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EL-18-1933Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Ave, Miami Shores, Florida 33138 Tel: 305-795-2204 Fax: 305-756-8972 Inspection Number: INSP-000817-2018 Permit Number: EL-7-18-1933 Scheduled Inspection Date: October 19, 2018 Inspector: DeVaney, Michael Owner: ERIC BANCROFT Address: 195 NW 91 ST Miami Shores, FL 33138 Project: <NONE> Contractor: LET THERE BE LIGHT ELECTRIC INC JAMES MUNGER Permit Type: Electrical - Residential Inspection Type: Electrical Final Work Classification: Alteration Phone Number: 3057133344 Parcel Number: 1131010000190 Phone Number: 3054589959 Building Department Comments REMODEL AND ALTER 2 BATHROOMS LAUNDRY AND KITCHEN BASED ON APPROVED DRAWINGS Checklist Item General Comments Passed False Comments Passed Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Inspector Comments s?' October,18, 2018 For Inspections please call: 305-762-4949 Page 25 of 33 Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit Permit NO. EL-7-18-1933 Permit Type: Electrical - Residential Work Classification: Alteration Permit Status: APPROVED Issue Date: 7/27/2018 Expiration: 01/23/2019 Parcel Number Applicant 195 NW 91 Street Miami Shores, FL 33138- 1131010000190 Block: Lot: DANELLE BANCROFT Owner Information Address Phone Cell ERIC BANCROFT 195 NW 91 Street MIAMI SHORES FL 33150- (305)713-3344 Contractor(s) Phone Cell Phone LET THERE BE LIGHT ELECTRIC INC (305)458-9959 Valuation: Total Sq Feet: $ 2,650.00 0 Type of Work: REMODEL AND ALTER 2 BATHROOMS LAUND Additional Info: REMODEL AND ALTER 2 BATHROOMS LAUND Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $1.80 $2.25 $2.00 $0.60 $150.00 $3.00 $2.40 $162.05 Pay Date Pay Type Amt Paid Amt Due Invoice # EL-7-18-68268 07/27/2018 Credit Card $ 112.05 $ 50.00 07/19/2018 Credit Card $ 50.00 $ 0.00 Available Inspections: Inspection Type: Review Electrical I 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 t all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zo• • • he , I authprtce the abov- =med contractor to do the work stated. 2C, 1 �f7 July 27, 2018 Authorized Si 'mature: Owner / Applicant / Contractor / Agent Date Building Department Copy July 27, 2018 1 --XDe BUILDING PERMIT APPLICATION ❑BUILDING LECTRIC ❑PLUMBING ❑ MECHANICAL JOB ADDRESS: 19 5 NW { City: Miami Shores Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 ❑ ROOFING RECE� 1 E° JUL 19 2018 l..lc FBC20t.* Master Permit No. k.0 Sub Permit No. Et 8- ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑PUBLIC WORKS ❑ CHANGE OF 0 CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS s,it- reEET County: Miami Dade Folio/Parcel#: / 3101 " 000 " 0110 Is the Building Historically Designated: Yes Occupancy Type: 201 Construction Type: Flood Zone: Zip: 3'1156 NO X BFE: FFE: OWNER: Name�(Fee Simple�p1Titleholder): EP / ( g/inic(tr> Phone#:20 S--7/ 3- 33 T 7 Address: 175 1 /V 5 1, q/ s ri? rt` City: /14 /14/"'1 / 5l-H &f .! State: L- zip: 33 /5O Tenant/Lessee Name: ,�� Phone#: Email: E lei L N/J�CfT 0 G/ I A // , COW\ CONTRACTOR: Company Name: Address: 5 E1,D Sw 11 I kv-e._ City: 01,1Pc.,✓wa. State: Li There Lie L, -.2 Phone#: H.58-99,T5 Zip: 3 S 1 4S Qualifier Name: __Jaynes Phone#: State Certification or Registration #: iSOO 6 7; 3Y DESIGNER: Architect/Engineer: Address: City: Certificate of Competency #: Phone#: State: Zip: Value of Work for this Permit: $ Q ,642) . Od Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration I I New Description of Work: 60.11fdai eh"- ❑ Repair/Replace n Demolition etAf Z bcc r'aov -i 7;2 .., r'ow-4 d ea ,'k.fs . l Specify color of color thru tile: Submittal Fee $ Scanning Fee $ Radon Fee $ Permit Fee $ /-6--"6", ap CCF $ _ CO/CC $ DBPR $ oa 0-5 Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ I' 2 . .-d (Revised02/24/2014) Bolding 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 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 rein .ection fee will be charged. Signature Signature ►V� OWNER or AGENT CTRACTOR The foregoing instrument w'as acknowledged before me this The foregoing instru en wa acknowledged before me this '5// 7 day of �-C.-V , 20 18 , by ( 6 day of .i,�., 20 / , by ,EtZie_, CIZo? , who is personally know to . I, nOA Un ' who is pers pally known to me or who has produced4:1,11I !Call me or who has produced -{" i t % SAA efi'"'S'( as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sig Print: Seal: •• = MY •�� •..�.. .. •• ham ~ P EXPIRES: November 2, 2020 Bonded Thru Notary Public Underwriters Sign: Print: Seal: rutura Lane NOTARY PUBLIC STATE OF FLORIDA Comm# FF937267 Expires 11/18/2019 ************************************************************************************************************ APPROVED BY .20CLL. > / Plans Examiner Structural Review Zoning Clerk (Revised02/24/2014) EC 13004666 5240 SW 111 AVE MIAMI FL 33165 *RI 305.458.9959 info lettherebeli htelectric.nett TO:+//�j fL-rr�j.t fa", /rr'/ap`T'!" /2sNL i/ 5+ .Slu;reA j FL 331 S?a TERM COD ESTIMATE / WORK ORDER INVOICE # 1 2 2 2 DATEm/i g TEL. ORDER T )f MOBILE, f/3, TECHNICIAN J CUSTOMER ORDER JOB NAME / ' f /e.,r. r, rn,r4/e2.4_, , JOB ADDRESS EMAIL ADDRESS Er'r bah C(nQ.(oQ tr 4/1 DESCRIPTION OF WORK HRS RATE AMOUNT 4-47cri .e.g9.!:12-1,%rif /4 ,r1Y- birif Inn r'sf- 6521. Ord n°f TOTAL LABOR MATERIALS PRICE AMOUNT SPECIAL INSTRUCTIONS FOLLOW UP MATERIALS LABOR OTHER TOTAL THANK YOU, YOUR BUSINESS IS MUCH APPRECIATED This proposal does not include any building permits and or associated fees. This proposal may be withdrawn if not accepted within 30 days. Upon receipt of goods our responsibility ceases. Ownership of materials remains with Let There Be Light Electric, Inc. until bill is paid in full. Any costs incurred as a result of non-payment of invoices, fees, plus finance charges of 5% per month from date of billing will be sustained by custpmer, including court costs and attorneys fees. I hereby acknowledge the satisfactory completion of the above described wof k. This contract shall serve as a notice to owner with the intention to claim a lien under the State of Florida Statutes APPROVED BY: DATE: Notice to Owner — Workers' Com p Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ensation 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: State of Florida County of Miami -Dade The foregoing was acknowledge before me this day of By (bO L Y Notary: SEAL: , 20_6 who is personally known to me or has produced as identification. MAHARAI K. GONZALEZ MY COMMISSION # GG 044602 EXPIRES: November 2, 2020 Bonded Thru Notary Public Underwriters JIMMY PATRONIS CHIEF FINANICAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 7/23/2018 PERSON: PETER D MUNGER FEIN: 800419169 BUSINESS NAME AND ADDRESS: LET THERE BE LIGHT ELECTRIC INC 5240 SW 111 AVE. MIAMI, FL 33165 SCOPE OF BUSINESS OR TRADE: Licensed Electrical Contractor EXPIRATION DATE: 7/22/2020 EMAIL: PETER.MUNGER©YAHOO.COM IMPORTANT: Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on 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 person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609