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EL-14-1043V_C �-d C � Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-229824 Permit Number: EL -5-14-1043 Scheduled Inspection Date: March 25, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: , Work Classification: Alteration Job Address: 578 NE 93 Street Miami Shores, FL 33138 - Phone Number Parcel Number 1132060141050 Project: <NONE> Contractor: SAME & 0 ELECTRIC INC Phone: (305)219-0427 tsulnaing uepanment comments UPDATE GFI IN KITCHEN AND BATH AND SMOKE Infraylo Passed Comments DETECTORS I INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-229646. The electric meter Ea enclosure is only rated for 100 amp. and main breaker is 150 amp.. Failed/�- Correction�� �c� is Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid March 24, 2016 For Inspections please call: (305)762-4949 Page 12 of 28 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 ❑BUILDING 1� ELECTRIC ❑ ROOFING MAY 2 1 014 BY: FBC 20 Master Permit No. LtL — t 7 Sub Permit No. Q L, ^ �� 3 ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [-]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: ' v A) 5- 9/ ? S�� City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone OWNER: Name (Fee Simple Titleholder)- /W 'vl "Alt 60 14514 Z Address: - ,"- D © /J 2, - City:. Va` -City:Va` State: BFE: FFE: 3t �tjg Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: +���T t� �G �^ "`z Phone#: Address: 5-1/o S w City: Qualifier Name: State Certification or Registration #: Certificate of Competency MI 'D C '0.0 o m 9 DESIGNER: Architect/Engineer: Phone#: Address: City: State: Value of Work for this Permit: $ �D ' ®a Square/Linear Footage of Work: Zip: Type of Work: ❑ Addition [& Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description � Work: T /� - 6 1�-� / ✓1 1K/ rG � /4-^)b 4il�- 4W 7 5 AA 0 9.A_. %>��4 W) lil • Specify color of color thru tile: /moo v Submittal Fee q t --4m ! , _ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews (Revised02/24/2014) CCF CO/CC $ DBPA $ Notary $ 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 iO 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 t ,,copy of the notice of commencement and construction lien law brochure will be delivered�to the person whose property i su ct to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first ins ectJ which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will n the p�- proved and a reinspection fee will be charged. Signature OWNER or AGENT The foregoing instrument was acknowledged before me this day of 20 I'C , by /"&& a� , who is personally known to me or who has produced identification and who did take an oath. as Signature CONTRACTOR The for oing instrument was acknowledged, before m this day of 20 by vis ho is personally known to me r who has produced �/ a� as identification and who did take an oath. NOTARY PUBLIC: NO Y PUBL C: Sign: Print: Print: Seal: Seal: =. ; Notary Public - State of Florida NL Ez.4 � MYCO �� ; •; My Comm. Expires May 30, 2015 Commission # EE 79436 a��`` Bonded Through National Notary Assn. Rf�• APPROVED B /'VI y Plans Examiner Structural Review (Revised02/24/2014) Zoning Clerk 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 may be 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. Owner Print Name: GHQ 't>6L0 62 OAJ ",?—A Signature:_ ( �� Y PUe,, MATILDE C. RAMIREZ State of Florida) ;�.r°��"`� Notary Public - State of Florida County of Miami- D My Com fres May 30, 2015 Swo to subs c °me gm # EE 79436 day of �.... 0 0 o ded roug ational Nntary Assn. Utz of i /,e z Contractor Print Name: Signature: State of Florida ) " County of Miami -Dade -; °� . Sworn to and subscribe day of , 20 By r�e, u csAba MATILDE C. RAA Notary Public - Stat My Comm. Expires M Comm sion # FRonde gh Nationa PLEASE CUT OUT CARD BELOW AND RETAIN FOR FUTURE REFERENCE - - - - - - - - - - STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY EXEMPTION CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE DATE: 4/9/2014 EXPIRATION DATE: PERSON: QUESADA MANUEL FEIN: 271014399 BUSINESS NAME AND ADDRESS: SAME & Q ELECTRIC INC 5310 SW7ST MIAMI FL 33134 SCOPES OF BUSINESS OR TRA ELECTRICAL I IMPORTANT - - Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or F compensation under this chapter. 10 L Pursuant to Chapter 440.05(12), F.S., Certificates of election to D be exempt... apply only within the scope of the business or trade 4W016 I listed on the notice of election to be exempt. E SR H Pursuant to Chapter 440.05(13), F.S., Notices of election to be E exempt and certificates of election to be exempt shall be R subject to revocation if, at any time after the filing of the notice E or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS? (850)413-1609