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DEMO-16-3125Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 � O (( _2 , � 9 Inspection Number: INSP-273136 Scheduled Inspection Date: December 21, 2016 Inspector: Devaney, Michael Owner: Job Address: 750 NE 97 Street Miami Shores, FL 33138- Project: <NONE> Contractor: R.Q ELECTRICAL INC tsunaing uepartment comments Permit Number: DEMO-11-16-3125 Permit Type: Demolition Inspection Type: Final Work Classification: Electric Phone Number Parcel Number 1132060142220 Phone: (305)790-9169 ELECTRIC DEMO OF KITCHEN AND BATHROOMS INSPE " rnaacu VVIII IIICIIw INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-272725. CREATED AS REINSPECTION FOR INSP-271209. No access at 3:25p. m.. 14 dec. 16 Need 2 20 amp. G. F. I. receptacles and 2 ckt. panel next to the existing Failed ❑ electric meter on the outside of the residence or a temp for construction pole. Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. December 20, 2016 For Inspections please call: (305)762-4949 Page 26 of 46 Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 F�ORLDA Permit NO. DEMO-11-16-3125 Permit Type: Demolition 01 t Worts Classification: Electric Permit Status: APPROVED Issue Date: 11/22/2016 1 Expiration: 05/21/2017 Project Address Parcel Number Applicant 750 NE 97 Street 1132060142220 Miami Shores, FL 33138- Block: Lot: INVESTINGHOUSE LLC INVESTINGHOUSE LLC 2061 NW 112 Avenue MIAMI FL 33172- 2061 NW 112 Avenue MIAMI FL 33172- Contractor(s) Phone Cell Phone R.0 ELECTRICAL INC (305)790-9169 /pe of Demo: Electric dditional Info: ELECTRIC DEMO OF KITCHEN AND BATHRO lassification: Residential canning: 1 Fees Due Amount CCF $0.60 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.20 Permit Fee $100.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $108.60 Phone Cell Valuation: $ 500.00 Total Sq Feet: 300 Pay Date Pay Type Amt Paid Amt Due Invoice # DEMO-11-16-62073 11/22/2016 Credit Card $ 58.60 $ 50.00 11/16/2016 Credit Card $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final 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 oning. Futher uthorize the above -named contractor to do the work stated. November 22, 2016 Authorized Signature: Owner / Applicant / Contractor Agent Date Building Department Copy November 22, 2016 r BUILDING PERMIT APPLICATION 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 ❑BUILDING ng ELECTRIC ❑ ROOFING NO 1 6 1� Tit( FBC 20 N Master Permit No. 13 — 6 — I 7 1$ Sub Permit No. I (a3 ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING [:]MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: j o City: Miami Shores County Miami Dade Zip: Folio/Parcel#: ( ) — 11,134 — O I �I - '� �,� � Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): '` �h ►� �o L L-- L Phone#: Address:_ City: State: Zip:7- Tenant/Lessee Name: _ �� Phone#: Email: CONTRACTOR: Company Name: _� %'- 1;� 10, J' , C \ j r L Phone#: Address: O� 4� N V�' City: X� C� Qs� State: V '�" O Zip: Qualifier Name: fko ` �o 0 rar•-1— : �'r« q Phone#:���• � ( O 9 � b State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: _ Value of Work for this Permit: $ S ,�' . Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace � Demolition Description of Work: <- � r J� Specify color of color thru tile: Submittal Fee $ 5 0 a Permit Fee $ l'947'Oa CCF $ , (00 CO/CC $ Scanning Fee $ Srr^^ Radon Fee $ I- DBPR $ 2 Notary $ Technology Fee $ V Training/Education Fee $ ' 2 Double Fee $ Structural Reviews $, (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE $ �_ Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien low brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a einspection fee will be charged. Signature Signature OWNER or A ENT CONTRACTOR The foregoing instrument was acknowledged before me this (� day of 20 ( O by who is personally known to me or who has produced Y ^ \,Oy5 I : C--Zv,—I�as identification and who did take an oath NOTARY PUBLIC: The foregoing instrument was acknowledged before me this )j5 rr day of 20 G by who is personally known to me or who has produced 0 Y; V t V 5 1 1* t It as identification and who did take an oath. NOTARY PUBLIC: Sign: Sign: Print: A Print: Seal:. ;� Notary Public State of Florida Brenda Bello My Commission FF 987682 Seal: tiM ,,,�c+ NOt� y Public State of Florida expires 06127/2020 Brenda Bello ,F r. ****** ;� My Commission FF 987882 r APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Report Viewer https:/JMmg-fldfs.comlarqvmicwtiirqx)rtViewer-mpx?datiL-- I COW FUUWMCIAL QFRCElt STATE OF FLOROA 00%RTMENT OF FWANCLIki. SERVICES ONISION OF WORKERS' COMPEDISATM "CERTMANEOFEL: CTMN TOSEM03WTYROUP—ORIDAWOMCERW COMPENSATMM LAW -- CONSTRUCTHM VIDUSTRY MG.MPTHM lbisaftWWm*AOtlhskOvid"%W bakwhas alas W lobe we ftm Fbdda mbeA9wcmvms2bm imL EFFECTNE DATE. 1211=15 EWMTM OAM. 11MM7 PERSOlk CLANUM ROOOLFO FEW 45=7567 BUSNESS NAME AND ADOREW RO ELECTRICAL INC MM fM IM 18MCE "LALEAMCMWENS FL 33MS SCOPES OF BUSMIMS OR TRADE- LUNMED 815CIRKAL CCOMACTOR OW SIR$* OdMcWA4F4bdhW WAN@& *WON *Maki" TI. GF6*20W-292CERTN4QEOF ELECT= T08EF)MWrfteWMEDM13 OUGSTWkWOMW04M lo(2 9=15. 7.39 PM RQ ELECTRICAL INC. License# llE000505 9801 NW 123th. Terrace Hialeah Gardens, FL 33018 Tel: (305) 790-9169 Fax: (305) 231-5578 Date: 11/09/2016 State of Florida County of Miami Dade Before me this day personally pp ersonall i eared 1 who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at -►sue ,� �17�4-rL " 5� 'e-4C —t) sf4QA5�5 or o r a ed) nd subscribed before me this I day of �%��� , 2016, by i t. le Personally know v OR Produced Identification _ Type of IdeaAcation Produced VILMA CASADEVALL MY COMMISSION #FF070028 EXPIRES December 13, 2017 398.0153 Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to UWner - VVorKers" compensation insurance txemotion 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 11 f-- day of tJ 0 I,— , 20-1-c— By N O )2 i,-, A1,- A,!:) rs who is personally known to me or has produced i -) Y '; -, as identification. Notary: Apr rue Notary Publio S1768283 Florid SEAL: Brenda Bello My Commissio8dExpires 06127/ 11/21/2016 MIAMI SHORES.jpeg AcnRri� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDI - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Honesty Trust Insurance 428 East 49st Hialeah, FL 33013 Phone (305)951-1544 _ Fax (305)675-8112 INSURED R O Electrical Inc. 9801 NW 123 Terrace INSURER B : scabezas@bellsouth.net Granada Insurance Not: (305) 675-8112 0 _ ( ) -----------INSURER F :-------i- laleah, FL33018 305 231-5578 COVERAGES CERTIFICATE NUMBER: _ REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, LTR TYPE C INSURANCE POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRXCLUSIONS AND CONDITIONS OF SUCHL'SUBRI "— �— POLICY EFF POLICY EXP INSR WVDj__-__,_POLICY NUMBERr(MM_/_DD_/Y_YYYj MMIDDIY_Y_Y_Y� LIMITS GENERAL LIABILITY I EACH OCCURRENCE s1,000,000.00 © COMMERCIAL GENERAL LIABILITY i DAMAGE TO RENTED _ PREMISES (Ee occurrence) _ s — ❑ ❑CLAIMS -MADE E] OCCUR 0185FL0030912 MFD EXP (Any one person s 5,000.00 A ❑ N N 10/31/2016 10/31/2017 PERSONAL & ADV INJURY s 1,000,000.00 ❑ _____ _ GENERAL_ AGGREGATE s 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER I PRODUCTS - COMPIOP AGG s 2,000,000.00` I ❑POLICY ❑ jE PR ❑ LOC AUTOMOBILE LIABILITY 1 COMBINED!IPtGLE LIMIT I Ea accident] s ❑ ANY AUTO BODILY INJURY (Per person) s ALL OWNED ❑ SCHEDULED BODILY INJURY (Per accident) s AUTOS AUTOS ❑ j NON -OWNED PROPERTY DAMAGE—� ❑ HIRED AUTOS ❑ AUTOS Per accident) I�-- Y s ❑ UMBRELLA LIAB ❑ OCCUR EACH OCCURRENCE I-E] EXCESS LIAR ❑CLAIMS -MADE �i-AGGREGATE WORS COMPENSATION AND EMPLOYERS' LIABILITY YIN KER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) C tf yes, describe under DESCRIPTION OF OPERATIONS below N I A ( I WC STATU- OTH- O1QRY LIMITS ❑ ER — I „ E L EACH ACCIDENT s I E L DISEASE • EA EMPLOYE ._ s — E.L DISEASE - POLICY LIMIT ---- -- s DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) ELECTRICAL CONTRACTOR CERTIFICATE HOLDER MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 N.E. 2ND AVE Miami Shores, FI. 33138 LI_ —- _ _ -— — _ - ACORD 26 (2010105) OF CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE t ©1888-2010 D CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD https://mail.google.com/mail/LI/O/Mnbox/l587f0bfee2e76e9?projector=1 1/1 CTQ BUSINESS CERTIFICATE OF COItTENCY a,IlEO00505 WRQ ELECTRICAL INC . D.B.A.: QUI ANA RODOLFO is certified under the haPter 10 of Provisions of C NWW`Y �yV 09 1301201� QUALIFYING TRADE(S) 0001 ELECTRICAL JLA—M. oaths P.E. Secre C/ Seaetry of N- Board 4'✓ MMartrDac city retain a0 property rights herein www.rteanudade.9oWecrn°mY