DEMO-14-1580Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-216332 Permit Number: DEMO -7-14-1580
Scheduled Inspection Date: August 11, 2014 Permit Type: Demolition
Inspector: Devaney, Michael Inspection Type: Final
Owner: , Work Classification: Electric
Job Address: 9723 NE 2 Avenue
Miami Shores, FL 33138- Phone Number (305)949-9049
Parcel Number 1132060134210
Project: <NONE>
Contractor: AP POWER ELECTRIC CORP Phone: (954)822-4496
lsunamg uepartment comments
DEMO ELECTRICAL
INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction ❑
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
August 08, 2014 For Inspections please call: (305)762-4949 Page 8 of 27
N
Miami Shores Village
Building Department JUi 22201t4/
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 201J
BUILDING Master Permit No.pem
PERMIT APPLICATION Sub Permit No.a„�mw
❑BUILDING [dELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
OWNER: Name (Fee Simple Titleholder): 6rc"r 427,93 A04- A fly x LG G Phone#:
Address: 10,C A)i A 163 Sf
City: Al hi* E;O.„„ &'ead- State: Zip: 3 3 162.
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: _41g" d e e- Phone#: 3dr 7 76 64 r /
Address: 32 $-$ S+
City: Ff . Ir . Cor" State: /e_ Zip: 3 S 3I 2- �-
Qualifier Name: Add- R r'Z Ae% Phone#:.3®� 7 7 (P — 4*
State Certification or Registration #: eR 13 61 yY3 y Certificate of Competency #:
DESIGNER: Architect/Engineer: sLieke .. &e -&AQ& WdZ_ Phone#: 46y(/v 3t6l
Address: UG waj ity: �+•�G�'i.�• State: & Zip: ,33/ 7
Value of Work for this Permit: $ 3S-415-0 Square/Linear Footage of Work: "W y6 S'* 'C
Type of Work: ❑ Addition ❑ Alteration ''❑ New
Description of Work: ""bl elect f cad
Specify color of color thru tile:
❑ Repair/Replace [Demolition
Submittal Fee $ Sn ° Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Technology Fee
Structural Reviews $,
(Revised02/24/2014)
Radon Fee $
Training/Education Fee $
DBPR $
Notary
Double Fee $
Bond $
TOTAL FEE NOW DUE $ �� • ��
CONTRACTOR
DRAWINGS
' /
JOB ADDRESS: q 0 -7 / 7 N�
A Pc`
City: Miami Shores
County:
Miami Dade Zia:
33/.3f
Folio/Parcel#: //— 3.2D(® ®
LI-XIC)
Is the Building Historically Designated: Yes
NO 1--'
Occupancy Type: Load:
Construction Type:
GQ S Flood Zone: BFE:
FFE:
OWNER: Name (Fee Simple Titleholder): 6rc"r 427,93 A04- A fly x LG G Phone#:
Address: 10,C A)i A 163 Sf
City: Al hi* E;O.„„ &'ead- State: Zip: 3 3 162.
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: _41g" d e e- Phone#: 3dr 7 76 64 r /
Address: 32 $-$ S+
City: Ff . Ir . Cor" State: /e_ Zip: 3 S 3I 2- �-
Qualifier Name: Add- R r'Z Ae% Phone#:.3®� 7 7 (P — 4*
State Certification or Registration #: eR 13 61 yY3 y Certificate of Competency #:
DESIGNER: Architect/Engineer: sLieke .. &e -&AQ& WdZ_ Phone#: 46y(/v 3t6l
Address: UG waj ity: �+•�G�'i.�• State: & Zip: ,33/ 7
Value of Work for this Permit: $ 3S-415-0 Square/Linear Footage of Work: "W y6 S'* 'C
Type of Work: ❑ Addition ❑ Alteration ''❑ New
Description of Work: ""bl elect f cad
Specify color of color thru tile:
❑ Repair/Replace [Demolition
Submittal Fee $ Sn ° Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Technology Fee
Structural Reviews $,
(Revised02/24/2014)
Radon Fee $
Training/Education Fee $
DBPR $
Notary
Double Fee $
Bond $
TOTAL FEE NOW DUE $ �� • ��
L-1
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 $2500, the applicant must
promise in good faith that a copy of the notice of commenm and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified co;
of the recorded notice of commencement must be posted at the job site
for the first inspection which occur seven (7) days a r the building permit is issued. In a absence of such posted notice, the
inspection will not be approved an a einspection will be charged.
Signature Signature
e
OWNER or
The forggoing instrument w s asif'c wledged before me this
—a day of 20 by
t ho is onaWT -k ow o
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC: 141
Print: ; A
Seal:allanded
SAMMY SALEM
W COMMISSION #d`FF033100
D0'IRES: OCT 20, X017 through1st$ft bum=
###########
APPROVED BY
(Revised02/24/2014)
CONTRACTOR
The foregoing instrument was acknowledged before me this
1W . day of a"10✓' 20 by
me or who has produced
NOTARY
Seal:
4eO4)Plans Examiner
Structural Review
who is personally known to
GELKA ACUNA
e COMMISSION # EE018198
IBES AWust 17, 22014
as
Zoning
Clerk
Miami Shores 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. In these circumstances, Miami Shores Village
does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore. you Mabe
persgggU liable for the worker compensation injuries of any person allowed to work under this permit Please check with your
insurance carrier since most property insurance policies DO NOT cover this type of liability.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERS�°AND ITS
CONTENTS. I
Print Name: JFAL (k ALIZ
Signature:
State of Florida)
County of Miami -Da )
Sworn to and subscri ed before me this
day of , 20
By
(SEAL)
Type of Identifica 'NON tmoo
EX4iRE8: OCT i0, 2017
Bonded throu0h 18t�ate DORM
Print
2 -
State of Florida )
County of Miami -Dade )
Sworn to and subscribed before me this
day of , 20
Lo
Of