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EL-15-604'1 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-231316 Permit Number: EL -3-15-604 Scheduled Inspection Date: April 23, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: LUNA, LUISA FERNANDA Work Classification: Alteration Job Address: 10090 N MIAMI Avenue Miami Shores, FL 33150-1216 Phone Number (305)757-3133 Parcel Number 1131010210090 Project: <NONE> Contractor: FELLO ELECTRIC INC Phone: (786)290-7576 ismiamg uepartment comments INSTALL CIRCUIT FOR IRRIGATION PUMPS Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-230756. CREATED AS REINSPECTION FOR INSP-230718. Motor name plate is 19.9 amp. at 120 volt. Failed ❑ NEC 210.19(A) branch circuit to have ampacity not less than load served plus 25% of continuous load. 430.22a single motor conductors to hav anpacity of not less than 125%of motor full load Correction 30 mar. 2015 Needed Sprinkler pump is O. K. Panel is not to code. An old fuse panel interior was removed and a circuit breaker interior was installed .new panel does not have a main breaker or U L. listing. Re -Inspection ❑ �-,� Fee No Additional Inspections can be scheduled until 77 re -inspection fee is paid v� April 22, 2015 For Inspections please call: (305)762-4949 Page 16 of 31 Project Address Miami Shores Village 10050 N.E. 2nd Avenue N Miami Shores, FL 33138-0000 Phone: (305)795-2204 Parcel Number Applicant 10090 N MIAMI Avenue 1131010210090 LUISA FERNANDA LONA Miami Shores, FL 33150-1216 Block: Lot: LUISA FERNANDA LUNA 10090 N MIAMI AVE MIAMI SHORES FL 33150-1216 Contractor(s) Phone Cell Phone FELLO ELECTRIC INC (786)290-7576 of Work: INSTALL CIRCUIT FOR IRRIGATION PUMP onal Info: ifisation: Residential iing: 3 Fees Due Amount CCF $0.60 DBPR Fee $2.25 DCA Fee $2.25 Education Surcharge $0.20 Permit Fee - Additions/Alterations $150.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $165.10 Cell (305)757-3133 Valuation: $ 680.00 Total Sq Feet: 0 Pav Date Pav Tvoe Amt Paid Amt Due Invoice # EL -3-15-54848 03/18/2015 Credit Card 03/19/2015 Credit Card $ 50.00 $ 115.10 $ 115.10 $ 0.00 Available Inspections: Inspection Type: Review Electrical In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations iertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ccepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes I understand that separate permits are auired for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS. ROOFING and SWIMMING POOL wort. 'NERS AFFID I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating druction and ning. Futhermore, I a0orize the above-named contractor to do the work stated. Mar -,h 19, 2015 Aur66#d Signature: Ownef-'' / Applicant / Contractor / Agent ding Department Copy 19, 2015 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 Master Permit No. PERMIT APPLICATION ❑ BUILDING 2 ELECTRIC F-] ROOFING MAR 1 R 015 FBC 20 LO Sub Permit No. :F �1 0 REVISION [:] EXTENSION RENEWAL ❑ PLUMBING F -I MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF CANCELLATION [-] SHOP CONTRACTOR DRAWINGS JOB ADDRESS: zL , Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load k OWNER: Name (Fee Simple Construction Type: Flood Zone: BFE: FFE: i Ll S -7y Address: lam'` I li 106 P %Vi City: ul, ('kA& I o WO (-e S State: Zip: Tenant/Lessee Name: Email CONTRACTOR: Company Name: `n r Address: _ 1 1-Y7, 'x& -4�n e#: one#: Zip: Qualifier Name: c.Aj Phone#: s 5 ,A9 t.- �- y -z I - State Certification or Registration #: ri>i: �'���d �Ek:-� Certificate of Competency #: b4 g DESIGNER: Architect/Engineer: Address: City: State: Zip: Value of Work for this Permit: $ quare/Linear footage of Work: Type of Work: Addition . u„ Alteration New ❑ Rep, air/Replace 'E] Demolition Description of Work,...,, Specify color of color thru tile: Submittal Fee $ Permit Fee $ /er&V CCF $ Scanning Fee $ Radon Fee $ DBPR $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) Training/Education Fee $ CO/CC $ 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 Zi 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 OWNE r AGENT Signature i e" -a-,- V L - CONTRACTOR The foregoing instrurnent was acknowledged before me this The foregoing instrument was a knowledged before mg this day of%20 , by re day of 20 1 , by �C o• who is personally known to &o-Ir".4ng- TllzQ� , who is personally known to me or who has produced ®e or who has produced •Wtjo. �- r as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NELWNALiEXgNMPOLAN00 NOTARY PUBLIC STATE OF FI 010M Si CMV4 FF01 P Vht: &1*6 Seal: NOTARY PUBLIC: Seal: azr—__ 1,; .KKK I. >x>k**1�*�x****>k**I��x***xl>k*>k**>k**>«>k*>x***•*�xr*>k*Ix**>K*�x>k>k****Ix>k>K>K>klx**>k>k�x�x**>x*****>k**>k>k*>k***>K>Kak>k**>k*>k�l>k*>k>K>k>xxl****>K** APPROVED B / i s Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) �C �A PLEASE CUT OUT THE CARD BELOW AND RETAIN F'OR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW 9 EFFECTIVE: 01/28/2015 EXPIRATION DATE: 01/27/2017 PERSON: ROGER ALCINDOR FEIN: 270128138 BUSINESS NAME AND ADDRESS: FULD ELECTRIC INC 500 NW 133 STREET MIAM4 FL 33168 SCOPE OF BUSINESS OR TRADE 1- ELECTRICAL WIRING WITHIN BUIL 2- LICENSED ELECTRICAL CONTRACTOR 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 L under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be H exempt.. apply only within the scope of the business or trade listed on E the notice of election to be exempt R E Pursuant to Chapter 440.05(13). F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice 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. CUT HERE QUESTIONS? (850) 413-1609 * Carry bottom portion on the job, keep upper portion for your records. OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 44,1.1; Ztl If• -,, is ix �,I i � •, • LXZE. ;S:E, NUhNFEIRI. Not" Z-141*111111�;51� Z"" Named 1i �Q: _J%1: ti,' HM i� I G it S ' I e�` Under be-5Fr1;. Wir;_; I,, u; Chapter 489' E*zE&n deW- AUG 31, 2016 (Il.`!bI ,li - 1 k Ill��r i MUST ,,I,'n �1 I Al ! = ve!� LICENSING I , y1 1. r REQUIREMENTS PRI ,,•'RI? E O. •; CONTRACTING IN ANY A,,I . .r ALCI DOR ROGER FELLO ELECTRIC INC NW 133 ST NAM FL 3316 ISSUED: 10/20/2014 DISPLAY AS REQUIRED BY LAW SEQ # L1410200001687 Munni pal (bntractor's Tax %cei pt Miami -Dade County, State of Florida THISIS NOTA BILL -DO NOT PAY OC NO: 06®00026 BUSINESS NAM EILOCATION RECEIPT NO. EXPIRES F81O�TRCINC NEW BUSINESS 500 NW 133 Sr SEPTEMBER 30, 2015 NORM M A,FL 33168 7456815 Must bedisplayed at placeof business PurSuant to CAunty Code Chapter SA -Art. 9 & 10 OWNER TYPE OF BUSINESS PAYM EDIT RECEIVEO FELLO H.ECrRCINC ELECTRCAL CONTRACTOR BY TAX COLLECTOR 200.00 10120/2014 0223-15400169 MRxnxxeinf=m11an,visitwww.lydamidadegMftMrAN dlea trx Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL -DO NOT PAY 5749958 BUSINESS NAMMOCATION RECEIPT NO. EXPIRES FELLO ELECTRIC INC RENEWAL SEPTEMBER 30, 2015 500 NW 133 ST 5995932 NORTH MIAMI, FL 33168 Must be display of business to C Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS MENT REC61VED FELLO ELECTRIC INC 196 ELECTRICAL BY TAX COLLECTOR CONTRACTOR 49.50 10120/2014 Worker(s) 1 06E000026 0223-15-000169 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt Is not a license. permit, or a certification of the holder's qualifications,to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. cooL The RECEIPT NO. above mast be displayed on all commercial vehicles -Miami-Dade Code See 80-216, M®oaoi For more information. visit q NVt.mIJpmj a e o ter glJgc� FELLELE OP ID: TF Armor©° CERTIFICATE OF LIABILITY INSURANCE 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. DATE 0311 212 01 Y1f) 03/12/2015 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 Newman Insurance Agency, Inc. 5700 Stirling Road CONTACT NAME:PHONE ac No Ext 954-963-9626 aC No: Hollywood, FL 33021- Jeffrey M. Newman E-MAIL ADDRESS' 11/04/2014 11/04/2015 INSURERS AFFORDING COVERAGE NAIC # INSURER A: Travelers Insurance Co MED EXP (Any one person) $ 5,000 INSURED Fello Electric Inc. 500 NW 133 St INSURER B: GEN'L AGGREGATE LIMIT APPLIES PER: PRO- POLICY ❑ JECT LOC OTHER: Miami, FL 33168 INSURER C $ INSURER 0: INSURER E: INSURER F: 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 UB D POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE 0 OCCUR 1660-SC285639-TCT-14 11/04/2014 11/04/2015 EACH OCCURRENCE $ 1,000,00 AMAGE TO RENTED— PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- POLICY ❑ JECT LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OP AGG $ 2,000,00 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident UMBRELLA UAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY �, / N ANY PROPRIETOR/PARTNER/EXECUTIVEE.L. OFFICER/MEMBER EXCLUDED? E-1 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A PER OTH- STATUTE I I ER EACH ACCIDENT $ E. L. DISEASE - EA EMPLOYEE $ E. L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached H more space is required) License# 06E000026 Miami Shores Village 10050 NE 2nd Ave. Miami Shores, FL 33138 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 REPRESENTATIVE '�/QI:ItI„'saM1f ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD /_4 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 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 CONTENTSILW% Signature: wne State of Florida County of Miami -Dade The foregoing was acknowledge before me this —1 Q— day of ISA , 20 3 L . By`St9SIcA who is personally known to me or has produced 7L �� 2 as identification. Notary: SEAL: Notary Public State of Florida Sindia Alvarez My Commission FF 158750 Expires 09/03/2018 Fello Electric Inc. Date: C)S I (2,120 1 State of 1--u2it)p County of M «rA l- -DAA. Before me this day personally appeared el�y who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at:9� O!'O� - t Sworn to (or affirmed) and subscribed before me this 13 day of M . 2o(`-, by �00G� 7'�L-U� N 1De12 Personally know OR Produced Identification Y Z Type of Identification Produced tA- -021W- U WNL Print, Type or Stamp Name of Notary °�s, Notary Public Stets of Florida Sincoa Alvarez My Commission FF 158750 o I Expires 09/03/2018 Construc rl� Qualifying Board COMPETENCY truTBUSINESS CERTIFICATE OF 06E000026 FELLO ELECTRIC INC ID.B.A.: 'ACINDOR ROGER is certified under the provisions of Chapter 10 of Miami -Dade County