EL-15-386Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-231556 Permit Number: EL -2-15-386
Scheduled Inspection Date: April 03, 2015 Permit Type: Electrical - Residential
Inspector: Devaney, Michael Inspection Type: Rgh
Owner: CAUZA, WILLIAM Work Classification: Service Change
Job Address: 270 NE 105 Street
Miami Shores, FL 33138- Phone Number
Parcel Number 1121360130470
Project: <NONE>
Contractor: ELECTRO SERVICES & ELECTRICAL CONTRACTOR Phone: (305)316-8479
sunamg uepartment comments
REPLACE 200 AMPS METER CAN ACCORDING TO
CODE AND PULLING NEW WIRE ADD 150 AMPS PANEL
BREAKS FOR EQUIPMENT
INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction ❑
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
April 03, 2015 For Inspections please call: (305)762-4949 Page 26 of 32
Iyal�,�5
BUILDING
Miami Shores Village
Building Department "_ FEB3 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
PERMIT APPLICATION
❑ BUILDING 06ELECTRIC ❑ ROOFING
FBC 200
Master Permit No.E 1S " 3 Y
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ PLUMBING ❑ MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
% CONTRACTOR DRAWINGS
JOB ADDRESS: cR- 70 1UE / 5
City: Miami Shores County: Miami Dade Zip: .3 3 l�
Folio/Parcel#: /%off- 13 6 Q ! 3 O y 7 Q is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: / FFE:
OWNER: Name (Fee Simple Titleholder): W ( 1 ? 1 a yds/ r7 h a- Phone#: D c� b ) ,12- f;) 3 $ F3
JJ p a
City: _ / a »u SG! 'L Q �, State: L 1 d t CL Zip: -%3/39
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:
Address:
I
l C S Phone#: L-3 0S__) 3 1 - 9 9 79
City: l m e U State: e-) 1 c/a Zip: `z' 3 3
Qualifier Name: t = Phone#: 316
State Certification or Registration #: /t / 7 L'_Certificate of Competency #: 1 E® 0 t�q 0 3 0
DESIGNER: Architect/Engineer: Phone#:
Ad
City: State:
Value of Work for this Permit: $ OzlSM Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New E�KRepair/Replace
Description of Work: A_ Pla, c_c. ,Z9t-jdmA-q Ma leA- C'm n4 =G
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $ -
a
®G.� iL • L71
Zip:
❑ Demolition
a
i
,7/
Permit Fee $ CCF $ CO/CC $
Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
Double Fee $
Bond $ r/J
TOTAL FEE NOW DUE $ 1 G-3• O
Bonding Company's Name (if applicable) Z4 -Ii c
i2fll vl c-li�- S C®n .
Bonding Company's Address (96 00 [j 1 j 5 t l/ . S l0
City / 4"[ X 14 P1 ( State /:'L-.- Zip S3/30
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State 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.
Signature V44VMSignature-
OWNER
ignatureOWNER or GENT CONTRACTOR
The foregoing instrument was acknowledged before me this
j day of �Zb f u -i , 20 /S_ , by
4.v1= Lwhoersonall k �o
p Y
me or who has produced ,::a, as
identification and
f�L�II�1�lP:
Print:
The foregoing instrument was acknowledged before me this
ZZ day of 4G Z 20 /s , by
NJ -I IrYL, who is personally known to
me or who has producedj!—rl as
identification and who did take an oath.
NOTARY PUBLIC:
Seal: �`,•L 'Commiission # E08m Seal: `nom' 'CFE1730i 9�f,�
'••.,;�„ Expires: APR. 21,2015 '-,9� ..5
APPROVED BY ON ��A Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
STATE OF FLORIDA
Q DEPARTMENT OF BUSINESS AND
_ PROFESSIONAL REGULATION
ER13014844 ISSUED: >09/22/2014
REG ELECTRICAL'CONTRACTOR
ALCIDE, HUBERT JR
ELECTRO SERVICES & ELECTRICAL CONT
(INDIVIDUAL MUST MEETiAALL LOCAL
LICENSING REQUIREMES IPRIOR
TO CONTRACTING INANYARIA)
HAS REGISTERED under the provisions of Ch.489 FS
Expiration dale : AUG 31, 2016 L1409220001593
Construction Trades Qualifying Board
I,
BUSINESS CERTIFICATE OF COMPETENCY
13E000030
ELECTRO SERVICES & ELECTRICAL CONTRACTOR INC
D. B.A.:
iCIDE HUBERT
Is certified under the provisions of Chapter 10 of Miami -Dade County
Local Business Tax Receipt
Miami—Dade County, State of Florida
THIS IS NOT A BILL —DO NOT PAY
7139181
BUSINESS NAME LOCATION
ELECTRO SERVICES AND
ELECTRICAL CONTRACTOR INC
8500 BISCAYNE BLVD S1030
EL PORTAL, FL 33138
OWNER
ELECTRO SERVICES AND
ELECTRICAL
Worker(s) 3
1
RECEIPT NO. EXPIRES
RENEWAL SEPTEMBER 30, 2015
7416191 Must be displayed at place ofbusiness
Pursuant to County Code
Chapter 8A — An. 8 & 10
SEC. TYPE OF BUSINESS
196 ELECTRICAL
CONTRACTOR
13E000030
PAYMENT RECEIVED
BY TAX COLLECTOR
45.00 0811812014
0223-14-006723
This Local Badness Tax Receipt only confirms payment oftbe Local Business Tax.The Receipt is not a license,
permit, or a certification of the bolder's gaaliricatiione,to do business. Holder mast comply with any governmental
or nongovernmental regulatory laws and requirements which apply to the business.
The RECEIPT N0. above must be displayed on all commercial vehicles—Miami—Dade Code See So -276.
MIAM Formore information, visit
JEFF ATWATER
CHIEF FINANCIAL OFFICER
STATE OF FLORIDA
DEPARTMENT OF FWANCUIL SERVICES
DIVISION OF WORKERS' COMPENSATION
• • CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW "
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE DATE: 11//2014
PERSON: ALCIDE
FEN: 461291035
BUSINESS NAME AND ADDRESS:
EXPIRATION DATE: 11/62018
HUBERT
ELECTRO SERVICES & ELECTRICAL CONTRACTOR INC
8500 BISCAYNE BLVD
S1030
MIAMI FL 33138
SCOPES OF BUSINESS OR TRADE:
ELECTRICAL WIRING
WITHIN BUIL
Pisuat InChw rr 44408(14). F.S. an deaer daowpwWjcnwtodemo m$mhonMOWWrbyftWgacoMcdodaecknorder Ole eer.Um
ACC> �®
`/� CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/
2/19/201515
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS 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 BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
B z INSURANCE CORP.
CONTACT
NAME:
PHONE . 305-681-1347 a No): 305-681-3695
11695 NW 7 AVE
MIAMI, FL. 33168
E-MAIL
ADD SS:
INSURERS AFFORDING COVERAGE NAIC #
wsURERA: GRANADA INC
INSURED
INSURERS:
INSURER C:
ELECTRICAL INTEGRATED SYSTEMS GROUP,
52 NW 111 STIR
MIAMI, FL 33168
INSURER D:
INSURER E:
INSURER F:
MED EXP (Any one person) $ 5,000
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
ADDL
SUBR
POLICY NUMBER
POLICY EFF
MM/DD
POLICY EXP
MM/DD
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE $ 1,000,000
✓ COMMERCIAL GENERAL LIABILITY
RENTED
PRE�G ET Ea occurrence) $ 100,000
MED EXP (Any one person) $ 5,000
A
CLAIMS -MADE [z] OCCUR
140827A
8/20/14
08/20/15
PERSONAL &ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMJECIT APPLIES PER:
PRODUCTS - COMP/OP AGG $
$
POLICY PRO- LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident
BODILY INJURY (Per person) $
ANY AUTO
BODILY INJURY (Per accident) $
ALLOWNED SCHEDULED
AUTOS AUTOS
NO OWNED
HIRED AUTOS AUTOS
PROPERTY DAMAGE $
Peracddent
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE $
AGGREGATE $
EXCESS LIAB
CLAIMS -MADE
DED I I RETENTION $
$
WORKERS COMPENSATION
WC SLIMIT OTH-
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N
E.L. EACH ACCIDENT $
OFFICERIMEMBER EXCLUDED? F—]
(Mandatory in NH)
N / A
E.L. DISEASE - EA EMPLOYE $
E.L. DISEASE - POLICY LIMIT $
If yes, describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space is required)
LICENSE #13E000030
ELECTRICIAN
CANCELLA'
MIAMI SHORE VILLAGE
BUILDING DEPARTMENT
10050 NE 2 AVE
MIAMI SHORES DFLORIDA 33183
THE
THrD(iEPOLICYE OVINO CE IES BE IMLLCBECDELIVERED BEFORIN
rights reserved.
ACORD 25 (2010/05) The ACORD name and 1¢9k arA �p§istered marl0 of ACORD
LECTkO
,qnj _
j f 0 � ca
I� �la- o czl-z
0 -n Wtl 13 el�-T 19)L c t
do PMvM /U
a�o ct�
q
cj/ak 0 FLOKI.D%i
CO Un ley a 119 AM
'FAQ- n�, q4J�s
SQ-
C/
� d
t
c (n t c -O -t m.�rn4
l
G3 l ��
ap�Y Ra®`� Notary m:
ublic State of
Florida
11
Joanna 4Ut Feliciano
a� �p�� pCreS 01/1212018 082753
M -W=- Sees vwage
Building Department
10050 N.E.2nd Avenue
IVfiamf Shores, Florida 33'313
Tok (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 empriuyer in One cunalruerm inhm'uy Vao etlouys une or more part tome or tffi--tune
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
:s. The corporafion is reglstereh anh iisteh as active writ 'ine ^rionba o7epartmem of
State, Division of Corporations.
No nwre 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, Miiami Shores M iilage does not require verification of
workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors..
Therefore, you may be versonally liable for the worker compensation iniuries 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
i
State of Florida
County of Miami -Dade
The foregomi was acknowledge beforethis 1
day of .e
By
whpli-s personally kodwn.tp4e,6r produced
as
S1~.AI - Sergio R. Peralta
_ Commission # EE086731
-
1.,7VF,,0V L rjx�: nn.,
wnz) nmu Am&-vncBozMDmco,INC.
Contractor
State of Florida
County of Miami -Dade b
The foregoing was acknowledge before me this
day of Ao'brc-yscl 20__X.
By.
who is personally known to me or has produced m;
as identification. ®� N
w
Notary public State of F�n�tla
$ oan"'J 75s
r. .,a ra- 0, 12Q1$
".-?o
FEB 2 3 2m
� I) s- -j-4 s/)e"�
540uc,, e: -I— 33/38CN �10
1%
E E
copy -
cone.
To #OuSe- PAY't�i
ane e�Kvr.�
ELECTRICAL REVIEW
APPROVED , _DATE, pI]:-
IV
-
IV e.J
��r7PY Jrg.�ra°<Q�
l �.0o o � • �: � Win•,
SOC rc--.) " 2-
T® Ia� - a -3, < 3 aj
3
Se�
Sy
v
.15
1.
F