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EL-12-837Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 181231 Scheduled Inspection Date: November 06, 2012 Inspector: Devaney, Michael Owner: MEJIA, GILBERTO Job Address: 165 NE 98 Street Miami Shores, FL 33138- Project: <NONE> Contractor: CREST ELECTRIC INC comments LOW VOLTAGE Failed Correction Needed Re- Inspection Fee 1. t 7m No Additional Inspections can be scheduled until re- inspection fee is paid. it -lob Permit Number: EL -5 -12 -837 Permit Type: Electrical - Residential Inspection Type: Rough Work Classification: Addition /Alteration Phone Number Parcel Number INSPECTOR COMMENTS False Inspector Comments 1132060132330 Phone: (954)520 -2748 November 05, 2012 For Inspections please call: (305)7624949 Page 34 of 34 6B� ING 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 PERMIT APPLICATION FBC 20 Permit Type: Electrical OWNER: Name (Fee Simple Addre._- /4_� WE City: lit Permit No. U— Ton Master Permit No. State: Ic Zip: 30/3 00 Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 14Y Al— `Q ', City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes CONTRACTOR: Address: c *5rQ3t City: jop+ Qualifier Name: NO y Flood Zone: IN • �� �� i State Certification or Registration #: ,���0 Y/ l T Certificate of Competency #: Contact Phone #: S�b ,E� a7W, Email Address: DESIGNER: Architect/Engineer: Phone#: Zip: 9 &A Value of Work for this Permit: $� D � Sgnare/.inear Footage oi? Work r. Type of Work: ❑ Addreess ❑Alteration ❑New jaRepair/Replace ,'" ❑Demolition Description of Work: Submittal Fee $ Permit Fee $ /r l'` er'G' Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $_ Technology Fee $ TOTAL FEE NOW DUE $ I 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 -" O r or A ent The foregoing instrument was acknowledged before me this day of , 20 byd��aevla/t , who (]personally known o me or who has produced As identification and who did take an oath. NOTARY PUBLI CHAkIESEPENNt110 MVC WiSS�#DO AJI 0amM�M>1 joy Pubic 241kiden ON Sign: � Print: If—/4"/es �?%i�E My Commission Expires: // �© Signature ontractor The foregoing instrument was acknowledged before me this day of , 20 11, by ILA&L, �i� , who is rson o me or who has produced as identification and who did take an oath. NOTARY CMAl1).ES E. PEW= MYArSSION s 2oa2 Sign: / / Print: djeS C � My Commission Expires: 41 r1/9— Za iz APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06110/2009)(Revised 3/15/09) 06 -21 -2411 JEFF A'1WATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER 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: 07/31/2011 PERSON: FLANAGAN FEIN: 691093959 BUSINESS NAME AND ADDRESS: CREST ELECTRIC INC 5234 Nil REBA CIR PORT SAINT LUCIE FL 34886 SCOPES OF BUSINESS OR TRADE: 1- ELECTRICAL cONTRAgmR EXPIRATION HATE: 0713012013 JACKIE H 1MP08TANTt Potsoant to Chapter 440 . 85(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election artdar this section may not recover bhneffts or compensation undet this Chapter. Pursuant 1e Chapter 440.09912) P.S., Certificates of electlart to he exempt... apply Only Within the scope Of the business at trade listed on the notice of election to be exempt. Purseent to Chapter 44ILDS01i: F.S., Notices of aiactibn to be exempt and certificates of election to he exempt sball ha shblaet to revoeallao if, at MAY time after the Ming of the notice or the issuance of the certificate, the person named an the notice of certificate no longer meets Ilia ragaitaments of this section for issuance of a certificate - The department sport revoke a certificate at any time for failure of the person pawed on We certificate to meet the regairsenanis of this section. pWC -252 CE91IF1CAtE OF ELECTION TO BE EXEMPT REV15E0 01 -11 QUMTIONS? (850) 413 -18t PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLONDA DEPARTMENT OF FINANCIAL 30tMES DIVISION OF WORi(ERV COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW _ EFFECTIVE: 07/31/2011 EXPIRATION DATE. 07/30/2013 PERSON- JACKIE H FLANAGAN FEIN: 661093959 BUSINESS NAME AND ADDRESS: CREST FLECTMC PC 5234 NW REBA CIR PORT SAINT LUCRE, FL 34986 SCOPE OF BUSINESS OR TRADE: 1 • ELECTRIC4 CONTRACTOR 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 this D chapter. Pursuant to Chapter 440.05(12). F.S., Certificates of election to be H exempL. apply only within the scope of the business or trade listed on Rthe notice of election to he exempt E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shell 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 sectiom QUESTIONS? 18501 413 -1606 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. OWC -252 CERTIFICATE OF ELECTION TO SE EXEMPT REVISED 01 -11 ter CITY OF %jai - W- 4 1,0 Lo UCIE LOCAL BUSMESS TAX RECEIPT 7EM.- October 1. 2011 to Sept MIW 30, 2.012 Vat L JI if ji M 1; 00 ', -ej "ON: rr>r V I I.,:; I r."? -I kre a L"y YOUR PLACE OF 8V,5,PjeSS UST BE EX14151TED C0JN,"WCUL)i,6-YA" ADDRESS ON12.' KW5234 NW REBA CIR F" CONT CONTRACTOR SushMm TOK 124180112-1036002 Fee: 1127.63 DbWAMU* 0.00 CREST ELECTRIC ING 5234 NW REBA GIR PORT 4WfkV "Al 1) 0 T R.F G'.):,," RY 1 :N • LOCAL BUSINESS TAX RECEIPT CITY FJTODRT MkUCIE jpaftva Few. IZT.03LEdeRees: 0.00 Total Ws payment : I2763 TERM October 1, 2011 t03q*w&w39. =�CIR -WX, AD Fee: @ fo Issued tw- CREST MECTRIC INC 5234 "LMOSINESS TAX RECEIPT CITY OF PORT ST. LUCIFE PORT ST WCIE, FL 34988 .127,�." Late Figs: 0,00 Tot 127.63 3191024 JpadDva ,.,, , _..,.qp4 : U, -,"A 47 $ntf. c;;n*,I,i aen, 'vvid, for O'n ;:umNiv i� relLw.d ty [,.,p 29112 127.83 0.00 bet 2011 PtNUbGr 30, 2012 JZ Fees: 127.83 Lgadis Ff. JeTthisfn4t 127 BUSIUMS Tax 124180112-1035M BUdft= Addy. =34 NW REBA GIR rw-. 127.03 clessificau": CC"ICONTRACTOR Discauft 0.00 318!024 JpWova 5234 NW REBA GIR 2011 / 2012 ST. LUCIE COUNTY LOCAL BUSINESS TAX RECEIPT RECQPT # 1001927 BOB DAMS, CPA, CGFO, CFC, ST. LUCIE COUIny TAX COLLECTOR FACILITIES OR EXPIRES SMENiM, 30, loll MACHINES / ROOMS SEATS EMPLOYEES 1 TYPE OF 1731 ELECTRICAL CONTRACTOR BUSINESS (ELECTRICAL CONTRACTOR) BUSINESS/ Jackie H Flanagan DBA NAME Crest Electric Inc MAILING ,hackie H Flanagan ADDRESS 5234 NW Reba Circle Pori: St Lucie, FL 34986 BUSINESS 5234 NW Reba Circle LOCATION Port St Lucie, FL 34986 City of Pt St Lurie Paid '07/26/2011 12.35 WI W CITY LIMITS ONLY P01000022753 0033 - 20110726 - 002162 RENEWAL ORIGINAL TAX $12.35 PENALTY COLLECnON COST TOTAL $12.35 NONEXEMPT" Law requires this Local Business Tax Receipt to be displayed conspicuously at the place of business in such a manner that it can be open to the view of the public and subject to inspection by all duly authorized officers of the county. Upon failure to do so, the Loral Business Taxpayer shall be subject to the payment of another Loral Business Tax for the same business, profession, or occupation. Pursuant to State Law, all Local Business Tax Receipts shall be sold by the Tax Collector beginning July 1st of each year and shall expire an September 30th of the succeeding year. Those Local Business Tax Receipts renewed beginning October 1st shall be delinquent and subject to a delinquency penalty of 10% for the month of October, plus an additional 5% penalty for each month of delinquency thereafter until paid; provided thatthe total delinquency penalty shall not exceed 25% of the Local Business Tax for the delinquent establishment. In addition to the penalty, the Tax Collector shall be entitled to a collection cost fee of from $1.00 to $5.00, based on the amount of the Local Business Tax, which shall be collected from delinquent taxpayers after September 30th, of the business year. This receipt is a Local Business Tax only. It does not permit the Local Business Taxpayer to violate any existing regulatory or zoning laws of the state, county or cities. It also does not exempt the Local Business Taxpayer from any other taxes, licenses or permits that may be required by law. Local Business Taxes are subject to change according to law. Jackie H Flanagan 5234 NW Reba Circle Port St Lucie, FL 34986