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EL-14-16124E_ 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-226145 Permit Number: EL -7-14-1612 Scheduled Inspection Date: January 13, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: HESKIEL, RAOUL Work Classification: Alteration Job Address: 9405 NE 9 Avenue Miami Shores, FL Phone Number Parcel Number 1132060010030 Project: <NONE> Contractor: POWER BRIGHT ELECTRIC LLC Phone: (305)305-3229 Bwiaing Department comments CHANGE OUTLETS KITCHEN OUTLETS AND REPLACE BATHROOM OUTLETS INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-225892. The inside is O. K.. ET The service is not. The meter enclosure is only rated for 100 amp.. Plans call for 200 with an outside main disconnect. Failed Correction Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. January 12, 2015 For Inspections please call: (305)7624949 Page 16 of 29 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 /ELECTRIC ❑ ROOFING ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS JOB ADDRESS: f JUL-% 0 6.044 JUL 252014 FBC 20 Master Permit No. K�-- I 35"<D Sub Permit No. t—�L o � S ` [EA 17, ❑ REVISION ❑ EXTENSION [:]RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores County: Miami Dade zip:1 Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: OWNER: Name (Fee Simple Titleholder): Address: JQ 6? -o I civi-4 1 Construction Type: Flood Zone: BFE: FFE: City N ,H State: r( Zip: 8 �� Tenant/Les ee Name: Phone#: Email: CONTRACTOR: Company Name: r3 0 (4J 5-T2 ) G LAI & (P C I C ]Ly C Phone#: Address:.� 2/-- �1/ S City: ,_�7 EL i / State: F2-- Zip: Qualifier Name: one#: State Certification or Registration M13 l 11 Ll !V - Certificate of Competency #: _ ) ii (2c2 DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ OO Type of Work: ❑ Addition Description of Work: Alteration State: Zip: _ Square/Linear Footage of Work: New epair/Repy�ce Specify color of color thru tile: Submittal Fee $ EX) • 03 Permit Fee $ Z's'-: e-1® CCF Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews (Revised02/24/2014) DBPR $ ❑ Demolition CO/CC $ Notary $ r Double Fee $ Bond $ TOTAL FEE NOW DUE $ 116 6 • 9 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature The foregoing instrument was acknowledged before me this e day of 201 . by who is personally known to me or who has produced ��y r'�L as identification and who did take an oath. Signatures. CONTRACTOR The foregoing instrument was acknowledged before me this day of 20 t4 • by =k %1-Z C—JN!(z' ,�, ho is personally known to me or who has produced Ft— -k-DZ%\Jft, Z as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: �QEtACJRp d dddi/�i, / ra Sign: �1 dad/ Sign: ti N \«S Print: Print: Seal: Q �����\ \D�. ¢ Seal: NSaSg ®� APPROVED BY y✓r�i/4 tans Examiner Zoning Structural Review Clerk (Revised02/24/2014) tilSl'�L[1 Z" ur" 3suSiJ.P arab aLEw rAWLIJ501MlVBLaJd 3sast UAAMllVPi ELECTRICAL CONTRACTORS LICRNSIIo SOARD (830) 487-1399 - 1940 NORTH MONROE STREET TALLANU 3EE IAL 32399-0783 CARDOZAs P #5 02 i85 ELECTRIC LLC STREW ETAXI FL 33055 Go mffonst Wfh this you become one of#is one n srnrenr-wwcA SI 6 20 � � 5 9 Florid find by the Ds of Bn and Rages, DBP AL REGULATE AICD Our ark from to y brokers, from P$OigSSBIONBL REGULATION bows lo barbeque Snit ft keep Floilda'seconomysftV. ER13014472 07/18/12 117059745 Evmy day we work to bnpmm the way we do business in order to serve you better,. Forkdmmstfon about our smrvkn, please fag ohoiten. REG BLBCTRICAL caW12ACTOR Time you can OW more inimmabmi about our ths, that CARDOZA, . -WILT ER mVM you, sDepartatertubscribe, a to d� � �n nwre about � f�� IIam ELECTRIC ALL LOCAL LICENSING ITS PRIOR Ourmbslon atom Da=tr wd he License may, Rhe Fably. We TO CONTRACTING IN ANY ARBA) strive to serve you better so #0 you can serve y� r s. = Thank you for do'sm In Fforida, wad congratulations, re an yow v lice!:: URS RUMSTaaan ,ter the �s��e o� cn.48s date. AUG 31. 2014 L12071801202 STATE OF FLORIDA swaratva -awn\ reA'LSL7alATl�YiTi-� n?,. f_'i144'_'A �t1T11M SEW 112471801202 Local Business Tax Receipt Miami -Dade County, State of Florida INS IS NOT A BILL — 00 NOT PAY 6666367 BUSINESS NA IE&OCATIOM POWER BRIGHT ELECTRIC LLC 4502 NW 185 ST MIAMI GARDENS FL 33055 OVMER POWER BRIGHT ELECTRIC LLC Worker(s) 1 LBT RECEIPT NO. EXPIRES RENEWAL. SEPTEMBER 30, 2014 6938352 Must be displayed at place of busirress Pursuant to County Code Chapter aA—Art. 9 & 10 SE!` TYPE OF BUSINESS PAYMENT RECEIVED 196 :LECTRICAL CONTRACTOR 10E00267 BY TAX COLLECTOR $45.00 07/05/2013 CREDITCARD-13-001483 This Local Basisess Tax Receipt only cardirms payment of the LSI Business Tax. The Receipt is not a HCense, permit w a ceMeation of the holds 's gmMcWoas. to do buius Holder must comply with any governmental or t uongovemmenlal regulatory bmM and ragauemams wbich apply to the business. The RECEIPT N0. above must be displayed on all commercial vehicles — Miami—Dade Coda Sac 8a—M For more information, visit www tow-rddadg aav/taxcotlector Keport Viewer Page 1 of 3 PLEASE CUT OUT CARD BELOW AND RETAIN FOR FUTURE REFERENCE r""^.....................•......."""""".................._........................;W(MAW....... ' STATE OF FLORIDA :`� "�'� ` �,< �}, Pursuant to Chapter 440.0%14), F.S., an officer of a. corporation who filing� of DEPARTMENT OF FINANCIAL SERVICES �4"�'iz�° ortiflcate election uncle th s�°�on may not eve b DIVISION OF WORKERS' COMPENSATION . i' compensation under this draper. CONSTRUCTION INDUSTRY EXEMPTION ra "" " ; .O Pursuant to Chapter 440.08{12�}, F.S., Certificates of election to be exempt .. apply only wftitirl the scope of the fussiness or trade L listed on the notice of election to be exempt. CWMFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA ' WORKERs' COMPENSATION LAW :D Pursuant to Chapter 440.08(13 , F.S. Notices of election to be pp )) 6 EFFECTIVE DATE: 7/7=4 EXPIRATION DATE: 7/1/2016� I exempt and sartmoates of eleayon to exempt shall be subject to revocation ff. at any Mtn after the filing of the notice ' H , or the issuance of the certificate, the pion named on the th6 this I PHI=Nt CARo07A WIL TER SR I E R notice or certificate no longer meets requirements of section for Issuance of a certificate. The department shall revoke time for failure the on the FEW; 272480,E I E a c artificate at any of person -named certificate to meet the requirements of this section. I BUSINESS. NAME AND ADDRESS: POWER BRIGHT ELECTRIC LLC , a : 14802 NW 186 ST I MIAMI FL 33006 I , c SCOPES OF BUSINESS OR TRA I iLICENSED ELECTRICAL https://apps8.fldfs.com/erreportviewer/reportViewer.aspx?data=kdvpginc9D7Q3gH6TER6eP 1 KMZ%2fSz5bXKY:MxkrekeESo... 7/14/2014 CT - IRS - - Boyd " MMHMW tEiTV:rATE CWETEC= . I OEM267 Or Eco AimkD.B �►._ CAFMZA VMM R .. � �fe m*wm af Cbmoff of c=ft 0712112014 15:00 f'AX) P.0011001 CERTIFICATE OF LIABILITY INSURANCE DATI:Dn'YYY) 077/21121H4 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 DOT=S NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the cereflaat,a holder is an ADOMONAL INSURED, the polloypes) must be endorsed. If SUBROGATION IS WAIA , su6Ject i the tense and conditions of the policy, certain policlee 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 Luda Estrella Accurate PH NE . (30226.8727 F mor (305)226.8787 8300 West Flegler Suite 114 ADD ' luciaeatrell8®9e0south.net Miami, FL 33144 INSURM41) AFFOROIN¢ COVERAGE NAIC 0 Phone (305)226.8727 _ Fax (306)2M767 INBURER A : Ascelnlant tnsu►ance ComPIn _ INSURED - murtst s: Power Bright Electric LLC INSURER C 4502 NW 185th Street INSURUR D Miami Gardens, FL 33055- 305-305-3228 INSURER E: COVERAGES cFIeT19IceTe M1rousse. INSURER F: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR RHE 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. Nita I TYPE OF INSURANCE ADD UBR POLICY NUMBER LICYlPR POLICY PXP UMliS GENERAL LIABILITY ® COMMERCIAL GENERAL LIABILITY OCCURRENCE 1,000,000,00 &MDAMAGE EN El ❑ CLAIMSWADE ® OCCUR B 100,000.00 A F-1 GL -44670.0 06M=14 06/2912016 MED EXP (Any am =n) 5,000.00 PERSONAL&ADV INJURY S 1,000,000.00 ❑ GENERAL ACQ11 TE$ 2 000,000.00 OEML AGGREGATE LIMIT APPLIES PER ® POLICY ❑ PR ❑ LOC PRODUCTS • COMPIOP AGG ..S 1,000,000.00 S AUTOMOBILE LIABILITY BINED SINGLE LIMIT ❑ ANY AUTO e eodtlerd BODILY INJURY (Pe PPM w) $ ❑ AUTOS N® ❑ u'FDULED BODILY INJURY (PM eoeww S WNED ❑ HIRED AUTOS ❑ P PERT 'DAMAGE s AUTO ❑ UMBRELLA U❑AB CCCUR ❑ 9X0Ess LIAR DLAMMS MADE EACH OCCURRENCE AGGREGATE S ❑ DED WORK9R8 COMPENSATION AND EMPLOYERS' LIABILITY YIN ❑ WC TA ❑ ANN PROPR1er0PJPARTNWtGXEIVE CUT OF 10EMMEMSER EXCLUDED? NIA (Menllnlmy M NH) ❑ E.L. EACH ACCIDENT S -Oy tp E8CRBIPWt0N OF OPERATIONS 17 . KL DISEASE • EA EMPLOYE S RL DISEASE. POLICY LIMIT $' DESCRIPTON OF OP9RATIONS I LOCATIONS I VEHICLES (AttavF: ACORD 101, AddldvrrM Remarks 8chadale, It wro apnea Is re wm* Certificate holder is listed as additional name Insured CERTIKICATI: HQLI]FR Village of Miami Shores Building Department 10050 NE 2 Ave Miami Shores, F133138 305-756-8872 ACORD 25 (2010105) QF VAIVVCLLAI IVIV SHOULD ANY OF THE ABOVE DESCRIBSD POLdCiES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL SE DELIVSRED IN ACCORDANCE VMH THE POUCY SROVISIONS. AUTHORIZED Lucia Estrella A 11111/11 ® 4918.10-10 ACOXP CORPORATION. All rights reserved. The ACORD name an 0go are registered marks of ACORD Miami shores V 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 anyperson 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 Contractor Print Name: �� ���, �� �('�i,c-�� Print Name: Signature: Signature: State of Florida) �������� �� 11/11///i State of Florida ) County of Miami -Da �$�` •,,...., ''�� - County of Miami -Dade) Sworn to and subscribed before me s Sworn to d subscribed before day of , 20 k`'°` :��° s day of \ni$,�jgt By •M By (SEAL) (SEAL) Type of Identification produced ��i,�„ ����`� Type of Identification AL