EL-14-2461X4 -
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-232969
Scheduled Inspection Date: April 30, 2015
Inspector: Devaney, Michael
Owner: PETERSEN, CARSTEN
Job Address: 1209 NE 98 Street
Miami Shores, FL
Project: <NONE>
Permit Number: EL -11-14-2461
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number (305)807-2221
Parcel Number 1132050090230
Contractor: WELL ELECTRIC TECHNOLOGY Phone: (305)726-7098
uepanment t:omments
DO NEW BATHROOM AS PER PLANS INSTALL
APPLIANCES OF KITCHEN AND LIGHT SWITCHES TO
NEW WALKING CLOSETS REPLACE LIGHTS FIXTURES
OF BATHROOMS INSTALL EXHAUST FANS
INSPECTOR COMMENTS False
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP-232796. Closet fixtures to have
covers.
Garage receptacles to have G. F. I. protection.
Repair low voltage line to A. H. U. in garage.
Failed ❑ Add arc fault breakers.
Correction
Needed ❑
Re -Inspection �� �6(
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
April 29, 2015 For Inspections please call: (305)762-4949 Page 15 of 29
Miami Shores Village NOV � 04
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 ❑PUBLICWORKS
JOB ADDRESS:
FBC 2010
Master Permit No./rl�I�
Sub Permit No. z/ � G/ 2yD /
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores County: Miami Dade Zip: 33 13K
Folio/Parcel#: // -3205— 001 -OZ-30 Is the Building Historically Designated: Yes NO
Occupancy Type: R-4 Load: Construction Type: —Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):_
Address:
City:
Tenant/Lessee Name:
Email:
Pe
State: Ur-e-1 Zip: -336 d
CONTRACTOR: Company Name: 1 t'C--` :1 li Phone#: 73
Address:
City: /,1A AX,4A State: Zip: 3 ✓
Qualifier Name: �,9.rJL/ ��� Phone#: :Z:�% A6 79
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer:
one#:
Address: City: State:
c�
Value of Work for this Permit: $ �� ° Square/Linear Footage of Work:
Type of Work: ❑ Addition M Alteration ❑ New ❑ Repair/Replace
Description of Work: DO ��'�_ /0A IZOdl�l �� � // -J ��� X �
p l=C� o ��� sir® �c�.�' � C
r°�G�l>� t�i"�ra✓�7 � �� �rF�°� %1�`L��.�? �`.C<�r��..� _ l��/B�� tf � 900 2 G'L`t-� A!7 �'l�e-e.t�it��'
Zip:
❑ Demolition
Specify color of color thru tile:
Submittal Fee $ �_� •d - Permit Fee $ ?-2 � f,7e, CCF $ CO/CC $
Scanning Fee $ _ Radon Fee $ DBPR $ Notary $
Technology Fee $ d Training/Education Fee $ C) Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
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
ApplicatiorNs 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 Signature
OWNE rAGENT CONTRACTOR
The foregoing instrument was acknowledged before me
this
day of 5�0 by
��7��'✓!/ ii!/ o is personally known
�or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
as
The foregoing instrument was acknowledged before me this
-�Zday of g y�, 20 by
o is personally nown
or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Print:
Seal:
Notary Public - State of Florida
My Comm. Expires Jul 5, 2016
Commission # EE 214350
APPROVED BY r��'�� )',�r%'���S/Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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:
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;
The officer is listed as an officer of the corporation in the records of the Florida
Department of State, Division of Corporations; and
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 M 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
Contractor
Print Name: � I g r� �l s � Print Name: ® IV e �
Signature: Signature:
State of Florida State of Florida)
County of Miami -Dade) County of Miami -Dade )
Sworn to and subs ribed before me this �� Sworn to and subscribed before me .this ® 6
day of day of
dry,
B B °�a� , MAXIMO RODRIGUEZ
y - a y =: ublic -State o4 F of
=� y omm. pl Jul 5, 1" * My Comm. Explres JulSA
Identification