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ELC-11-774Permit Number: ELC -5 -11 -774 J Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 inspection Number: INSP - 159095 Inspection Date: May 24, 2011 Inspector: Devaney, Michael Owner: EVERETT, HENRY Job Address: 9636 NE 2 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: UNLIMITED ELECTRICAL TECHNOLOGIES INC Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number (727)461 -4370 Parcel Number 1132060132500 Phone: (786)299 -9500 Building Department Comments RE -BUILD OF DAMAGED ELECTRICAL DISTRIBUTIONBOXES, EXIT SIGNS, EMERGENCY LIGHTS ANS ASSOCIATED RACEWAY AS PER 40 YR CERT INSPECTION Passe • i' Inspector Comments e/ / ®%� e�e59 '1 Ili r /- --..e � e , ) T P ' / Cite / 3 6(7 2/ ��� IM Failed Correction Needed ri Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until May 24, 2011 For Inspections please call: (305)762 -4949 Page 1 of 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING Permit No. iC 11 --T PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): ��c�' v f t,�EL a es E /.("T Address: i) Deti"�W DZ City: (-�ZALW d�,� eAK�14 State: i"L Tenant/Lessee Name: Phone #: Email: Phone #: 7Z 7' I l° .766_ 32-16 Zip: -3376 JOB ADDRESS: 6 3 b ■= 2- ,> V City: Folio/Parcel #: Miami Shores County: RPOig Miami Dade Zip: '3306 t -�2��- 01.3 ° /soo NO Flood Zone: IJ l P Is the Building Historically Designated: Yes CONTRACTOR: Company Name: V4f11.►..4+eQ L rem Phone #: `J 06 -1 ti ti - LA S © 0 Address: 1 'Z-� OV b.—a )'0 l P I City: N; o%} eca.L bR,N see ii i 1' State: Zip: 35Y' Qualifier Name: >�f lKtri- 1.9 Lt vt1�,� Phone #: — i%�v-Lcict • Q 5n State Certification or Registration #: &= CD m° Z0"dtf Certificate of Competency #: iL.(aoo�S9 Contact Phone #: 1C' ` = ck.54b0 Email Address: (941 4 t .Ltvt , i Co 1 DESIGNER: Architect/Engineer: C (-Au . 10 Jc,Fgc Phone #: 786 .38 2 -16 ctr Value of Work for this Permit: $ 6 '0 °0 Square/Linear Fotage of Work: Type of Work: Address ❑Alteration Description of Work: l 0 O ®T s L E� UNew Repair/Replace ❑Demolition `itsTR.k i3�Tld t11" p A q 0 '\\`' "Tt 0 t■-1 SScC(ATeo c Wi f� ******** ***** *** * * * * * ************ * ***** Fees************* *** * ****** ** * ** *** * * *** * * *** *** Submittal Fee $ Scanning Fee $ Notary $ Double Fee $ Permit Fee $ J _1 "4 ®c� Radon Fee $ Training/Education Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ l 61.1-t) 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDMONERS, 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 . i chment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection whic 91' ven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will ion fee will be charged. Signat Signature P , by f AL1 14 I v or who has 6 oduced._ Itification and who did take an oath. Contractor The forego _ instrument was ackn dged before dayo ���' , ,20 1 ) ,by kno n to me or who has produced identification and who did take an oath. PUBLIC: NOTA Sign: Print: My Commission Expires: 1+ ,,,,i, Sign: ,^s Print: ,@,, ••ct�`,° -� c,,,,,,,, 'e My Commission Expire 'a � `� t, WOLH��� tpe **: k****s k: k**:k******:k***si:y:********* **********: k**** ********s F***** ***aE:k****:k**** **** * ** **** ******* ************* 2C / Plans Examiner APPROVED BY Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) QUESTIONS? (80:413-11 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO RE 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. 03 -21 -2011 EFFECTIVE DATE: PERSON: FEIN: 03/21 /2011 VILLAR 650873004 BUSINESS NAME AND ADDRESS: UNLIMITED ELECTRICAL TECHNOLOGIES INC 12888 NW 101ST PLACE HIALEAH GARDENS FL 33018 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED ELECTRICAL CONTRACTO EXPIRATION DATE: 03/20/2013 OMAR 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 440.051121, 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 440.05113), 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 tiling 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. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 PLEASE CUT OUT THE CARD BELOW QUESTIONS? (850) 4 AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE 03/21/2011 EXPIRATION DATE: PERSON: OMAR VILLAR FEIN: 650873004 BUSINESS NAME AND ADDRESS: UNLIMITED ELECTRICAL TECHNOLOGIES INC 12888 NW 101ST PLACE HIALEAH GARDENS, FL 33018 SCOPE OF BUSINESS OR TRADE 1- CERTIFIED ELECTRICAL CONTRACTO 03/20/2013 IMPORTANT 0 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 L under this section may not recover benefits or compensation under tl D chapter. H E R E 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 the notice of election to be exempt Pursuant to Chapter 440.05(13), F.S., Notices of election to be exemp and certificates of election to be exempt shall be subject to revocati 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 r 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. CUT HERE * Carry bottom portion on the job, keep upper portion for your records. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11