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EL-15-544Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-230647 Permit Number: EL -3-15-544 Scheduled Inspection Date: Match 20, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: Work Classification: Service Change Job Address: 578 NE 93 Street Miami Shores, FL 33138 - Project: <NONE> Phone Number Parcel Number 1132060141050 Contractor: SAME & Q ELECTRIC INC Phone: (305)219-0427 Building Department Comments UPGRADE SERVICE TO 150 AMP 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. March 19, 2015 For Inspections please call: (305)762-4949 Page 35 of 40 �R'LbR1 p` Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Parcel Number Applicant 578 NE 93 Street � _��.w...._..,..�.._.�....1132060141050..�..�...._...�_..�.�....___..__..__.�..__............�....-.rv..w._......_o� TRUST MORTGAGE LENDING G Miami Shores, FL 33138- Block: Lot: TRUST MORTGAGE LENDING GROUP 8200 SW 52 Terrace DORAL FL 33166- 8600 NW 53 Terrace DORAL FL 33166- Contractor(s) Phone Cell Phone SAME & Q ELECTRIC INC (305)219-0427 of Work: UPGRADE SERVICE TO 150 AMP ional Info: ;ification: Residential ning: 3 Fees Due Amount CCF $1.20 DBPR Fee $2.25 DCA Fee $2.25 Education Surcharge $0.40 Permit Fee - Additions/Alterations $150.00 Scanning Fee $9.00 Technology Fee $1.60 Total: $166.70 Phone Valuation: $ 1,200.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # EL -3-15-54771 03/12/2015 Credit Card $ 50.00 $ 116.70 03/18/2015 Credit Card $ 116.70 $0. 00 Available Inspections: Inspection Type: Review Electrical In consideration of the issuance to me of this permit, I agree to perform the work ereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or acifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either mys my agent, servants, or employes. I understand that separate permits are _ required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS„ 00-0RS, OFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing construction and zoning. Futhermore, I authoCZ9"the-s Authorized Signature: Owner nd xhays l work will _1)� done in compliance with all applicable laws regulating Agent March 18, 2015 Building Department Copy March 18, 2015 1 Miami Shores Village g Building Department BAR 12 2015 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 ill N,I�►�`� FBC 20 L� BUILDING Master Permit No. Eu 1�749 PERMIT APPLICATION Sub Permit No. ❑ BUILDING VLELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: S 4 � `' �— \ � S.+ City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: [k ` 32 d (p — t/ Z 0S__0 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: —Flood Zone:6qhone# BFE: F\FE: `{?Q OWNER: Name (Fee Simple Titleholder): s°` 1 —666( �C�C ` . Address: f?r, D® its W S ienA-- '*040_4 City: _PO Tenant/Lessee Name: Email State: '204 • Phone#:C4<4 ce s— 2r� - CONTRACTOR: Company Name: _ `-��-n.�� �� e- � Phone#: 0T'"�— Address: S-3 10 _9-ZN City: co '+"L / /'9 4- State: L-E—it Zip: Qualifier Name: Phone#: /�W— �V4 d4— State Certification or Registration #: 140 47 00001 �-- Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State Value of Work for this Permit: $ � �°4 v Square/Linear Footage of Work: Type of Work: ❑ Addition [Z (Alteration ❑ New Repair/Replace Description of Work: �P Specify color of color thru tile: Submittal Fee $ �`Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $_ Structural Reviews $ (Revised02/24/2014) �Vid4:p Training/Education Fee $ Zip: ❑ Demolition 4W -'_A r ,r CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ r, TOTAL FEE NOW DUE $I Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State ®7 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. Signattrr --" — Signature OWNER or AGENT CO RACTOR The foregoing instrumenppas acknowledged before me this The f rre`going instru en as acknowledged before me this day of 20 15 byd day of 20 , by ho is personally known to who is personally known to me or who has produced as 4 who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: t` Sign: Sign: Print: Print: „ ,P y o� DANAY BAZAIN Seal: r°, �: Notary Public - State of Florida Seal: ° Pn AUe� NotaryPublic •State of Florida • : : My Comm. Expires May 1, 2017 " Commission rF FF 013542 t : My Comm. Expires May 1, 2017 ",,OF � �o?�•. ; �:•' Commission #r FF 013542 Bonded Through National Notary Assn. '' OF ; '� Bonded Through National Notary Assn. ************* * * * * * * ********************* ***** AGO✓` APPROVED BY 12-tyAt7- Plans Examiner Zoning Structural Review (Revised02/24/2014) Clerk Detail by Entity Name Florida Profit Corporation TRUST MORTGAGE LENDING CORP Filing Information Document Number P04000096919 FEI/EIN Number 412142273 Date Filed 06/25/2004 State FL Status ACTIVE Last Event AMENDMENT Event Date Filed 09/27/2013 Event Effective Date NONE Principal Address 8200 NW 52ND TERRACE STE 100 DORAL, FL 33166 Changed: 05/29/2014 Mailing Address 8200 NW 52ND TERRACE STE 100 DORAL, FL 33166 Changed: 05/29/2014 Registered Agent Name & Address TRUST MORTGAGE LENDING 8200 NW 52 TERR BLDG 100 DORAL, FL 33166 Name Changed: 09/08/2014 Address Changed: 09/08/2014 Officer/Director Detail Name & Address Title PD GONZALEZ, LEANDRO Page 1 of 2 http ://search. sunbiz. org/Inquiry/CorporationSearchISearchResultDetail?inquirytype=Entity... 3/12/2015 Notice to Owner - Workers' Com Miami shores V Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 nsation 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 ii 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 and has acknowledge that he or she will not use day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature:—_. Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this day of20 By who is personally known to me or has produced as identification.EI.. OANAY OAZAIN Ve,- `i ; Notary Public - State of Florida Notary: 'i My Comm. Expires May t, 2017 Commission # FF 013542 SEAL: " Bonded Through National Notary Assn. A R �' .. ,� 1 INSURANCE 016 THIS CERTIFICATE IS I.len A&A MATrER.OF INFORMATION l ONLY AND COWERS f#O MGM UPON TM CEI IFICATE t'MWpt "fa CERTIFICATE DOES NOT Ar-FIRMATIVELY OR N `iIVELY AMEND, EXTEND OR ALTER TFtE # VEftAoE AyfOMXD B1' Tft FOMES fWLOW. THIS CERTIFICATE OF INWRAMM DOES NOT CONSTITUTE A CONTRACT EN THE 133WNG INSti S� AUTHORM REPRESENTATIVE OR PRODUCER ANO THE CERTIP4okTIE HoLoM RTitWTt if holderl; ADO o MAL INSURED, the gaol ) -ust be o - if S DATION t5 I!i►J41 s to t"Fm and sEotlpd°stiorrs of the policy, certain policies titre S" dm A ata cerwirmft does not confor dgtft to the, CeMficsW h0kler in lift of .€ endolr r� MmiI OURElS INSURANCE, INC— -ic_ - �� is , a 7 .- tutlAM F 331416GRANADA ltl t t l COMPANY, €�Irnct� SAM E 0 ILFTR9C:1N.:. c „ . �._ .� .. ..,, 950 SW 104 CT APT 301 C sart�� n: MIDI FL3 974 _ VSE... CERTIFICATE NUMSek. RM, ON NUMSEW TEAS 'to CI STIEY THAT THE FOLICt S OF INSURANCE LISTED W�t HAVE BEEN MSUED To THE INSURED NAMMASOVE FOR HE,lC�' INOICAVLO. NOTWTIHSTANDING ANY REOVIREWNT, TEMA OR CONDITION CIE ANY CONTRA& CIV OTHER 66CWENT WITH RI; "ECT TOMOCH THIIS CER'nFICA` E MAY BE ISSUED GRY P T N> THE, INSURANCE AFFOWED BY T+W, pOilG S, DESCRIOED HEREIN IS SUBJECT TO ALL THE I Y �CLUSiON,S ASIC CONDITK)NS GF SMH I.I ES< UMITS O Y I SE FK I3CE5� BY` AI S. xr - - .. _-. ( GENERAL LUAU PY C ttAk 1 ' RU4L Gf-MMAL UAMLI i i C I ., ? 9 Cse G i omjo 3 01"F .0006 17 -0' ; 01112M15 ; 01112M% I t Pi[Rtt . W ATE S , ri "t+ti. AGGPWGATE LIMIT APPLIrS PER LOX=_,,.. pamY a .. E t€ 9gmw W,$ WOV WJuw PWPOMW. 5 ;m3 Aiii4 OWLY numv I q P3N-�tS€1rL§ iUA8 j r-- i I �k , EJiCYtfte$ 3 0.Y4�1Fifla'` #ataCtF� � �. � A'€YE'C�T� ffi < i ' a .1-jAND - Gdi%W LyY S � Tl4 .' OTS , Y a N r f' Tom. Lti_ A 6,EialCXs[�z EASE - �..� s>nzcYurT ; IDPWATONS) LOCAVIONS VWIC= JAKkk -010RO Ott SAME &- Q. E�.ECTR1C, INC 531 0 SW 7 TH STREET CORAL QABLES, F LORIDA 3 134 305 219 0427 March, 16, 2015 Re: 578 NE 93 Street Miami Shores Florida To: Whom it may concern I, Manuel Quesada , of Florida Driver License # Q230-545-56-058-0, as qualifier for Same & Q . Electric, Inc. License number 10E000092, will be performing all the electrical work under this permit at the above mentioned property. k `" - f 0j C, a MAR 12 2815 A0 c--,> �> , 1� Ck 5-; e; -i >r,-0 �aE3 jAE iii LE S �� 6om 2-ALC2 a p� ••11 VIII/. p I W O � � R� � Pn P DANAY BAZAIN !"t� f N�tary Public - State of Florida •� • . * •? MyComm. Expires May 1, 2017 - Through Natio�tDMlaty Assn. Xjj • 9999.. • 999••• ••• •• 0• • 0 0 • 0 0 09 •90000 0900 9999.. � �� � • 9999 }�. �. � ��. '<, • •9.9.9 A0 c--,> �> , 1� Ck 5-; e; -i >r,-0 �aE3 jAE iii LE S �� 6om 2-ALC2 a p� ••11 VIII/. p I W O � � R� � Pn P DANAY BAZAIN !"t� f N�tary Public - State of Florida •� • . * •? MyComm. Expires May 1, 2017 - Through Natio�tDMlaty Assn. Xjj