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EL-14-2805Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-225807 Permit Number: EL -12-14-2805 Scheduled Inspection Date: January 14, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: JOSEPH, JACOB SOPHIA Work Classification: Repair Job Address: 715 NE 91 Street 2-A Miami Shores, FL Phone Number Parcel Number 1132060440020 Project: <NONE> Contractor: METPLANET ELECTRICAL Phone: (754)214-1695 Buildina Denartment Comments REPLACE 100 AMP ELECTRICAL PANEL INSPECTOR COMMENTS False Inspector Comments Passed E� Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. January 13, 2015 For Inspections please call: (305)762-4949 Page 11 of 28 . L- (--'\ BUILDING PERMIT APPLICATION 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 DEC 2 9 2014 FBC 20 (C) Master Permit No, ELlq- �f Sub Permit No. ❑ BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Addr( City: _ State: Phone#: %-4 S-; -_2 i � Tenant/Lessee Name: Phone#: Email CONTRACTOR: Company N 0l% Address- —00 City: c��9 Qualifier Name:' State Certification or Registration #: DESIGNER: Architect/Engineer: Address: City: Value of Work for this Permit: $ . a Square/Lin Type of Work: ❑ Addition ❑ Alteration ❑ New Description of Work: Specify color of color thru tile: Submittal Fee $ Scanning Fee $ Technology Fee $_ Structural Reviews$ (Revised02/24/2014) 0 9 m Phone#. State: Zip: 1t ootage.bf Work: Dj Rep'air/Repla .,reDemolition Permit Fee $ �SLA'P®(i CCF $ CO/CC $ - Radon Fee $ DBPR $ Notary $. 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 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 bsence of such posted notice, the the inspection will not be approved and a reinspection fee will be charged. /I Signature Sign OWNER or AGENT ONTRACTOR The foregoing instrument was acknowledged before me this The tforoingJin(ru nt was acknowledged before me this day of�e� ,2014 by *-day 20 �� , by i 6LSO ho is pers nally known to Jai C7�' Su �� ho is petsonally known to or who /4'L - me smeorwoasprouceas '" a %° tate of Florida identificati a f �rti}�tYls . • s My Comm. Expires Sep 25, 2015 NOTARY P C• ea' Commission # EE 101246 %°F �`Op Bon rough National Notary Assn. �,,,,,a Print: Seal identification and who did take an oath NOTARY PUBLIC: Sign: Print: Seal: \\l\�ti�l{IIlldldf�� SQrnCD — fill n, 101\\o �e�• /sf APPROVED BY 75',0&94 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) M ConstruqionlQdesdualifyinq Board CS;"NESS CERTIFICATE OF COMPETENCY 07E000659 ETPLANET ELECTRICAL CONTRACTOR INC AA.: L-L-r-ul" ► JL -AN LESLIE Is certified under the provisions of Chapter 1 d of Miami -Dade County VALID FOR C Local Business Tax Receipt _ Miami -Dade County, State of Florida THIS IS NOTA BILL -DO NOT PAY 6056402 BUSINESS NAME/LOCATION METPLANET ELECTRICAL RECEIPT NO. EXPIRES CONTRACTOR INC 6317879 + DOING BUSINESS IN DADE SEPTEMBER 30, 2015 COUNTY Must be displayed at Place of business Pursuant to County Code ChaPte€ 8A —Art. 8 & 10 OWNER SEC_ TYPE OF BUSINESS N',ETPiANET ELECTRICAL CONTRACTOR 196 ELECTRICAL_ PAYMENT RECEIVED CONTRACTOR Workerls! BY TAX COLLECTOR 1 07EO00659 90.00 1210312014 58 This it, or Business Tax f the ht only Confirms payment of the Local Business Tax. The Receipt is not license, Permit, or a cortinmen cation of the holder's gaalitiicatious,to do business. Molder mast Comply with ally governmental or nongovernmental regulatory laws and requirements which apply to the business. MiAM The RECEIPT Np, above must be displayed on all commerc►al vehicles—Miami—Dade Code See 8a-276, For more hiformation,visit yyygvv.mia Ade•a. iaxCOMeCf}r "., STATE OF FLORIDA DEPARTMENT REGULATION ND PROFESSIO 0812012014 ER13W 3875 UE 0R' , REG ELECTRICAL C+DNTRACTCONTRgC TELFORT JEANTOR INFRICi►+ METPLANET EIS A�CAL (INDIVIDUAL M1TR MEQ LICENSING REQIIII�EMEt1b �,,MTRACT11 G 1N ANS AR�i ,..,iaions of Ch.489 FS. CERTIFICATE OF LIABILITY INSURANCE I DATE z"114 &yyM THIS CERTI ICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGWTS 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 MwEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT., If the aartlficate holder to an ADDITIONAL INSURED, the Polley(los) must t Yndoreed. If SUBROGATION IS WAIVED, subject to tpe terms and conditions of the policy, certain policies may require an ondoisement. A statement on this certificate does not confsr rights to the certificate holdlar in lieu of such endorsement(s). tODUCM I NpRpACT LEYNNIMARRERO Insurance Agency, Corp. IJohnson $t wood. FL, $3021 ASCENDANT INSURANCE .,.. mMUKMK 0 ILANET ELECTRICAL CONTRACTOR, INC. Jean Teifort INSURER C GRANT 5T INSURER D .YWOOD, �L 33024- (754)214-1695 INSURER E INSURER F : CERTIFICATE NUMBER: REVISION NUMBER: ERTIFY THAT THE POLICIES OF INSURANCE. LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A80VE FOR THE POLICY PERIOD NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS E MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, I AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, TYPE DF OWRRAWE -- OENEM LIANRtiY © cOMMERMAL 12ENEnAL UASILnY a❑ CLAIMS -W> [ OCCUR Y GEN'L AwRc-aATE Lmlrr APPLIES PER: AUTOWNLR 1J AMUTY ❑ AALL NYAUTO OWNED qq((pp'pp$$ ❑ ❑ AUTOA; vvNED ❑ HIRED AUTOS ❑ AUTOS AND UMMM-L 1 U" ❑ OCCUR Excess i Ilia F1 CLANS YIN NIA POLICY NULISER IItM LIMITS EACH OCCURRENCE $ 1,000 DAMAGE TO REWTED 900,000. 18Es iffe �pcurcenxl S GL -4422" I04!02)201.4 04/OZ2015 MEDF,XP °ftP�) s 5,0DO.00 PERSONAL & ADV INJURY E 1.000.00 OF OPERATIONS/ UXATLDNS 1 VEHCL.ES (Attach ACORD lDl, Addklonal Rowwim Schedule, S mowc spwo rs required) iL CONTRACTOR LICENSE # ER13013875 rE HOLDER S BODILY INJURY (Per pwo" $ BODILY INJURY (Per acddera} $ ROeEq DAMAGE s S 9 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORE VILLAGE BUILDING DEPARTMENT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 50TH AVE ACCORDANCE WrM THE POLICY PROVISIONS, MIAMI, FL, 33138 AUTHORPED REPRESENTATIVE FAX 305-756-8972 LEYNNI MARRERO ®1008-2010 ACORD CORPORA'nON. All rights n 25 (2010105) QF The ACORD name and logo are laegistomd met'ks of .1 • -0 Report Viewer .EFF ATNATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * : CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATM LAW • • CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual Rated below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 4/2MM4 EXPIRATION DATE: 4/24/2016 PERSON: TELFORT JEAN L FEIN: 134331852 BUSINESS NAME AND ADDRESS: METPLANET ELECTRICAL CONTRACTOR INC 6231 GRANT COURT HOLLYWOOD FL 33024 SCOPES OF BUSINESS OR TRADE: LICENSED ELECTRICAL CONTRACTOR PumuaM to Chadw 440.0941 F.S.. r COM of a mbWaOOo w o W W ace ca'INg, as WW MOM WA 1640aw ft 61 sNamur Women" 1X* tormm: �wa�lwRoaor nw�aaou6l�aanYum tw hHno D10W P r Mwdo.ffi.e.pMgMborftfYa a>rpcitaaak 0926 tedftn. OF43•F2OWG252 CERTFICATE OF ELECTION TO BE EXEMFr REVISED 07-12 OUESTONS7 MW13-ION https://apps8.fldfs.com/crreportviewer/reportViewer.aspx?data=kdvpginc9D7Q3gH6TER6e... 6/4/2, 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, You maybe 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. 1O,,wner Print Name:aL U � ha Signature: Stateof.dh .�_�.,,� County ; dec) SAM WILLIAMS Sworn t ire %ftfeq&-tWe rida day of �" _� p 51� 101246 Bonded Through National Notary Assn. By (SEAL) County of Miami -Dade )n Sworn to and subscribed before me this CG day of D ►frCa - , 201`'� .\\\\ i (SEAL)_ 1'�'; = 9v Type of Identification produced