EL-14-2351Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-226653 Permit Number: EL -10-14-2351
Scheduled Inspection Date: January 20, 2015
Inspector: Devaney, Michael
Owner: HURTADO, YINA
Job Address: 10916 NW 2 Avenue
Miami Shores, FL 33168-4303
Project: <NONE>
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Service Change
Phone Number
Parcel Number
1121360020200
Contractor: A PLUS ELECTRICAL TECH INC Phone: (305)216-1164
Isunaing uepartment comments
RAISE ELECTRICAL RISER ABOVE EYE LEVEL ADD
ADDITIONAL GROUND FOR GROUNDING SYSTEM.
EXPIRED PERMIT EL05-1189
INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction
Needed ❑ flA,
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
January 16, 2015 For Inspections please call: (305)762-4949 Page 31 of 32
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: (30S) 762-4949
OCT 23 2014
BUILDING Master Permit No. -P-7L-05- A E)!]
PERMIT APPLICATION Sub Permit No./F'-
)
❑BUILDING ELECTRIC [:D ROOFING [ REVISION [ EXTENSION ❑RENEWAL
[]PLUMBING [ MECHANICAL [:]PUBLIC WORKS [ CHANGE OF [] CANCELLATION [:]SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores Countv: Miami Dade Zip: c
Folio/Parcel#: Is the Building Historically Designated: Yes NO t,/ �.
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple
0,41 Phone#: I Y(0- 25 2
Address: C� �l /° Lm.'
City: 11- l r 4 Zvi jk` -"�1S State: E (— Zip:
1-Y-7
Tenant/Lessee Name: Phone#:
Email: t.
6
CONTRACTOR: Company Name:a �,'� �� ��% 'rl'C-; `c ��' % �� � Phone#: ,dl
Address: �3 L ��` ,l
City: a� ° State�� Zip: '
Qualifier Name:- /r
— 147, 7 _ - Phone#:(-�5e'S`) -9-Al�-'
State Certification or RQ'Istration #: 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 LJ� Repair/Replace ❑ Demolition
Description of Work: S e i" l e-' &4a, "` ldz '0�d?t��
Specify color of color thru We:
Submittal Fee $, Sid• �_ Permit Fee $ %���' CCF $ ` �0 CO/CC $
Scanning Fee $ d C � Radon Fee $ 4— DBPR $ Notary $
Technology Fee $ _ �� Training/Education Fee $ Double Fee $
Structural Reviews $ !2 Bond $ 0
TOTAL FEE NOW DUE $ i
i
(RevisedO2/24/2014)
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: 1 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 $2300, 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 �
Signature ' Signature
O ER or AGENT CONT
The foregoing instrument was acknowledged before me this
day
of , llr��i 20 by
y �'l :saw (tea . who is personally known to
me or who has produced " --
identification and who did take an oath.
NOTARY PUBLIC:
Print:
Seal' • v My Comm. Expires Oct 17, 2016
Commission # Et 844671
'w�'' •= �•°F� �- Bonded Through National Notary Assn.
The foregoing instrument was acknowledged before me this
Z1,
day of m d �,®`' X20 _ �7'_' by
"Is—oersonally known to
me or ho has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
C. n1YCnV .,y, �_ ,.,.;,14r
Seal: Nosy POW - State of (Iti
• My Comm. Expires Oct 17.2016
Commission # EE 844671
Bonded Through National Notary Assn.
*ee*aeee�a��a�*+aa��e�*��xa,a�**�x*x��ee�xe,a��ssx�e,s**e�rsease*a�asw*w�xw***s
APPROVED BY A ,/k Z $ 40'�-y Plans Examiner
Structural Review
(Revised02/24/2014)
Zoning
Clerk
IMU� 'w -oil ;0
pip
I.J
RICK SCOTT, GOVERNOR
LICENSE NUMBER
KEN LAWSON, SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD
The ELECTRICAL CONTRACTOR
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2016
VAZQUEZ, RIGOBERTO
A PLUS ELECTRICAL TECHNOLOGIES, INC.
10181 NW 21ST STREET
PEMBROKE PINES FL 33026
ISSUED: 08/08iL014 DISPLAYAS REQUIRED BY LAW SEQ# L140806MI791
JEFF ATWATER
CHIEF FINANCIAL OFFICER
• ` CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA YORKERS' COMPENSATION LAW * *
CONSTRUCTION INDUSTRY EXEMPTION
This c effies that the individual ksled below has elected W be exempt from Flaw Workers' Compertsation loan.
EFFECTIVE DATE: 14111/2013
PERSON: VAZQUEZ
FEIN: 452137777
BUSINESS NAME AND ADDRESS:
A PLUS ELECTRICAL TECHNOLOGIES INC
101$1 NW 21 STREET
EXPIRATION DATE: 10111!2015
RIGOBERTO
PEMBROKE PINES FL 33026
SCOPES OF BUSINESS OR TRADE:
LICENSED ELECTRICAL
CONTRACTOR
JR
Pursuant to C 440MK14). F.S., an officer of a corporates vrtro efecis exemption from lift chaptar by tV a c r0cate of ataon wider this section may
not recover beneRts or compensation under this dfaplar Punont to Chapter 440.05(12). F.S.. C401cales, of eiNion to be exempt.. apply only er r the 500PO
of the bushms or trade on the notice of ale,lon to to exempt. Pursuant to Chapter 440.05(13). F.S., NoNtms of ehcNon to be exempt and cordrazles of
etecdwtoboamrosWbasublWtomvocabnf.atww*mawftfoVofft ngroorftbmarmofUmmMeaWfteperim.m on the ndw
tardecate no kmger msels the reqs of Oft sedan for Issinince of a cardficaft The deparbowt std revoke a cardlicale at any dw for Mure of flys
person named on the certiftate to most ft requirement$ of Nth section.
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTKMS? (850)413-1 19
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 mU be
personally liable for the worker comvensation 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.
Ls..,. -1
Print Name: `dr�� k[C,�{ �� 0
Signature: �J
State of Florida )
w �.+ Rr4ERO
rem
2018
Commission # EE 844671
,,,,'D
By u on ,
(SEAL)
Tvpe of Identification
e
Contractor
State of Florida ) .
County of Miami -Dade)
Sworn to and subscribed before me this
day of _ s_
• State of Florida
Commission # EE 844671
�;n.h�diin -9Arr ��. d 83 :....was va �x•uvK�.��.
:.A � � - � r
A ♦.
t�
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� _.!'�, yip a ,�;air`3 V1�i.+(q �<
r ..n��. y,.. m . i:: 3. .. ._ .. u. n
�`
CERTIFICATE OF LIABILITY INSURANCE"TEOUN
DI"M
09/08/14
PRODUCE!
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Safeguard Casualty Insurance
9996 Pines Blvd
Pembroke Pines, FL 33024
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
POLICY NUMBER
INSURERS AFFORDING COVERAGE NAIC III
INSURED
INSURERA:- Travelers
INSURER B:
A Plus Electrical Technologies Inc.
10181 NW21 Street
Pembroke Pines, FL 33026
INSURER C:
INSURER D:
INSURER E:
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
DISK
ADDL
POLICY NUMBER
POLICY
DATE tMMMDMnnffl
POLICY EXPIRATION
LIA®TS
EACH OCCURRENCE $ 1,000,000
GENERAL LIABILITY
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE 1K OCCUR
660-5A330937
08/08/2014
08/08/2015
PREMISESDAMAGE O RENTED
$ 100,000
MED EXP are $ 5,000
PERSON& & ADV INJURY $ 1,000+000
GENERALAGGREGATE $ 2,000,000
GEM AGGREGATE LIMIT APPLIES PER:
-411
PRODUCTS - COMP/OP AGG $ 2,000,000
POLICY PRO- LOC
AUTOMOBILE
U481UTY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident) $
BODILY INJURY
(Per fin) $
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Peraaddent) $
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE $
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
OTHER THAN EA ACC $
ANY AUTO
AUTO ONLY: AGO $
EXCESS 1 UMBRELLA LIABILITY
EACH OCCURRENCE $
AGGREGATE $
OCCUR F] CLAIMS MADE
$
$
DEDUCTIBLE
$
RETENTION
WORM COMPENSATION
WE STATU- oTH-
AND EMPLOYERS' LIABILITY Y I N
ANY PROPRIETORIPARTNERIEXECUTWE ❑
OFFICEMMEMBEREXCLUDED?
TORY LIMITS I ER
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $
(Mandatory in NH)
If yes, deacnbe under
SPECIAL PROVISIONS bebw
E.L. DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES t EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Electrical Contractor EC0002993
SHOULDAHYOFTHEABOVEDESCRIBEDPOUCHESSECANCELLEDBEFORETHEEXPMMM
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO !GAIL 30 DAYS WRITTEN
Miami Shores Village Building Dept NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
10050 NE 2nd Ave IMPOSE NO OBLIGATION OR LABILTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Miami Shores, FL 33138 REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 28 (2009101)
The ACORD name and logo are registered marks of ACORD
Dome
77
Local Business Tax Receipt
�
Miami -Dade County, St* of Floflda
THIS 10 NOTA — RIOT PAY
6895289
BUSINESS NAMEILOCA'TION
y RECEIPT NO.
A PLUS ELECTRICAL TECHNOLOGIES
INC RENEWAL
SEPTIEW& iOr 2015
DOING BUS IN DADE CO
7170913
Most be displayed at place 0 business
MIAMI FL 33000
PursUaftto C0UntYC_ do
Chapter BA — Art. tA 10
OWNER
A PLUS ELECTRICAL TECHNLGIES INC
SEC. TYPE OF BUSINESS
PAYMENT RECEIVED
196 -ELECTRICAL CONTRACTOR BY TAX COLLECTOR
Workers) 1
E CO002093
$75.00 09/11/2014
This Local BusinessTax Receipt only confirms payment of the Local B
pen* or a certification of the holder squalffloations. to do buslnes&
or nongaveammmal regulatory lam and requirements which apply to
The RECEIPT NO. above must be displayed an all apkarmiall V1
For ww P fulonnation, visit
C2EDITCARD-14-036734
Aecelptis note Roomm,
0
rnd is 6-;- c--/- c -/z- A R
v o /-E /- �l/e —r -Z
170 f 0
�<AlAfp
OCT 2 31014
T- p; pe- W,-tV
-Ora
PERMIT #:
Miami Shores Villa
le
APPROVED BY
DA TP -
ZONING DEPT
BLDG DEPT
SUBJECT TO CCMPLIANCE WITH ALL FEDERAL
STATE ANf) CCUMY RULES MID REGULATIONS
rorD/,
7
E.RMO
Stdo of FlorWa
Nomy Pubk - I
My Com. Expires Oct 17, 2016
Commission # EE 544671
TP cwf. -
ot i
�.:-m...: ...: r.. __�.t...- a. -'....mss .e69t C .
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n
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CHANGE OF CONTRACTOR / ARCHITECT
:VermitN.-;Z.-61-Ugq
diner's Name .(Fee Simple Title Holder) Y d 6 ,-j a'<TA60 Phone
Owner's Address: Jr q /I,-
City: d `j 1- .,F c i
Job Address (Of where work is being done):_
City: Mta� ms
State : C Zip Coder
�1. ")
State:Florida_ Zip Code: -
Contractor's Company Name: e Phone # !/.4o,`
Address:
City: z �� ° ' Mate: Zip Code:
Qualfier's Name : - _ - Ii , "L L 6� Lic. Number: �%�'9
Architect/ Engineer of Record Name: Phone #:
Address: k
City:
State: Zip Code:
Describe Wort�� "
I he eby certify that the work had been abandoned and/or the contractor/architect is
unable or unwilling to complete the contract. I hold the Building Officl I and the
Miami Shores harmless for all legal involvement. �'
Signature—
The
ignature_The foregoing instrument was aknbwieded before me
this -L day of _ ° 20;4,by-V;,.-, G p'
Who is personally known to me or who has produced
as indentiflcation.
N 1y E. R1141110
Sign: My omm. Expires of 16
Seel: - ps;= Commission # EE 844671
OilBonded Through National Notary Assn.
Signature
The foregoing 1nstrumlent-wjs—JjCn&Wged before me
thisy of 20 by l'z,
wholso�ermsonaally known t me or who has puced
as indentific don.
iilotary '�� E. Rn0ERQ
Sign: � '+ le - seE8U44671 :+ crCommission # EESeal. qQJBonded Through National y Assn.
F: No
� \\»,. a , , /�,\\A
91/30/2014 .
English customerservice USPS Nowle
AQUVS.CQfVr
USPS Tracking'
Tracking Number: 701405100=77364382
UM-COMS - USPS Tracldn=
' P0
Expected Delivery Day: Wednesday, ftPftmbOr 10, 2014
ON USPS.C=
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FW-Chw Man*
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DATE& TIME
W Us 0,F I TE rV,
LOCATfOl
Sephwnber 11, 2614,12:13
pm
Delivered
HMMK FI. 33016
(cu I.- i° e M " td e1 12" 1
(1 I 5. , I I e in t. C, " I I --, 4 4
C
F t. 33 1
September 10, 2014 ,1:55
Notice Left (No Amiltorbasd
pin
Rec[PlerdAvallable)
HIALEAH, Fl. 33M6
SeOwnber9, M14,1128
Departed USPS Origin
PM
Facility
MIAMI, Fl. 33152
Seplarnberg, 2014, 7-40
Arrived at USPS Origin
Pm
Facility
MIAMI, Fl. 33152
September 9, 2014,12:03
P111
Acoepwtoe
MIAMI, Fl. 33153
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Date: September 29, 2014
Yina Hurtado:
The following is in response to your September 29, 2014 request for delivery information
on your Certified Mail'" item number 70140510000077364382. The delivery record
shows that this item was delivered on September 11, 2014 at 12:13 pm in HIALEAH, FL
3301+6. The scanned image of the recipient information is provided blow.
Signature of Recipient : ��•..., �''=`�---����;•
Thank you for selecting the Postal Service for your mailing needs.
If you require additional assistance, please contact your local Post Office or postal
representative.
Sincerely,
United States Postal Service
September 9d-, 2014
Ray Williams Electric
2450 82nd St
Hialeah, FL 33016
To whom it may concern,
I am writing to notify my intention of changing the general contractor for the electrical project with
permit number: EL -12-05-1189, of the property located at: 10916 NW 2n' AVE, Miami Shores, FL
33168.
Thank you in advance,