The URL can be used to link to this page

EL-14-1781Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-217946 Permit Number: EL -8-14-1781 Scheduled Inspection Date: August 19, 2014 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: GADOL, EDWARD Work Classification: Repair Job Address: 37 NE 100 Street Miami Shores, FL 33138 - Phone Number Parcel Number 1132060131410 Project: <NONE> Contractor: HOP ELECTRIC INC Phone: (305)428-2769 sunaing uepartment comments SERIVCE REPAIR 200 AMPS FPL TO RECONNECT Infractio Passed Comments 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 18, 2014 For Inspections please call: (305)762-4949 Page 19 of 27 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION ❑BUILDING P LECTRIC ❑ ROOFING 7RECE� AUG X14 22014 FBC 20 10 Master Permit No. Sub Permit No. ER— ,LI 1_1 ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 3 / A CZI /0 Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): EZ- ,,,Z 7. 6 At I- Phone#: ,?-nS X 7 27 Address: e'S City: "^ /Z)o .sg— S CJ State: r unt Zip: 3.3l;s Tenant/Lessee Name: Email: CONTRACTOR: Company Name: or,6v—GPhone#:' .:z 99,9_3 V /Q W Address: j DIF, tO Z Akt - City: 444 -State: �- Zip: / Qualifier Name:4P7�::5; f� r ' Phone#: 0 7 State Certification or Registration #:6C,4t1,f& L 9 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace Description of Work: ❑ Demolition Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) Training/Education Fee $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 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 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. I /\ in r S g atu e 2—&J,�L� Signatu OWNER or AGENT W T e foregoing instrument was acknowledged before me this The foregoing instrument leas acknowledged before me this day of 'I20 f� , by I day of Ou 0� , 20 ' 1 . by fi1: who is personally known to who is personally known to me or who has produced as me or who has produced R --- as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: `��° �' Sign: Print: Print:— Seal: Seal: a APPROVED Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) &. 003475 HENRY, ORESTE P HOP ELECTRICAL INC 794 MW 116TIi STREET IFL 3316 8 ratulations! 1MItFt this license YOU bec me one of tt PrOfeftional Regu�j� Our licensed by ft partment of Business and ardTiteand they p from Florida's dit b orokew �� boxers to ba moque restaurants, Every day we work to improve the way we do serve You better. For information about our services, s j ase log onto m order to about our divis ons and t M, Them You can find more inlOrmaati r�ula#i�s that Impact you, sub�xibe Initi department newsletters and team more about the Department's Our mission at the DepRegulate Fek*. artment partment Is: License Ef�EnU o°nstenthr strive to serve you better so that you can your customers• 'I !lank you for doing business In Florida, and congratulations on your new licenses 40 STATE OF DEPAITMi PR.FE I EC13004429 ,R � ANC IS,CERTIOIED underthEX�e provisions of Gh.488 6S. ►die: AUG31,21►te .. I.141SW RICK SCOTT GOVERNOR DETACH HERE ,. KEN LAWSON ..... __ ..r .. SECRETARY STATE OF FLpR--N)A DEPA*TmENT QF Bt`---°-- - ELECTRJCAL REGULATION tLCto r Kl,GAL" CON- ACTOR Named below JS CERTIFIED U die provisiOn$_ of Chapter 489 FS. Expiration date: AUC 31, 2046 y HENRY'ORE$TI_ P HOP EEEQ— IC,t> r� �NW 11.6TH _SW „F piM tl f=L B"`�I .' q2 ISSUED: 0W9/201a .,,�....... =:A tom% **MMMMCFB=MToSEBMWTfft=RCFWAWOMMWWWSWMMLAW.. CONSTRUCTION INDUSTRY EyEMiTIVS This Cerulea that the individual listed Mow has elected to be exempt from Florida Workers' ComPrensation law. ERMM EDATE M1t1J2014 RA:MOATE 4117!2016 PERSM HENRY ORESTE P FED& 271346525 BUSIMMS NAME ANDA S: HOP ELECTRICAL INC 10822 NW TM AVE A- 33168 SCOPES OF BUSBIM OR7R4DE LICENSED CONTRACT CTRICAL oFs+z-awC-M CERnFICATE OF ELEC'M To BE MEMPr REWSM 0-12 sz c85nl413-1609 Mmllpoem.flus.MWWW&"MmwkwWMRWMM?dO--*MftM703aHBTERWIV4NPOPN4MrDRMWI11 1/2 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,ov u may be personally 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 UNDERSTAND ITS CONTENTS. O e Print Name: Signature: V-D"Na--3 (��►�� State of Florida) County of Miami -Dade) J`k Sworn to and subscribed before me this day of 1\A4:),) -6A , 2014 W d [r3rrrr/�''%, By (SEAL) Type of Identification vroduce-d -P'. 'i QJ Cad,^:'�J\• Contractor Print Name: Signature: State of Florida ) County of Miami -Dade) ++n+urrrr� Sworn to and subscribed before me�,�` day of F---' V LJ 3 , 20 i By (SEAL)"a�°�\°��\ r CD Type of Identification produced DATE (M CERTIFICATE OF LIABILITY INSURANCE 11/04/13DfYYYY, THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(fes) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Annette Willis Insurance PHONE FAX (A/C, No): 18401 N.W. 27 Ave DDR PRODUCER --------------- - - -- Miami, FL 33056 CUSTOMER ID : ---- -- Phone (305) 625-2403 Fax (305) 625-6472 INSURERS) AFFORDING COVERAGE I NAIL 0 INSURED INSURERA: NATIONWIDE INSURANCE HOP Electrical Inc INSURER B 794 NW 116 Street INSURER c Miami, FL 33168- INSURER D: INSURER _E.,__- INSURER .,__INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INR — - D B --- ----___._ )'DLI-CY EFF POUCY EXP LTRI TYPE OF INSURANCE_ R POLICY NUMBER (MMIDDIYYYYI ; (MMIDD)YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 AGE TO RENTED ( fl COMMERCIAL GENERAL LIABILITY PR M SES Es occurrence) $ 100,000 J L CLAIMS -MADE D%* OCCURACP5905354732 MED EXP (Any one person) $ 1,000 A i I .11/08/2013 11 /08/2014 ❑ PERSONAL & ADV INJURY $ 1,000,000! ❑ �ENERAL AGGREGATE_ —.t $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I PRODUCTS - COMP/OP AGG : $ 2,000,000 1 — Ll POLICY I i�T _ _ ❑ LOC + _____j - AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) F' ANY AUTO BODILY INJURY (Per person) $ F ALL OWNED AUTOS BODILY INJURY (Per accident) $ ICJ SCHEDULED AUTOS __-__ PROPERTY DAMAGE ! ❑ $El ' HIRED AUTOS' (Par accident) i NON -OWNED AUTOS $ Ll ❑ UMBRELLA LIAR ❑ OCCUR EACH OCCURRENCE ❑ EXCESS LIAR CLAIMS -MADE { AGGREGATE $ --- --- _� DEDUCTIBLE $ L (__RETENTION _$ $ r - WORKERS COMPENSATION WC STATU- 0TH-' AND EMPLOYERS' LIABILITY Y1 N i TORY LIMIT$ ..- ER - ANY PROPRIETORIPARTNERIEXECU IVE E.L. EACH ACCIDENT i $ OFFICER/MEMBEREXCLUDED? --- - - - (Mandatory in NH) N / A E.L. DISEASE - EA EMPLOYE $_ If yyeess describe under DESCRIPTION OF OPERATIONS below ) E.L. DISEASE - POLICY LIMBI S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) ELECTRICAN CERTIFICATE HOLDERCAN_C_ELLATION _ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BE,FORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Building Dept ACCORDANCE WITH THE POLICY PROVISIONS. j 10050 NE 2nd Ave Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 26 (2009/09) QF The ACORD name and logo are registered marks of ACORD