Inspector: Devaney, Michael Inspection Type: Final Owner: FACCIDOMO,JUDE&FRANCES Work Classification: Addition/Alteration Job Address:30 NE 93 Street Miami Shores, FL 33138- Phone Number (305)374-5730 Parcel Number 1132060130200 Project: <NONE> Contractor: B.L.F ELECTRICAL INC Phone: (786)380-2509 Building Department Comments AC UNIT RELOCATION , NEW BATHROOM , NEW Infractio Passed Comments OFFICE IN GARAGE ,WASHER AND DRYER INSPECTOR COMMENTS False RELOCATION Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-262173. Not ready for final. Need to pass r h inspection first. Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid December 16,2016 For Inspections please call: (305)762-4949 Page 41 of 60 pe Miami Shores Village ■ �8t7� ir� l�lydittlal r� 10050 N.E.2nd Avenue NE Ibt "Sfij"friA �� )o Miami Shores,FL 33138-0000 Phone: (305)795-2204 Expiration: 01/ 7/2017 Project Address Parcel Number Applicant 30 NE 93 Street 1132060130200 Miami Shores, FL 33138- Block: Lot: JUDE&FRANCES FACCIDOMO Owner Information Address Phone Cell JUDE 8:FRANCES FACCIDOMO 30 NE 93 Street (305)374-5730 MIAMI SHORES FL 33138- 30 NE 93 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 3,000.00 B.L.F ELECTRICAL INC (786)380-2509 _....... __.. ._ . _..__ .. .,.....rmy Total Sq Feet: 500 Type of Work: Available Inspections: Additional Info: Inspection Type: Classification:Residential Final Scanning:1 Meter Box Alteration Relocation Fire Alarm Service Change Underground W.W. Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 DBPR Fee Invoice# EL-6-16-60387 $3.38 07/11/2016 Credit Card $239.56 $0.00 DCA Fee $3.38 Education Surcharge $0.60 Permit Fee-Additions/Alterations $225.00 Scanning Fee $3.00 Technology Fee $2.40 Total: $239.56 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 is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-nam cor r>t�ctor to do the work stated. July 11, 2016 Authorized Signature:Owner / Applicant / C ntractor / Agent Date Building Department Copy .Duly 11,2016 1 V� Miami Shores Village Y21 - Building Department � 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(30S)762-4949 Fh BUILDING Master Permit No. Kr 16, // R/ PERMIT APPLICATION sub Permit No. (-, L (0 - 16' te) ❑BUILDING EKLECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL F-IPLUMBING F-1 MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 2z 0 Ale 9 3 5 r/- City: Miami Shores County: Miami Dade Zip: 3313 Q Folio/Parcel#: Is the Building Historically Designated:Yes NO D< Occupancy Type: Load: Construction Type: � Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titlpholder):,Fxp"tte5 J 3yW F °til_Soena Phone#:30 Address: 30 AIF' 93 S1 City:A•j'fa'* .t S 40st S State: rL- Zip: 33/ 3 P Tenant/Lessee Name: Phone#: Email: "C'C( Qy'-o Gl.LLt��• CONTRACTOR:Company Name: /�—✓'L.°l� �C /l/G� �� Phone#: e � -3�'®—��1 . Address: x-33 City: A ,s State: /C_ Zip: .3-3a Z Qualifier Name: li#'D,k1l � Phone#: State Certification or Registration#: 7ZG f 3 6 0 2V-e-5& Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 3000 Square/Linear Footage of Work: ��y Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: AC l.itr^t 1��4C�2/7�(_ �p�lN 60VktV7fTlZt11 Specify color of.color thru tiler.. Submittal Fee$r i° ' PtWmit/Fee$ �-7/ CCF$ CO/CC$ c a Scanning Fee$ Radon Fee$ ° DBPR$ Notary$ Technology Fee$ � ° �C � Training/Education Fee$ Double Fee$ V Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ J- (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 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-recarded notice of commencement must be posted tit 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. Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this - Z'9 f'day of Juo- 20 & by 29 � day of � rIn 20 14p by A&dneeS FQCGcO"o who is personally known to 1�111JR. JAeRADA who is personally known to me or who has produced /�Al &k44A .e h�-IA4-e as me or who has produced_ f. J IEM UMNSE as identification and who did take an oath. identification and who did take an oath. PUBLIC: NOTARY PUBMC: Sign: a r > Print• y Public.Stift of Florida nm.Expires Oct�,201 B Seal: YINET CAMPBELL mission 0 FF 173168 �. m m� Oct 30,2018 COMMIasloe I FF 1n188 ED BY .� Plans Examiner Zoning r Structural Review Clerk (Revised02/24/2014) SURES yI Miami shores Village logo Building Department h � 9 k,Ea ny810050 N.E.2nd Avenue LORNp' 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: l. 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. —�KJ Signature: G Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this Z 7 day of AJn-e ,20—&—. By�l l lyao c� F., c a c A&4!::?o who is personally known to me or has produced QLD' IC identification. Notary: " r °= Notary P lic-State of Florida SEAL: NMy Comm.Expires Oct 30,2018 '••., � Commission#t FF 113169 BLF Electric Inc. Date: 00 - 23—Il n Stare of E].nR(QA County of Mgr-ll - QAQs Before me this day personally appeared \/L41)IM7f2 LABRADA who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at: Sworn to(or affirmed)and subscribed before me this O�? day of JLAM6 201W , by ULAQAt IJR CMR DA Personally known OR Produced Identification Type of Identification Produced PL f)RJVER_, E Uo -JQSE ,.�;�►' YiNET CAMPBELL Print,Type or St jnp Name of No ry =� Notary polic.State of Florida �N • My Comm.Exp"s Oct 30,2016 % � �? � CommlBSion�►FF 173169 E f 1 1t?A°!o Report Memw 4 JEFF ATWATM cMieF EfPG4NU4 MTe OF R MMA C?EPAR t AE�+I F OF FINA ICIAL 8E0t1/tCE " t3 #st�t C)F iI�RCERB'COMpF3 $ATIf11� *`C9RTlF1CA OPEi;ECI €}A!Tf!RE EXEMPT FROM FLORIDA WORKERS'CC?MPEIY�Z/A f1?R411 I A�*' CONSTRUCIIJON INi3USTt Y,.- ► _ This'cerGoees that the indtviduaf t d to be exempt from Rodds Mrkers`Campers rr� ut; EFFECTIVE DATE:. 31267241�i- EXPIRATION DATE. 3t26t018 PERSON, I.;aEWA A;4DtMIR A FEIN. 161720283 BUSINESS' AIADDRESS: BLF ELL-CTRIC INC i 11740W 46 ST,APT-337 1 FL_ 33D12 SCOPES OF B4kSINES3 OR TRADE: 4iCE,SEq I LI CTRICAI ELECTRICAL WIRING CflPI3RAC° Ok' WITHIN BUIL DFS-F2 DWG252.CERTIFMATEc0. V4KT0 QC NRf*f REMSED W13 F i b"3li dtb?($ f413 f609