EL-14-2045l
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972 uo_s$�]D
Inspection Number: INSP-224285 Permit Number: EL -9-14-2045
Scheduled Inspection Date: December 08, 2014 Permit Type: Electrical - Residential
Inspector: Devaney, Michael Inspection Type: Final
Owner: , Work Classification: Alteration
Job Address: 1090 NE 92 Street
Miami Shores, FL
Phone Number (305)987-0644
Parcel Number 1132050270410
Project: <NONE>
Contractor: JLP ELECTRICAL SERVICES INC Phone: (305)725-8388
tiunai
comments
KITCHEN REMODEL ADD Refrigerator OUTLET AND ' -""'"
MOVE DISPOSAL DISH WASHER OUTLET INSPECTOR COMMENTS False
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP-224203. Add 2 receptacles on
EEr back side of counter 6"below top on each end . Dryer to have 4 wire
receptacle.
Disposal to have 20 amp. receptacle.
Failed ❑ Pot breaker lock on disch wascher breaker.
Correction
Needed '
Re -Inspection
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
December 05, 2014 For Inspections please call: (305)762-4949 Page 17 of 29
Miami Shores Village
Building Department SEP 19 2014
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Ems'
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC ^201®
BUILDING Master Permit No. n 'tel -- go
PERMIT APPLICATION Sub Permit NoJLi I Iq - `>'s
❑BUILDING g/ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
F-1 PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP
CONTRACTOR
JOB ADDRESS: loq 0 �j C 1� Z -5V
City: Miami Shores County: Miami Dade Zip:
DRAWINGS
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): �G tl l n C�� �� �; ,n—Phone#: W) 06'+A
Address: 160 (_a M U- � � -mak
City: 0%, V%f 'i 'S'Oorb-" State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: �UZ je AeGTe Jeyl/f��S Lf�,r Phone#: yFzyz� z �� �2 r l
Address: �if"�! 2 C"� // -� 7 7��
City: State: �C' Zip: �.7� .� !6�Z1&
Qualifier Name:�C0S ,�////��' Phone#:
State Certification or Registration #: ���/ �� Certificate of Competency #: oz—J�7r
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ G V Square/Linear footage of Work: IOU S
Type of Work: ❑ Addition ES- Alteration ❑ New ❑ Repair/rrReplace ❑ Demolition
Description of Work: �ii(� .Ai ��mod�O AA a `e-F(Id�e-cv"�Qr OLAEV
CA 11 Movib C)ONV
Specify color of color thru tile:
Submittal Fee $ rnfl� Permit Fee $ CCF $ < C�C� CO/CC $
Scanning Fee $ ° Radon Fee $ DBPR $ Notary $
Technology Fee $ °�� Training/Education Fee $ Double Fee $
Structural Reviews $ G Bond $ g
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
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 whicp occurs s ven (7) days after the building permit is issued. In the absent of osted notice, the
inspection will not be apprAyeed a►� r 4igspection fee will be charged.
Signature t t/ - V
WNER or AGENT
The foregoing instru ent was acknowl ged before me this
a" �6 dayof20 1L4, by
�1N'N W . j)[�A-e e I who is personally known to
me or who has produced 'FL DZ- - as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: //��
Print: �Ar£i.�� 'A- -0\cg
Signatu
The foregoing instrument was acknowledged before me this
dayof20 by
i n rc,l1 D who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY P LIC i
Sign:
U
Print: U1S' cis__
as
Seal: Seal: =p�PaY,P°B</� WISFER"EZ
A EVELYN ARTOLA MY COMMISSION # EE 838180
Notary Public, State of Florida * * EXPIRES: November 7, 2016
Commission# EE 187448 "lq,FaF wp\ Banded Thru Budget Novy SeMms
f
APPROVED BY`4 _� 19 9 0' Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
RICK SCOTT, GOVERNOR
ER13014772
KEN LAWSON, SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD
The ELECTRICAL CONTRACTOR
Named below HAS REGISTERED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2016
(INDIVIDUAL MUST MEETALL LOCAL LICENSING
REQUIREMENTS PRIOR TO CONTRACTING IN ANYAREA)
PINERO, JOSE L
JLP ELECTRICAL SERVICES, INC.
19477 NW 56 PL
MIAMI GARDENS FL 33055
ISSUED: 06/19/2014 DISPLAY AS REQUIRED BY LAW
0f
SEC) # L1406190001179
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002425
Local Business Tax Receipt
Miami—Dade County, State of Florida
-THIS IS NOT A BILL - DO NOT PAY
7022908
BUSINESS NAMFULOCATION RECEIPT NO. EXPIRES
JLP ELECTRICAL SERVICE INC RENEWAL SEPTEMBER 30, 2015
19477 NW 56 PL 7298987 Must be displayed at place of business
MIAMI FL 33055 Pursuant to County Code
Chapter BA - Art 9 & 10
OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED
JLP ELECTRICAL SERVICE INC 196 ELECTRICAL CONTRACTOR BY TAX COLLECTOR
Worker(s) 1 12E000224 $75.00 07/16/2014
CHECK21-14-020876
wwel R.m:wwoe Tav Ti.n Rowuiwt is n t a 1ir —
ACC M0 CERTIFICATE OF LIABILITY INSURANCEDArE (MMIDDIYYYY)
. ...... .......... ... 1 09/18/14
fRiS CERTIFICATE i6 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.
-. .. .... .. .............. . ...... .....'.' .............. ... . ........... ....... ...... ........
*,ANf. .-if ifie certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the poftc). certain policies may require an endorsement. A statement an this certificate does not confer rights to the
certificate hokler In Neu of such endorsemenqs).
PRODUCERCONTAI
MARIA ALMOLDA
Blanco Insurance Associated Inc.
....................... .. ----------- -- --
PHONE Ext};.._. .. (305)888-0524 a -0044
)272
...... .. .... . ............. . .......
1460 E. 4th Ave.
-MAIL nvda@bWncWnwance.com ... ..... .............
Hialeah, FL 33010
...... . ..............
. .. ...
Phone (305)888-0524
Fax INSURER A: GRANADA
........ ... ......... .. ........ ......
f INSURED
i—
- -------..._.__..._................._.............--------•--......
.. ..... ......
JLP ELECTRICAL SERVICES INC
i—IN
19477 NW 56 PL
ik"'AMPRAI .......... ._ ..... ... ..........................................
MIAMI GARDENS. FL33055
(786) 942A192 ............... ............. .. . . . .... ......... . ............
...... . ... .. .......
L
INSURER F:
COVERAGES
CERTIFICATE NUMBER: REVISION NUMBER:
IS *6_CERTIFY *THATTHE POLICIES'OF NdSURANCE�LISTED iki HAVE BEEN ISSUED f6 THE INSURED NAMED ABOVE —F-O- R"-T-H'EP0'LIC*'Y'* PERIOD*
INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR COMMON OF ANY CONTRACTOR 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,
a EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
!!NSR
I LTR 11 TYPE OF INSURANCE
JADDI
tfUBRiPOLIO
t
?oL!cY_NU' MBER
POUC EXP
GENERAL LIABILITY
Sa COMMERCIAL GENERAL LIABILITY
A
i E] 0 CLANS -MADE W O=M
El
GEWL AGGREGATE LIMIT APPLIES PER:
0 6d PR 0 LOC
jEe T
i AUTOMOBILE LL481UTY
❑ANY AUTO
I ALL UTOS ❑AUTOS OWNED SCHEDULED
❑ A
-
HIREOAUTOS ❑
NAUTONOSOWMED
............... ....... ... .... ......
UMBRELLA LIAR [D OCCUR
rl Excess u4B n n AIM-UAnr
N IN 20185FL00036200
I
U Ppp....U_fq�� ....... ...
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRETORIPARTI N CUTIVE_
(MaOFFIndatwy In Mil .
CERWIEMBER EXCLUDED?11 1 NIA N
06/14/2014
0511412015..
DAMAGE TO RENTED
1�
.i moi
ME9 W ("P1q.P.a_.)........._x.....5.004.00..,.....
PERSONAL & ADV INJURY
$ 100,000.00
........ ...... -.1 1
�.......
$ 1,000,000.00
...........1 1.-...... � ....
GENERAL AGGREGATE •--._.._$___2,000,000.00
PRODUCTS - compiop AGG
.............
$ 2,000,000.00
.. ...........
.. ..... ......
... ............ .. . . ............
ii� SINGLE LIMIT
...............
SWILYIWURY(Pw person}
... . ......
$
BODILY INJURY (Per accident)
...... .................... .......
$
--.__.......__....1
$
............... ...... ....... .. ... ............ . ........
DESCROMONOFOPEItATIONSILOCATR)14SIVEI#CLES (AttaO ACORD 1101, Additional Remadw SahedWe. If more space Is req*ed)
ELECTRICAL WORK - WITHING BUILDING.
CERTIFICATE HOLDER
City of Miami Shores
10050 NE 2nd ave
Miami Shores, Fl. 3313ts
ACORD 25 (2010/06) QF
E.L. DISEASE - EA
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESMATIVE
MARIA ALM
J
0 ORD CORPORATION. All rights reserved.
he RD name and logo are registered marks of ACORD
PLEASE CUT OUT CARD BELOW AND RETA N FOR FUTURE REFERENCE
r
STATE OF FLORIDA
I DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS` COMPENSATION
F
CONSTRUCTION INDUSTRY EXEMPTION
aO
CERIt MIM CW EULCMN TO BE EUNIFrFROM FLORM
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VOUNOs•COMPefS TMIAW
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OFFECINE D IL 40=4 EXP RATM DAM
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BUSNMNAWEANDADDREM
.ILP B.EMIMCAL SERVICES INC
[ E
U;47TNW 6EPL
I
IRM CAROM FL 33M
SM—ES OF BttW4M OR TRA
ELECTRICAL
DMF2-DWC-252 CERTIFICATE OF ELECTION To BE EXEMPT REQ ism BT t2
Purawd b Chapter"0;04%)4 FS, an otRcerof a empoteow
who etetxs exempt[= from this chapterbyOng a eeANcete of
election unci" this sec§ort way not remw Dertffs of
conwartsaftnurAwthtschapter. q
Pww- t to Chapter 44Ot Qgt2). F.&, CscWkaWs of eiedion to [
he exempt_ apply Q* vAthk the swpe at the buwmss or Nada
fisted ort the notice of ebKftc to be exempt I
PumLot b Chapter"G-W3)F.S.. NofieasofetlecruxD to he
exempt and oarfeates of ekbcrm I* be, exempt than to
sahjtmf to mvocafi= it at any, Hme after the On of the notice
Orth& tars Ofthe cW0001k go person awned an the
nam or—'sate—bv-meafsthis WTAwnwft at tots
seWonftrtsawnceataceditdaThe dam[ahajcmvohe [
acardfieaOa at MW time for ftHim of am persm tamed at ate
carte to mart; the. mqubmwft of aft saca►-
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FA
QUESTIONS? (85m)413 -IMS
Miami shoresVillage
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 maybe
ersonall liable for the worker com ensation in'uries of an erson allowed to work under this ermit. 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
CONTENTS.
Owner
Print Name: J h n� t�
Signature:
State of Florida )
County of Miami -Dade)
Sworn to,apd subscribed before me this
day of��`%� , 20
yP JAY 000
By JV#P/ v t#
1SS10�1#06M
Print Name:
State of Florida )
County of Miami -Dade)
Sworn to and subscri ed
day of
By J(T
AND ITS
iVCHW JAY IQJ= M
MY COMMlS M #MffiM
(SEAL) o BMW WfC1-ATX/ABonded throagh iet State Insurance