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ELC-18-967Inspection Worksheet Miami Shores Village 10050 N. E. 2nd Ave, Miami Shores, Florida 33138 Tel: 305-795-2204 Fax: 305-756-8972 Inspection Number: INSP-000792-2018 Scheduled Inspection Date: October 19, 2018 Inspector: Devaney, Michael Owner: PARK LLC Address: 9801-9845 NE 2 AVE Miami Shores, FL 33138 Project: <NONE> Contractor: SAME & Q ELECTRIC INC MANUEL E QUESADA Permit Number: ELC-4-18-967 Permit Type: Electrical -Commercial Inspection Type: Electrical Final Work Classification: Addition/Alteration Phone Number: Parcel Number: 1132060134380 Phone Number: 3052190427 Building Department Comments INSTALL NEW H HATS (EXTERIOR) 22 INSTALL NEW 30 PUMP TO HOSE BIBB, 40 YEAR REPAIRS AS NOTED UP GRADE RISER SERVICE (METER ROOM) Checklist Item General Comments Passed Comments False Inspector Comments Passed Failed Correction ❑ l Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. October 18, 2018 For Inspections please call: 305-762-4949 Page 2 of 33 5/2/2018 Detail by Entity Name D vj::;.,..::r C:: >:r• .,.... ')wL` um Qr U4 Deo:�rt t enl of State / Division of Corporations / Search Records / Detail By Document Number / Detail by Entity Name Florida Limited Liability Company 9801 PARK, LLC Filing Information Document Number L16000130646 FEI/EIN Number 81-3267935 Date Filed 07/11/2016 State FL Status ACTIVE Last Event LC DISSOCIATION MEM Event Date Filed 12/04/2017 Event Effective Date NONE Principal Address 4141 NE 2ND AVENUE 204-A MIAMI, FL 33137 Mailing Address 4141 NE 2ND AVENUE 204-A MIAMI, FL 33137 Registered Agent Name & Address HOWARD B. NADEL, P.A. 301 W. HALLANDALE BEACH BLVD. HALLANDALE BEACH, FL 33009 Authorized Person(s) Detail Name & Address Title MGR CHEMTOV, SHAWN 4141 NE 2ND AVENUE, SUITE 204-A MIAMI, FL 33137 Title MGR Fuentes, Maria 10820 SW 200th Drive Miami, FL 33157 http://search.sunbiz.org/Inquiry/CorporationSearcWSearchResultDetai I?i nqui rytype=EntityN ame&di rectionType=Initial&searchN am eOrder=9801 PARK%20LI & .. 1/2 CA L+ Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 T I 305 795 2204 F 305 756 8972 R 1 W018 C .( ) - ax.( ) ;.11� _"i INSPECTION LINE PHONE NUMBER: (305) 762-4949 LLAT T s FBC 20 BUILDING Master Permit No. PERMIT APPLICATION sub Permit No. -�� — 9� ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP ¢, t� , - CONTRACTOR DRAWINGS JOB ADDRESS: 1120 k �� �/�!/ City: Miami Shores County: Miami Dade Zip: �l 3133 Folio/Parcel#: 201, 013 3 ED Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): /, � p IG ��(� Phone#: Addresss:,/ 414) NE o'-' _ -A rE— 12,014 �AC City: State: ! Zip: Tenant/Lessee Name: IvV -TrPGE IPX/A-1017s Phone#: r a�� Email: CONTRACTOR: Company Name: A & L'—_ w_(I6 Phone#: �.J�J 2 �� QZ �- Address: �3 k' (DS (_� S.A- City:cle�CA� 6 (_'- s State: jl�7L Zip: 1 4 Qualifier Name: t"N R 4-Sy �� '�..- Q-1 GS P';Phone#: bad *z 1 O T -a �} State Certification or Registration #: _C 3 Q (� j Z� Certificate of Competency #: DESIGNER: Architect/Engineer: Address: Value of Work for this Permit: $ Type of Work: ❑ Addition Phone#: City: State 12- - 00 Square/Linear Footage of Work: M Alteration [M New ❑ Repair/Replace _ Zip: ❑ Demolition Description of Work: /)ez-1,0 H - 1447-5 yh-i) (-2 2-) v P &n A-15 E 2 S rL '4F1 V t c F- 1M>o I'- /2D©Al . Specify color of color thru tile: �-- Submittal Fee $ Q Permit Fee $ 3 �J �� CCF $ 90 CO/CC $ � Scanning Fee $ Radon Fee $ > r-�t 5' 6 3 Notary $ (o Technology Fee $ v Training/Education Fee $ Structural Reviews S S Ci lt� • c' (Revised02/24/2014) Double Fee $ ' Bond $ (10 TOTAL FEE NOW DUE $ 4 S _� . IT & . mma r" 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 approvefind a, feinspection fee will be charged. Signature or AGENT The foreping instrument As acknowledged before me this day of _ 20- R , by CJiree'r^� , who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: tiRA R88Rl6UEi-- Print: ;�> of Florida Seal: s,9 M Corn K:Expires Sep 8, 2020 �*h o°; fi"„r Bonded through National Notary Assn. Signature _ 4�-� CONTRACTOR The for oing instrum nt was acknowledged beforemethis day of d 20 1g by "W1V'011ILliE ,who is personally known to as me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: A RODRIGUE2 ` b'•;'Yp a of Florida Print:821111367 Seal: '•;�na�� My Comm: Expires Sep 8, 2020 Bonded through National Notary Assn. as c� APPROVED BY 7 16 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Property Search Application - Miami -Dade County Page 1 of 1 THE 'PROPERT OFFICE OF ADHIS R'�v Summary Report Property Information Folio: 11-3206-013-4380 Property Address: 9801 NE 2 AVE Miami Shores, FL 33138-2407 Owner 9801 PARK LLC Mailing Address 4141 NE 2 AVE # 204 A MIAMI, FL 33137 USA PA Primary Zone 6400 COMMERCIAL - CENTRAL Primary Land Use 1111 STORE: RETAIL OUTLET Beds / Baths / Half 0/0/0 Floors 1 ............---- Living Units 0 Actual Area Sq. Ft Living Area Sq. Ft Adjusted Area 10,803 Sq.Ft Lot Size 13,000 Sq.Ft Year Built 1953 Assessment Information Year 2017 2016 2015 Land Value $338,000 $338,000 $286,000 Building Value $1,162,000 $463,449 $417,104 XF Value $0 $11,054 $11,090 Market Value $1,500,000 $812,503 $714,194 Assessed Value $1,500,000 $785,613 $714,194 Benefits Information Benefit Type 2017 2016 2015 Non -Homestead Cap Assessment Reduction $26,890 $0 Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Short Legal Description 1 534165342 MIAMI SHORES SEC 1 AMD PB 10-70 LOT 13 & LOT 14 BLK 32 LOT SIZE 100.000 X 130 OR 15605-3244 0692 4 Generated On : 2/27/2018 Taxable Value Information 2017 2016 2015 County Exemption Value $0 $0 $0 Taxable Value $1,500,000 $785,613 $714,194 School Board Exemption Value $0 $0 $0 Taxable Value $1,500,000 $812,503 $714,194 City Exemption Value $0 $0 $0 Taxable Value $1,500,000 $785,613 $714,194 Regional Exemption Value $01$0 06/01/1992 $0 Taxable Value $1,500,000 $785,613 $714,194 Sales Information Previous OR Book - Price Description Sale PageQualification 3022Qual 08/17/2016 $1,750,000 by exam of deed 4364 15605- Sales which are disqualified as a result 06/01/1992 $0 3244 of examination of the deed ..._..... 09873- Sales which are disqualified as a result 11/01/1977 $1 0684 lof examination of the deed The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appraiser and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asp Version: http://www.miamidade.gov/propertysearch/ 2/27/2018 Detail by Entity Name Detail by Entity Name Florida Limited Liability Company 980.1. P� ARK, LLCM Filing Information Document Number FEI/EIN Number Date Filed State Status Last Event Event Date Filed Event Effective Date Principal Address 4141 NE 2ND AVENUE 204-A MIAMI, FL 33137 Mailing Address 4141 NE 2ND AVENUE 204-A MIAMI, FL 33137 Page 2 of 2 L16000130646 81-3267935 07/11/2016 FL ACTIVE LC DISSOCIATION MEM 12/04/2017 NONE Registered Agent Name & Address HOWARD B. NADEL, P.A. 301 W. HALLANDALE BEACH BLVD. HALLANDALE BEACH, FL 33009 Authorized Person(s) Detail Name & Address Title MGR (CH EMTOy,-SHAWN-) 4141 NE 2ND AVENUE, SUITE 204-A MIAMI, FL 33137 Annual Reports ReportYear Filed Date 2017 04/03/2017 Document Images 12x0412017 -- CORLCDSMEM View image in PDF forma[ 04!03;2017 -- ANNUAL REPORT View image in PDF format 07/11/2016 Florida Limited Liability View image in PDF format Fly,— 11:1-t of Statx, Dw.—I o. _ ryora•.ic:-i< http: //search. sunbiz. org/Inquiry/CorporationSearchISearchRe sultDetail?inquirytype=Entity... 2/27/2018 Proof of Coverage Page 1 of 1 WC Mobile App WC Home Search Our Data CFO Home Employer List Page This database was last updated Monday, April 30, 2018 12:09 AM. Return to Search Page Federal Employer ID Number Information 1 records found for federal employer id number 271614399. Click the links below the Employer Name column for more detailed information. Record Employer Name I Employer Address ICov Exem 1 SAME & Q ELECTRIC INC 5310 SW 7TH STREET, MIAMI, FL 33134 Cov Exem 1 records found for federal employer id number 271614399. Return to Search Page https:Happs8.fldfs.com/proofofcoverage/EmployerList.aspx 4/30/2018 Proof of Coverage Page 1 of 1 WC Mobile App WC Home Search Our Data CFO Home Employer Detail Page This database was last updated Monday, April 30, 2018 12:09 AM. Carrier Location Information Return to Search Page Employer Information Employer Name Employer Type NAICS Code ISAME & Q ELECTRIC INC (CORPORATION IN/A Coverage History Governing Class Effective Detailed Coverage Carrier Office Policy Wrap Code' Date Information Number up 05190 Nov 28 2017 Detailed Coverage NORMANDY INSURANCE NHFL0060532017 NO Information COMPANY 05190 Nov 28 2016 Detailed Coverage NORMANDY INSURANCE NHFL0060532016 NO Information COMPANY 05190 Sep 30 2016 Detailed Coverage NORMANDY INSURANCE NHFL0076382016 NO Information COMPANY Represents the Governing Class Code associated with the Named Insured on the policy, as reported by the Insurance Carrier, and is not validated as correct. Exemption Listings Exemption Holder Name - Click on the name(s) below to view more detailed information ALAIN J VENTURA SANDY QUESADA Owner Election Listings No Owner Election of Coverage Listings Employer Name History Employer Name Name Type' Change Date (SAME & Q ELECTRIC INC ILegal lCurrent I Return to Search Page https:Happs8.fldfs.com/proofofcoverage/EmployerDetail.aspx?EmpID=001536024 4/30/2018 Proof of Coverage Page 1 of 1 WC Mobile App WC Home Search Our Data CFO Home Exemption Detail Page This database was last updated Monday, April 30, 2018 12:09 AM. Return to Previous Page Exemption Details Name Title Effective Date -Termination Date Exemption Type._ "Business Activities I Employer Name MANUEL-E— �� "�� Apr 18 2018 .� �v�+— Apr 17 2020 �"�'--� Construction "�Click Here toView---SAME"&"Q) Activities Listed on"� QUESADA SR ECECTRICINC Exemption MANUEL E Click Here to View SAME & Q QUESADA SR PR Apr 18 2016 Apr 18 2018 Construction Activities Listed on ELECTRIC INC Exemption MANUEL E Click Hereto View SAME & Q QUESADA SR PR Apr 9 2014 Apr 8 2016 Construction Activities Listed on ELECTRIC INC Exemption MANUEL E Click Here to View SAME & Q QUESADA SR PR Apr 9 2012 Apr 9 2014 Construction Activities Listed on ELECTRIC INC Exemption MANUEL E Click Here to View SAME 8 Q QUESADA SR PR Apr 13 2010 Apr 9 2012 Construction Activities Listed on ELECTRIC INC Exemption 'Termination may be through the revocation of the exemption, or expiration of the exemption. "The exemption only applies to the business activities listed on the exemption. Return to Search Page https://apps8.fldfs.com/proofofcoveragelExemptionDetail.aspx?pr_person_id=000437288 4/30/2018 SAME & Q ELECTRIC. LICENSED AND INSURED EC13007128 14110 SW 165 ST 'MIAMI ,'FLORIDA ,33177 305 219 0427 DATE: 5/2118 State of Florida Miami Dade County Before me this day personally appeared Manuel E. Quesada who, being duly sworn, deposes and says: That he will be the only person working on the Project located at: 9801— 9845 NE 2nd Avenue Miami Shores FL 33138 Sworn to (or affirmed) and subscribed before me this 2nd day of May, 2018, By, Personally known Y OR Produced Identification Type of Identification Produced _ Stamp Name 9 ry �A CAROLINA R. HERNANDEZ MY COMMISSION # FF 928131 =: p EXPIRES: October 15, -2 ;j° ' Bondid Thru Notary NE Underwriters Miami S hores Village Building Department 10050 N.E.2nd Avenue 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 -tune 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 1 day of E _ , 20� By who who is personally known to me or has produced QA. Q as identification. NO eA�ReLINA R. HERNANDEZ ' MY COMMISSION # FF 928131 SEAL:{: P EXPIRES: October 15, 2019 Bonded Thru Notary Public Underwriters Miamihores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* - (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:, A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER, B. - COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. __ _ _ COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. ■■rrrrrrrrrrrr�rrr�rrrr�rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr�rrrrrrrrrrrrrrrr�rr BUSINESS NAME: BUSINESS ADDRESS: CITY, BUSINESS PHONE: (� CELL PHONE (_� QUALIFIER'S LIC NUMBER: FAX NUMBER QUALIFIER'S NAME: STATE ZIP. Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Parcel Number Permit NO. ELC-4-18-967 Permit Type: Electrical - Commercial t I t Work Ciassifieation: Addition/Alteration Permit'Status: APPROVED Issue Date: 513/2018 1 Expiration: 10/30/2018 Applicant 9801-9845 NE 2 Avenue 1132060134380 Miami Shores, FL 33138- Block: Lot: PARK LLC Owner Information Address Phone Cell PARK LLC 4141 NE 2 Avenue (_- MIAMI FL 33137- 4141 NE 2 Avenue MIAMI FL 33137- Contractor(s) Phone Cell Phone SAME & Q ELECTRIC INC (305)219-0427 of Work: itional Info: ,sification: Commercial nning: 4 Fees Due Amount CCF $7.80 CCF $0.00 DBPR Fee $5.63 DBPR Fee $0.00 DCA Fee $0.00 DCA Fee $3.75 Education Surcharge $2.60 Education Surcharge $0.00 Permit Fee $0.00 Permit Fee $375.00 Plan Review Fee (Engineer) $45.00 Plan Review Fee (Engineer) $45.00 Scanning Fee $12.00 Technology Fee $10.40 Technology Fee $0.00 Total: $507.18 Valuation: $ 12,500.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # CC -4-18-67139 04/12/2018 Credit Card $ 50.00 $ 457.18 05/03/2018 Check* 20201 $ 457.18 $ 0.00 Avaname Inspections: Inspection Type: Final PE Certification Window Door Attachment Tie Beam Slab Termite Letter (Store Front Attachment Insulation Drywall Screw Fill Cells Columns Window and Door Buck Calling Grid Review Planning Review Electrical Review Building Review Building Review Structural IReview Plumbino nical 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 p mit I ass a responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELE RICAL, MBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDA T tha II the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construct' and zo f re, I authorize the above-named contractor to do the work stated. O'k-Q-'r, 1 t_ -A • May 03, 2018 re: Owner / Applicant / Contractor / Agent May 03, 20 1 Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit ivo. ELC-4-18-967 Permit Type: Electrical - Commercial Work Classification: Add'ition)Alteratlon Permit Status: APPROVED issue Date: 51312018 1 Expiration: 10/30/2018 Project Address Parcel Number Applicant 9801-9845 NE 2 Avenue 1132060134380 Miami Shores, FL 33138- Block: Lot: PARK LLC Owner Information Address Phone Cell PARK LLC 4141 NE 2 Avenue 0-- MIAMI )_MIAMI FL 33137- 4141 NE 2 Avenue MIAMI FL 33137- Contractor(s) Phone Cell Phone SAME & Q ELECTRIC INC (305)219-0427 of Work: ional Info: ,ification: Commercial ning: 4 Fees Due Amount CCF $7.80 CCF $0.00 DBPR Fee $5.63 DBPR Fee $0.00 DCA Fee $0.00 DCA Fee $3.75 Education Surcharge $2.60 Education Surcharge $0.00 Permit Fee $0.00 Permit Fee $375.00 Plan Review Fee (Engineer) $45.00 Plan Review Fee (Engineer) $45.00 Scanning Fee $12.00 Technology Fee $10.40 Technology Fee $0.00 Total: $507.18 Building Department Copy Valuation: $ 12,500.00 Total Sq Feet: 0 Available Inspections: Inspection Type: Final PE Certification Window Door Attachment Tie Beam Pay Date Pay Type Amt Paid Amt Due Invoice # CC -4-18-67139 04/12/2018 Credit Card $ 50.00 $ 457.18 05/03/2018 Check #: 20201 $ 457.18 $ 0.00 Framing Store Front Attachment Insulation Drywall Screw Fill Cells Columns Window and Door Buck Celling Grid Review Planning Review Electrical Review Building Review Building Review Structural Review Structural Review Plumbing Review Mechanical May 03, 2018 2