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EL-18-3220Inspection,Worksheet ( j Miami Shores Village 10050 N.E. 2nd Ave, Miami Shores, Florida 33138 Tel: 305-795-2204 Fax: 305-756-8972 �C Inspection Number: INSP-001131-2018 Scheduled Inspection Date: October 29, 2018 Inspector: DeVaney, Michael Owner: BISCAYNE 10125 LLC Address: 10125 BISCAYNE BLVD Miami Shores, FL 331382647 Project: Contractor: SOUTH FLORIDA ELECTRICAL ENGINEERING INC JORGE RODRIGUEZ Building Department Comments TEMPORARY FOR TEST Permit Number: EL-10-18-3220 Permit Type: Electrical - Residential Inspection Type: Electrical Final Work Classification: Temp for Test Phone Number: 7863903177 Parcel Number: 1132050190190 Phone Number: 7865238879 03-16-2017 Permit process extended due to the fact that the applicant was working on obtaining outside agencies approval. 01-08-2017 Stop work order issue for failure to pass required inspections. FBC 2014, Section 110.1 Checklist Item General Comments Passed Comments False Inspector Comments Passed Failed Correction — ®� Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. October 26, 2018 For Inspections please call: 305-762-4949 Page 2 of 27 Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Issue Date:10/24/2018 Parcel Number Permit NO.: EL-10-18-3220 Permit Type: Electrical - Residential Work Classification: Tempi for Test Permit Status: Approved Expiration: 04/17/2019 Project 10125 BISCAYNE BLVD, Miami Shores, FL 33138-2647 1132050190190 <NONE> Contacts BISCAYNE 10125 LLC Owner BISCAYNE 10125 LLC Applicant 10125 BISCAYNE BLVD, MIAMI SHORES, FL 33138 10125 BISCAYNE BLVD, MIAMI SHORES, FL 33138 Mobile: 7863903177 Mobile: 7863903177 SOUTH FLORIDA ELECTRICAL Contractor ENGINEERING INC JORGE RODRIGUEZ Business: 7865238879 Description: TEMPORARY FOR TEST 03-16-2017 Permit process extended due to the fact that the applicant was working on obtaining outside agencies approval. 01-08-2017 Stop work order issue for failure to pass required Fees Amount Application Fee - Other $50.00 CCF $0.60 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.20 Permit Fee $50.00 Scanning Fee $3.00 Technology Fee $2.50 Total: $110.30 Building Department Copy Valuation: $ 500.00 Inspection Requests: 305-762-4949 TotalSq Feet: 626.53 Payments Date Paid Amt Paid Total Fees $110.30 Credit Card 10/19/2018 $S0.00 Credit Card 10/24/2018 $60.30 Amount Due: $0.00 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 EXCPTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFI)�gVIT.ertify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating con ru i a zoning. Futhermore, I authorize the above named contractor to do the work stated. Owner / Applicant / Contractor / Agent October 24, Date It Page 2 of 2 SOUTH FLORIDA ELECTRICAL ENGINEERING INC 979 NE 36th AVE Homestead FL 33033 LIC# 14E000085 DATE: 10/16/2018 STATE OF FLORIDA COUNTY OF MIAMI DADE Before me this day personally appeared JORGE A. RODRIGUEZ who being duly sworn, deposes and says: that he or she will be the only person working on the project located at: 10125 BISCAYNE BLVD MIAMI SHORES FL Sworn to and subscribed before me this 16 October 2018 by JORGE A. RODRIGUEZ Personally known Or produced identification Lisbeth Lopez Pimentei COMMISSION #FF922657 Nota �!y��= ��'4'z-- EXPIRES: September30,2019 `� www.AARONNOTARY.COM ` BUILDING PERMIT APPLICATION Miami Shores Village RECEIVED Department RE1 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 OCT2010 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20t9r Master Permit No. ggRC - 3, 16 - 6 3 4 Sub Permit No. ( 6 — 3 Zo ❑BUILDING ® ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1 oar, 6W D City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: I1 3205 - O t9 - 000 Is the Building Historically Designated: Yes NO - Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): CLA 0t)iG 3c nn 0ii `'� Phone#: Address: I L70 11A, CO, C,& t4 Ave- - t j kTIE Ito City: LALA,N a l)EnCN State: FL Zip: 3�139 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: So 0 T t-1 t �-o Ri DA r,-kk C-Trttl.A,� phone#: 7::i� Address: SDI-11 N* 36 Tµ AvE City: I -to ME ST CAD State: (1 Zip: 33a;3 Qualifier Name: rL�C'C Q0 brit 4UE4 Phone#: State Certification or Registration #: 14 C 00o 0 8S Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 50.0 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: TEt1 Po (LA rLY Fog `E Ste' Specify color of color thru tile: Submittal Fee $ Permit Fee $ )d O.Oo CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) 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 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 reinspection fee will be charged. Signature _ Signature OWNE o A ENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 15 day of OC-rpt E l- , 20 ( F by iS day of Ocro► Gr 20 18 by CLA0DL0 tie-OZ who is personally known to -�o44E Ru 0 nt4uG l; , who is personally known to me or who has produced as me or who has produced identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: as Sign: Sign: Print: Ul SI e—, R ( Gk,�, Print: U sgc" LOfti Seal: AS �Lisbeth Lopez Pimentel Seal: ,�'u��„ Lisbeth Lopez Pimentel COMMISSION IFF922657 a ,n-- '* *' — COMMISSION ORN2657 EXPIRES: September30,2019 _fir �rr EXPIRES: September 30, 2019 e '' • C�`��`� www.AARONNOTARY.COM **************>(�ile****************************************************♦***MIM�WtAURFitiNl�{(itAillk.001d**** APPROVED BY ��4'�-1 !�' Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Building MIAMI• 11805 SW 26th Street Miami, Florida 33175-2474 786-315-2100 miamidade.gov AFFIDAVIT FOR 30 DAY TEMPORARY ELECTRIC SERVICE ELECTRICAL CATEGORY 26 ELECTRIC SERVICE WILL BE DISCONNECTED "WITHOUT NOTICE" UPON 30 DAYTERMINATION UNLESS APPLICATION IS RENEWED OR CERTIFICATE OF OCCUPANCY OBTAINED. It is understood that the temporary electrical approval bythe Miami -Dade Building Department is given in connection with the building being constructed under the Building Permit # RC.- 3 - %L- 634 and Electrical Perm it# at address lot75 13%ScA'Yn:- 61-vD for owner: E-AyDio 13cre,E and is being given only for construction purposes or for testing the following equipment in said structure: The owner does hereby agree to assume the responsibility of maintaining the installation in such manner that there is no hazard to life or property. Such approval is in no event to be considered a RELEASE of said structure for the purposes of use and occupancy, and no occupancy shall be granted or permitted until final inspections have been called for and approved by the inspection divisions concerned, and/or a Certificate of Occupancy or Completion is obtained. The undersigned also understands that the temporary electric approval is subject to rescission and cancellation and electric power can be cut off atthe discretion of the Building Official and will be disconnected if the building concerned is occupied before final inspections are approved and/or a Certificate of Occupancy or Completion is obtained. CIAyDko P,E.edE 0E-, T` being first duly sworn, depose and say that I am the owner of the above described property, and that I agree that the structure covered in this agreement shall not be occupied until the building contractor has obtained approval of final inspections and/or obtained a Certificate of Occupancy or Completion. Note: Failure to comply with the provisions of this affidavit will result in your being unable to obtain future Tempor Test p �oXP�Y.�F-, Lisbeth Lopez Pimentel 4e4i4) �Q' SignLu re caner Signa of Notary � " EXPIRES: September 3O,2019 My Commission Expires: '�% 2,�� www AARONN(1TARY.COM I, �oR4C ��9�t �� being duly sworn, depose and say that I am the EI�C'tNIL'al Contractor for the above -described property and that the electrical installations as now existing will not create a safety hazard if temporary service is connected. ,tiff,,, , MY• ��,� '. Ldeth Lopez Pimentel COMMISSION IFM2657 • ° , 2019 Signature f Electrical Contractor Signa ur of Notary My Commission Expires:"'��, ,��`�` WWW.AARONNOTARY.COM 1 nnA Co CHA co�1 , being first duly sworn, depose and say that I am the Building Contractor of the above described property and that I will not permit occupancy of this building until final inspections have been called for by the contractors and sub -contractors concerned and final approval by the inspection division obtained and that I have the authority insofar as the owner of said property is concerned to prgdi�,�l��cu a ntil such final ins ections are obtained and/or a Certificate of Occupancy or Completion is iss ° : LopezuPimentel COMMISSION IFF922657 EXPIRES: September 30, 2019 v �' • ' TARY.COM Signatur of Building Contractor Signatur f Notary My Commission Expires: Date: Signature of Electrical Inspector Date released to FPL: 123 01-124 6/06 ..• Notice to Owner — Workers' Corn Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 nsation 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 Fl County of Miami -Dade The foregoing was acknowledge before me this a l ( day of 0 C_ io(�CrL- 20 12 who is personally known to me or has produced as identification. Notary: SEAL: P�' Lisbeth Lopez Mmentel 2� COMMISSION iF'92M7 EXPIRES: September 30, 2019 www.AARONNOTARY.COM