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EL-14-1142Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-216705 Scheduled Inspection Date: July 29, 2014 Inspector: Devaney, Michael Owner: PECK, STEPHEN Job Address: 173 NE 107 Street Miami Shores, FL Project: <NONE> Permit Number: EL -6-14-1142 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number (305)801-4427 Parcel Number 1121360070310 Contractor: C. ALBERT ELECTRICAL CORP Phone: (786)417.4096 umiamg lueparitment comments REPLACE THE SERVICE INSPECTOR COMMENTS False Inspector Comments Passed DT - Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. July 28, 2014 For Inspections please call: (305)762-4949 Page 34 of 40 BUILDING PERMIT APPLICATION ❑BUILDING kELECTRIC 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 .,� _, JUN 0 8 2014 BY: -- — FBC 20 V3 Master Permit No. L-A -Z-- Sub Permit No. ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING r_j MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 141 V p� t F 10 :7 S "VV4 City: Miami Shores County: Miami Dade Zip: 34116 1 Folio/Parcel#: -►003E„ Oslo Is the Building Historically Designated: Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): fou ke h b7. Perk Phone#: 410P 001— W27' Address: (000 I/6 KB4'i %vN Way - l i0 y City: MAI%w►± State: (... Zip: W/Y Tenant/Lessee Name: N P% Phone#: Email: CONTRACTOR: Company Name: �G.���/='�f /��r_- ci`i�rtt%C� Phone#: 74e6 c1l 7 t�0 '3 6 Address:��et-1Y5' S W //0 -P/f/4e. City: 11w1, ',4W/ state: )c7c Zip: 3 3% % Qualifier Name: W one#: 3 o 6- a?l 7 901.2.. State Certification or Registration #: 'FC /300 13 ell Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ / W,00 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New lel Repair/Replaccee� ❑ Demolition Description of Work: %1rd�G0 7�/Is/Zt//L/_% �G%v/� • /,,a,ye� �J�X Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews (Revised02/24/2014) DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ --.1 ( is -:!16 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 bt 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 6 0, ^', � (T"+ 4,, OWNER or AGENT The foregoing instrument was acknowledged before me this Signature CONTRACTOR The foregoing instrument was acknowledged before me this y day of . 20 / Y • , by o94/• day of _off , , 20 I y , by &%Ift S1.1 r. , who is personally known to 4,r W r2w, ^ , who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: as me or who has produced identification and who did take an oath. NOTARY PUBLIC: as Sign: lei Sign: Print: CAV -ODS iso Pri �A Notary Public Stale of FloridaNotary Public State of FkMa Seal: Carlos A Russo Seal: Carta A Russo M' Canmission EE123743 E Commtsabn EE123743 or Expires 091021201b or w xpMas 09/0212015 �***����kffiffi&*�k�k**��&* �k+k�k�k�kakile�kfl��k�k�kffi&�k��*�k�*�k�kakak�e�k�k�k+kffi�k�kffi�kxe�k�k�k*�k�k�k*�kffi�6*�k�k�k�k�k4&�k�k�k�k�k�kffi�k�k�k�k�k�k�k8��k4�k�k�k�k�k�k*�k�k�k�k XPi/L` APPROVED B Plans Examiner a Zoning Structural Review Clerk (Revised02/24/2014) 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 may be personally liable for the worker compensation injuries of any person allowed to work under this permit Please check with your insurance carver 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: Signature: 6.` - State of Florida ) County of Miami -Dade ) Sworn to and subscribed before me this day of PWic $We d %Ws By - (SEAL) Contractor Print Name: �. S Signature: State of Florida ) County of Miami -Dade ) Sworn to and subscribed before me this _ ^ day of _ _ _ _ _ 20 1 By_ Sate of Ffida EE12V43 CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKM COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 07/30/2042 EXPIRATION DATE 07/30/2("4 1 • PERSON: RUSSO CARLOS - A FEIN: 651150385 BUSINESS NAME AND ADDRESS: C ALBERT ELECTRICAL CORP 8445 SW 110 TERR MIAMI FL 33176 SCOPES OF BUSINESS OR 1- ELECTRICAL CONTRACTOR IWORTANT: Pursuant to Chapter 440 . 05114), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election ander this section may not recover benefits or compensation ander this chapter. Pursuant to Chapter 440.owb, F.S., Certificates of election to be exempt.. apply only within the. scope of the basiness or trade limed an the notice of ofto be exempt. Personal to Chapter 440.0913), F.S., Dices of election to be exempt and certifitates of election to be exempt shaft be subject to revocation if, at any time after tits 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 section. QUESTIONS? ($50) 413-1609 OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 i ... 09-27-2012 .JEFF ATWATER STATE OF FLORIDA CHIEF FiNNXIAL OFFICER DEPARTMENT OF FINANCIAL. SERVICES DIVISION OF WORKERS' COMPENSATION * - * CERTIFICATE OF ELECTION TO BE EXEMPT FROitE 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: 09/26/2012 PERSON: FEBLES FEIN: 651150385 BUSINESS NAME AM ADDRESS: C ALBERT ELECTRI �j_C�ARP 9445 SW 110TH TERRACE Mimi FL 33176 SCOPES OF BUSINESS OR TRADE: 1- ELECTRICAL WIRING WITHIN BUILD EXPIRATION DATE 09/2612014 IMPORTANT: Pursuant to Chapter 440 . (1504), F.S., an officer of a corporation who elects exemption from this duVer by filing a certificate of election Under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12►, F.S., Certificates of ejection ta be exempt.. apply only within the scope of the business or trade listed on the entire of election to he exempt. Pursuant to Chapter 440.05513), F.S., Notices of election to be exempt and certificates of election to be, exempt shall be subject to revocation if, at gay time after the filing of the notice or the issuance of the certificate, the person named an 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 persue aauted an the certificate to most! the requirements of this section nuccnnatci tncnt a,z_utno Local Business Tax Receip t Miami -Dade County, State of Florida THIS IS NOT A BILL - DO NOT PAY 4917663 BUSINESS NAME/LOCATION C ALBERT ELECTRICAL CORP 9445 SW 110 TER MIAMI, FL 33176 OWNER C ALBERT ELECTRICAL CORP Worker(s) RECEIPT Na.RENEWAL EXPIRES 6133723 SEPTEMBER 30, 2094 Must be displayed at place of business Pursuant to County Code Chapter 8A - An. 9 & 10 SEC. TYPE OF BUSINESS 196 ELECTRICAL CONTRACTOR PAYMENT RECEIVED BY TAX COLLECTOR EC13001341 75.00 07/24/2013 This Local Business Tax Receipt only coufimis S 1-13-034577 paymeut of the Local Business Tax. The Rece pt is Doot a license, permit, or a cedfflcatioa of the holder's qualfficatious to do bussone. Holder must comply with any governmental or nougoverumeutal regulatory laws and requirements which apply to the business, MMMADE The RECEIPT N0. above must be displayed on IAan commercial vehicles Miami -Dade Code Sec 8a-276. � for more '"formation, visit "naw laiamidade aov/tY.ollector 9445 SW 110TH TERR. MIAMI FL 33176 SCOPES OF BUSINESS OR TRADE: ELECTRICAL WIRING WITHIN BUIL Pursuant to Chapter 440.05(14), F.S., an officer of a aarpmvffw who elects exemption from this chapter by filing a certificate of election under Oft section may not never benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., CertiliCales of ebcbbn to be eft... apply only win the a , of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.1813), F.S., Notices of election to be exempt and c w0cates of election to be exempt shall be subject to revocation 9, at any tine after the fling of the notice or the Issuance of the certificate, the person named on the notice or cedificate no longer meets the requirements of this section for issuance of a certificate . The department std revoke a certificate at any time for fallure of the person named on the ceac ate to meet the requirements of finis section. DFS-F24DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS? ($50)413-1809 a AUG gt� Y oT�� I CARP ,°�xFl fi SEQ#L120904 Kim E�1N 9BCAR�t JUN -03-2014 09:08 From:CLAWSON & COMPANY .= - To:3057568972 Page:1/1 np In• AK "�:..=�"`'' CERTIFICATE OF LIABILITY INSURANCE DAA13�20140141� 0610 Q6�0 THIS CERTIFICATE 19 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: H the certlflCaW holder Is an ADDITIONAL INSURED, the policy(ies) 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 endorsemen s). PRODUCER Clawson S Company, Ina 2731 Executive Park Drive, #8im Weston, FL 33331 CONTACT EI HONE 954-389-6930 N.I: 964-389-0482 NO, e�aeAtL ADDRBss: PRODUCTS - COMP/OP AGO S PRODUCER cusTomin to . CALBE-1 INSURER(S) AFFORD COVERAGE NA10 B INsu1ERA:Scottsdale Insurance Company INSURED C. Albert Electrical Corp Albert Russo INSURI3I e r 9445 SW 110 Terrace INSURER C Miami, FL 33176 INSURER ID: ALL OWNED AUTOS INSURERS: INSURER P: CAVFRAt;r Q rrs� 1,,�� �� "`• KftYIbIUN NUMBER: THIS 1S TO CERTIFY THAT THE POUCIE3 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. GENERAL LIABILITY A X1 COMMERCIAL GENERAL UAsILi Y CWMB MADELX OCCUR 843845 107130/201310713012014 8 MED EXP LPERSONAL & ADV INJURY 13 1.000.0001 GEN L AGGREGgT E LIMIT APPLIES PER X POLICY PRO. LOC AUTOtalOf�gE LiABMTY UnnrtKAL Ag0RF-GATE $ PRODUCTS - COMP/OP AGO S ANY AUTO COMBINED SINGLE LIMIT (Ea 80=9M) $ ALL OWNED AUTOS BODILY INJURY (Per PMM) $ SCHMULED AUTOS BODILY INJURY (Per awkIeN $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE. $ (PER ACCIDENT) $ UMBRELLA UAB 0.=89 LIAB OCCUR CLA6NS BAADE $ EACH OCCURRENCE >g DEDUCTIBLE AGGREGATE $ i NTrON $ $ WC STATU-OTH- WORKERS COMhENSAMUN AND EMPLOYER»' LIABILITY ANY MSEEREXXRECCLUD OFFICOWFED? Y❑ (MYandatory in NN) DES) dIPTICN OPERATIONS DelOw NIA E.L. EACH ACCIDENT $ F.L. DISEASE - EA EMPL $ E.L. DISEASE . Pni My i wrr Ia OF OPERATIONS 1300 r # EC 1300 13Q1LOCATION$! v6ploLF.G (ALmeR ACORD t41, A"UQRW RWnaft SdW%dNo, mars apace is roqui") Miami Shore, Village Building Department 10050 NE 2nd Ave. Miami, FL 33138 ACORD 25 (2009106) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. m 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Tax Potm Nm)mb,er:11413"W-tt31Q" 7USinstrnnmensprepored by JosePh C. Frecfidftc.]r 10$00 Biscayne 111vd: Suite Glp Mind- >�t+bixda 3316I Reeord.aml Retnrn tet:. TM MEMVW made-th sAi�`dh►y ofIMay, between, KIM NWT Z tNOM a stuff ewoMIn, wbmaftmis3248_Eo eR04PitW=g%PA 15241, andWorm n:GRemanilBumaimew. Reese,hudmdand wife,whog-add as23620W.LongBeachPO* h4esidU6:.1L60041; €i ar*.and-. z Stephen: Peck; a singles n :whom ad[inm is: 173 NE:1O7 Sfrc; Wfior4 Shore$; FL 33151, Grattt `, i�1771(ESS�ET7� That said. Grantor, fb r and in oMMaration of the sum of Tea and ODI -100 ($10.x) Dollars, and other gm& and valuable consideration to said Grantor, in hand pales by said Grantee the r=eipt wl +elf is herebyacknowla%cd, hereby gram, borptim. sells, alians, remiss, rekeasas, cxmveys and conte unto.the said Grantm, and Grantee's heirs and assigns forever, all that certain land,: sulfate, X11 and being ue Nami-Dade County, in the StMe.of Florida, to -wit: Lot 15, Stock 201, ofDUNNING'S NUM: SHORES EXTENSION NO.3,:aeeordirig to the Plat&emf, as`recorded'in Ptal Book42,-at Page 33, of the Public Records of Mani -Dade Comnty, Florida.. More comarnowy known as: 173 NE'tO7 Sftet, Miami Shores; FL 313161. SUBJECT TO: 1. Takes for the cureeaand subsequent years. 2. Conditions; m reservations, easements and Urrutations . w g ordinances, if srny,but nottoreimpose mom TO6El'HER vicith all t its,' hereeiimrnerik-o"d appurtenances thereto bdong ng or in arTwise appertaining - TO HAVE AND TO HOLD thesame in fee sin;ple fever. AND the Grantor hereby covenants with said,Grantee=that the Grantor is lawfully seized of said land in fee simple; that the CrantDr has good right and lawfufauthmity to sell and convey said tarsi; that the Grantor herd fully warrants the title to said land and will defend, ,the =sam against the lawful claims of all parsons whomwever, and that said land is free of all encumbrances. •"Grantor' and " Gmntec- mx p od for-siapdar or plural,. weentextretiwres. —. (iriitiaisofeollcrs) fJ Gw 6AV-A 6C- �Z q - 11-4 Z P.O. Box 162,411 Miami, Florida 33116 Phone: 305.271.7962 15' ALLEY 10' ASPHALT PAVEMENT .p�0f NE AMI S FAN 17 a 4 Carlos A A Rt�so n EE123743 Nov APPROVED La 4- PN N w ZONING r ISO,AA^ps 0.03' S1 RUCTURAL <0 O 13.86 " tO ELECTRICAL. t3N£ STORYca •• RESIDENCE #173 ' a 0.03 D 57' m -- _-• PLUMBING m .. ... . . . . . •. ........ . ........ . . . . . • .. ... .. . .... PARKWAY now 7;-2;14.B' ASNOU mmmy _N.E:10?t_h STREET 15.6' ASPHALT PAVEMENT ... .•.. .• . . .. ... ... . . . . . .. .. . . . . . . . . . . . .. . . . . ... . •• . • • • • • • • • • • • •• •• 009 • .• 0. MECHAN BY GE DATE SUBJECT TO COMPLIANCE Wt H ALL FEDERAL. STATE AND COUNTY RULES D REG3LAt1O4S JUN 0 BY:__p .p�0f Notary of Fbr�da . Carlos A A Rt�so n EE123743 Nov Lied S fired Rosi ku" & Commereid 2Aji G -3 1( S 'D [ZY r IL �l I IL, w ALL 11S ( 5 L t d !S aft 06,.j 1 J)Ok u, P Skw: rL t 5 GA e-AGQ Q-'Jlk -d - ....... . .. .. . ......... . .. ... .. . .... . . .... .... ... . . .. .... .. . . . ... .... ••• • • • • ••• • • • • • • • • • • • • • •• •• • • • •• •• ••• • • • ••• • • P.O. Box 162411 Miami, Florida 33116 Phone: 305.271.7962 �t tt L UJ4�l:iZ �FAi" I SAAAL RPPACC-s. .� 5 kA AL 4 D L A C. L"- c M l 2 lLD u1 A 01_ t 6 a t_ Fit, c,. t_ %zA ll o a Y k .9 F taL'o -i vv (t= f AO 2ro 'Loci Lt dS. Tr-.nno r,� Nafauy Puftuft of Balch Curbs A Russo MY C01=0160M 'EEt23743 uc Re CpuJ-)u 14 > j� I T14H ,Cca�atgt�: 0 1) 114. Cam OU 3/9 • C-00 a -�L 6 tW-kAr cc V IZ. COAO5 P.O. ®ox 162411 Miami, Florida 33116 Phone: 305.271.7962 _ 0,)b k6. L• 3. b 1 ��- p,, L C- k; eta 1ti� iL Coo �\l N4 ` . ......... . . ....... ------------ • i*A&Lo 04 oy •�. .�. MAtiOrCIL `'{d/. % ...M r -t ... . qAu R L. Sb f, lOAOl t N 4 h= 6.A a.A 6 t. NOINY PlAft Shft of FimMe L'p ARtww MYConm*"EE,23743 Exon 08A2/2Q18 �je7i^4/