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
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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 �'
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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
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INOICAVLO. NOTWTIHSTANDING ANY REOVIREWNT, TEMA OR CONDITION CIE ANY CONTRA& CIV OTHER 66CWENT WITH RI; "ECT TOMOCH THIIS
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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.
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