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EL-14-1116c 1 ' - Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-215863 Scheduled Inspection Date: July 15, 2014 Inspector: Devaney, Michael Owner: DAVIS, KARIN AND TIMOTHY Job Address: 80 NE 94 Street Miami Shores, FL 33138 - Project: <NONE> Permit Number: EL -5-14-1116 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1132060130300 Contractor: ALES GROUP ELECTRICAL CONTRACTORS Phone: (786)244-0004 comments VVIIIIIIVIIW RELOCATE 2 SWITCHES AND INSTALL 2 NEW LIGHTING I II IIIYVIIV r - FIXTURE INSPECTOR COMMENTS False 6/13/2014 NEED TO PROVIDE WORKERS COMPENSATION AND LIABILITY INSURANCE 6/16/2014 LIABILITY OBTAINED AND UPDATED Inspector Comments PassedE21/_ Failed CW Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. July 15, 2014 For Inspections please call: (305)762-4949 Page 31 of 31 Miami S s hores Village �,. 71 7 Building Department MAY 302014 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (30S) 762-4949 FBC 20� r� BUILDING AcPC_ L 7 LC`? ' Master Permit No. d� �f- PERMIT APPLICATION Sub Permit No. :E LA --L— I 1 ❑BUILDING tg ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION r-] RENEWAL F-1 PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: go t"JE / nq -.577 City: Miami Shores Countv: Miami Dade Zip: Folio/Parcel#: / /d�0 2676 —0/- fes Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): %/ D%t7 C, Phone#: 3 its- 50 4/?57 Address:tS ® tf 1� C/� 7r City: M4, Z/ 6hOO-Z CJ State: r K Zip: '3-)186 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: 4=49�2 C-zxcu$7 LAG, lobi% Phone#: Address: A IFJ6 eS W % 0264--1 ff City: !l4�tt-'l/ State: FL, Zip: 3 3? Qualifier Name: /=4 �Iop/ G., Phone#: State Certification or Registration #: ECDD© /2m Certificate of Competency #: DESIGNER: Architect/Engineer: Address: City: State: Zip: 0 Value of Work for this Permit: $ -NC Square/Linear Footage of Work: 4z) Type of Work: ❑ Addition JA Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: / �`L���i¢�i� �- %t9! 7���% y� � z" mL4,. Specify color of color thru the: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ 670 Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) CCF $ CO/CC $. . DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 11.S'. 10 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 w 'ch occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will notsbt apAroyb# and a reinspection fee will be charged. OWNER or AGENT The foregoing instrument was acknowledged before me this 2 �?' day of��jj o 20 1 q , by l 1 ryl0j- NS1 a. a4i5 who is personally known to me or who has produced_�Q,IrSo na II U V f)W J as identification and who did take an oath. Sig nature .Llf a r CONTRACTOR The foregoing instrument was acknowledged before me this 2-600( day of PA -04M , 20 ISA , by JZgVV'0'1 Loy' , who Is1wisan�____ allymown to me or who has produced identification and who did take an oath. as NOTARY PUBLIC: NOTARY PUBLIC: Sign Sign: Print' 1'01_G>I Mot'.elh' gc� Print: ►-�av'a i„" ra✓j' Seal: NotaryPubBc Shft dFlorWa Seal: { "�,ADRIANAOIRARDI Fabiola Moreno -Bo :+ MY GOMMSSION HE I6717 t My Commission EE032698 EXPIRES: January 22,201-., Expires 1010$12014 ftrdwTiuu Nctwy Pubic Undewkw-_ ' ■*�ie�k+N �k��k#4�+k���d�IIe�k��d��9�&+k���b �bA��kNr�k���ab�e���6� APPROVED BY ^ / 7� �� de)!Po Y Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 19 --- 1 I t(/,o Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 BUSINESS NAME: A I -e-S C vO✓+,n ' c'r't BUSINESS ADDRESS: W(.o S -j '7'6_` PIV� -CITY-ELS wn' STATE FL ZIP CODE �314`4 BUSINESS PHONE: (7�9f_ ) ZtoZ^ 13FAX NUMBER) 2�Z ►3 � CELL PHONE CIM ) 2-2 3- G 0&1 �f QUALIFIER'S NAME: R-CLo rJL-n 4-e - QUALIFIER'S LIC NUMBER: F_ COO 1 Z� E-MAIL ADDRESS (IF APPLICABLE): akb -e_e el l/1'�71 I - CJc ► Created on 3119109 BY MLDV I RV 3126109 MLDV q W7 `T - �- 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 -rime 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 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. Owner Print Name: 1, a1() 1,r - wl-5 Signature: 4&�2� State of Florida ) County of Miami -Dade ) Sworn to and subscribed before me this day of _)za .0 , 20 . By Expires o1Hvzia Contr Print Name: �' ° / Signature: State of Florida ) County of Miami -Dade ) Sworn to and subscribed before me this °`) day of , 20 ►t. . (SEAL) .ham ��• JEFF ATWATER CHIEF F114MCIAL OFFICER STATE OF FLORIDA DFPARiMENT OF FINANCIAL. SERVICES DIVISION OF W ORKERS' COMPENSATION CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLOMDA W ORIOM COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensaftn law. EFFECTIVE DATE 113/2014 EXPIRATION DATE: 1/312016 PERSON: LORENTE RAMON FEIN: 592157712 BLWANESS NAME AND ADDRESS: ALES GROUP INC PROLOCK AND SAFE / ALES GROUP ELECTRICAL CONTRACTORS / ALES GROUP GENERAL 896 SW 70TH AVENUE MIAMI FL 33144 SCOPES OF BUSS OR TRADE: LICENSED GENERAL LICENSED ELECTRICAL DOOR AND WINDOW CONTRACTOR CONTRACTOR INSTALLATION F.B, y d�ecaporeem dno e1eGs 9'an8tis c3lnimA a c�u� 8 Q01fi8Cd8. Tho Sha11 DFS-F2-OWC-252 CERTIFICATE OF ELECTION M BE EMWPT REVISED 07-12 QUESTIONS? (850)413.1805 JEFF MWarER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARMENT OF FINANCIAL SERVIM MOM OF WORKERS' COMPEIiSATM • . CffMRCATE 0FElXCTM TO BE EXEMPT FROM FLOISDA WONOW COMPENSATIONLAW • • CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Worken3' Compensation Raw. EFFECTIVE DATE' 18=14 EXPIRATION DATE: 113/2018 PMON: GONZALEZ DAVID F1: 592157712 BMINESS NAME AND ASS: ALES GROUP INC PROLOCK AND SAFE / ALES GROUP ELECTRICAL CONTRACTORS / ALES GROUP GENERAL CONTRACTORS 898 SW 70TH AVENUE NfiA11A1 FL 33144 SCOPES OF BUSINESS OR TRADE: LICENSED CONTRACTOR CONTRACTOR CONTRACTORLICENSED CTRtGAL DOORINSTALLATIONDOW DFS-F2-DwC•252 CERT{FdCATE OF EIECTtO1V TO BE E7EWT REVISED 07-12 auEEMONS? (880)413.160+1 RDrCERTIFICATE OF LIABILITY INSURANCE 15/19/201 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 AAtEPID, 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 pogcypes) must be endorsed, B SUBROGATION IS WANED, subject to the terms and coni tions of the poky, certain policies may fequke an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endanumnonnaL PRODUCER ANDYS ASSURANCE AGENCIES 1441 W Flagler St Miami, FL 33135 """` (305) 642-8407 N, (305) 643-5969 ADDRESS: and ' r@ andysassurance . con MUMER!" AffORDIMS coveRAoe N=0 INsurRA:WESTERN HERITAGE INS CO INSURED ALES GROUP INC INSURER s: ASCENDANT CObIldERCIAL INS INC d/b/a PROLOCR & SAFE/ALTS GROUP INSURER C: ELECTRICAL CONT/ALES DROOP GC INSURER o: 896 SW 70 AV=UE INSURER E: MIAMI, FL 33144 INSURER F: COVERAGES CPRTTFIr`ATF N1 IU=D - 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, TERAS 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. IN" MAY HAVE BEEN REDUCED 13Y PAID CLAIMS. LTRR TYPE OF INSURANCE Me 1NM POLICY NUMBERAWK LIMITS "` GENIML {y'{"" CLAIMS MADE t x l OCCUR � EACH OCCURRENCE S 1 000 000 DAMAGE 10 FEN1 EU— PREMISES oaaare�e $ 100,0001 MED EXP (Arty are person) $ 5,000 AI SCP097986.9 01/03/14 01/03/15 GEML AGGREGATE LIMIT APPLIES PER X POLICY !_I PA 7 LOC PERSONAL&ADVWURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMPIOP AM $ 1,000,000' OTHER: $ L!!HfOMK)BI E LIABILITY EWA)MSINGLE LIMIT $ 1,000,0 I B ANYALRO r-1 �OOWNED D $ SCHEDULED CA -35460-0 02/24/14 02/24/15 BODILY INJURY Per BODILY INJURY(PwaCcidevd) $ HIRED AUTOS A(IT0 gEDV.F0,1TY$ S UMBRELLA LIAR EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $_ AGGREGATE $ �11 DED I I RETENTIONS WORKERS COMPENSATION $ AND EMPLOYERS LIABILITY YIN ANY EXCUID£G? � D NIA STATUTE 1 ER EL EACH ACCIDENT ; $ yyees, 0 SOTION OF OPERATIONS below EL DISEASE - EA EMPL - $ EL DISEASE -POLICY LBAIT $ I i � i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Add8bw1 Remarks Sdwdul% may be aftdW if nwe spmw is required) Locksmith (14913), Door & Window Installation (91746), Alarm Installation (91127), i Electrical Work (92478), General Contractor (91580) & Subcontracted Work (91585) i I i 1 Miami Shores village Building Department 10050 NE 2 Avenue Miami Shores, Fl 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ACORD25(2013/04) JUN 16 JWCORJInam wW Logo are negWered 1988-2013 ACORD CORDO. AI rights reserved. of ACORD // P a Alejandro Martinez Jr. Manager 2440 NW 54th Street MIOW, FG 3 3942 Phone:(305) 545-6677 GeN;(30) 748-3529 cam rlat nders.Cam P�. ly- �a'�' r�crsfer perm, J AC+r�I►KL7- 1.ABOFff"9 MB AM CERTIFICATE OF LIABILITY INSURANCE TN19 CERTIPICATE TS H ISOED AS A MATER OF INFOWAAMON ONLY AND CIONFin NO MHM UPON THE 09RMCATE HOLDLR THLS OERlV=TE DOES HOT AFFtI>IBATNELY OR NECATNE.Y ANNEND, 'OR ALTER THE COVEl"s AFFORDED BY"gEFOLMUM BELOW. TNG CIOt11F1CATE OF MOURANCE DOES HDI CONIMME A CONTRACT BEi>fEEN THE MUM MBLMERM AUTNORIZED R71t1ESENTATNE OR PRODUCM AND THE CEIMCATL K LDEIL IMPORTANT; Tf ON, cert hotdaw w an ADDITIONAL anuf c the poll"Qw) mum b9 endonmb If SUBROGATION13 wi i M 6ulr do tho tWM and Condom OT1Ire fir. "rhm 100161e9 nnty'nlx 100 an mtft=Hk=L A 8ft&nw4 on ab C912MOM does not mer r hts to Isle t lt»ider In Hen of such cadal gt TB MIA Labor Flndem of TltbjnL hro 1eO10Am, id. $uftLalIG Wcrtty FL 38463 THIS IS T(3 CERTIFY THAT. THE POUCH OF INSURANCE LISTED SE.OW HAVE BEEN ISSUED TO TH9 IN& IMICAU NOTWITHSTANDING ANY I9OUIREMENT, TERGA OR CONDMON OF ANY CONTKWrOR QTHO CERTIFICATE MAY as wuED OR MAY pBRTAIN, THE INSURANCE AFFORDED >$Y THE POLICIES DESCRU E7fCLUSION$ AND CONDITIONS OF SUCH POLICIES. UWTS SHOWN MAY HAVE SEEN REDUCEO BY PAID CLAIAM TE TVpE0F!n a M Mll MM A X aaAL LFp.mr X jp"=jG2&Gj l2B7%"013 12181@014 J clans& I! LAI OOMM tAGGMATEUIfirf.APFUWpM or "I YIN El OMM31 W10112014 DOCUMENT WITH RESPECT TO WHIM:I MIS D HEREIN 19 SMECT TO ALL THIS TERNS, ■� 4{�:-111 f LA b - f 1,000 PRAINOT62M 1218112013 1213V014 CWms Mom 1.01m, 12181=13 tWIM1114 F�oNc�orew�7�nstln��ns1 [a�Arr��c1.Am��,emeres��eveau� ftbrells fo0aws form over then Lfab, Pr+cd• Ldab, EmPk IW BAmft Lib, Auto & f mp**r LI*W4 r SI>aa1� Aga Bu"ag Datparta M -t 0 =0 NTE 2nd Avenue, MWaf Sm m& FL 83128 are mWft& 1 base and ars rospt.4. to genual OabMW wFtert r uTrsd by vin +xlltrsat SHOIAD ANY OF TM ABOVE UMMMED POLN m w OANCft,L6fi B@Fq= TM WMATM DATE 7tQRE0F, NOT= NAIL BE D>}L NlD IN ACCOMOM VMTH6.POuay PROVISIONS, Atex Qroup IrKi. D@A EEafh�t Contrastore � � • 868 BN TONT Avemm ..r , 44 01918-2010 ACORD CORPORATM. AN dghts roes MW i201O108j The Af ipFZD nasrrre and logo are rel marks *fA0ORD