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EL-15-807Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Parcel Number Applicant 1195 NE 100 Street 1132050190360 KARIM &METIS CORINA ATASh Miami Shores, FL Block: Lot: Owner Information Address Phone Cell KARIM & METIS CORINA ATASH FL (305)790-5551 1195 NE 100 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone JJ ELECTRICAL OF DORAL LL (305)305-1620 of Work: LOW VOLTAGE onal Info: kation: Residential 1ina: 1 Fees Due Amount CCF $0.60 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.20 Permit Fee - Additions/Alterations $100.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $108.60 Valuation: $ 500.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # EL -4-16-55122 04/23/2015 Credit Card $ 108.60 $ 0.00 Available Inspections: Inspection Type: Review Electrical In consideration of the is ance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and i trict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ECT CAL, PLUMBING, MECHANIC L, WINDOMOBOORS, ROOFING and SWIMMING POOL work. OWNERS F AVIOcertify that all f going�ia;t:�iis accurateand that all work will be done in compliance with all applicable laws regulating constructio d zoning. Futhermore, contractor to do the work stated. 23, 2015 `Authorized Signatur n&" / Applicant / Contractor / Agent Building Department Copy April 23, 2015 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-235061 Permit Number: EL -4-15-807 Scheduled Inspection Date: May 21, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: ATASH, KARIM & METIS CORINA Work Classification: Low Voltage Job Address: 1195 NE 100 Street Miami Shores, FL Phone Number (305)790-5551 Parcel Number 1132050190360 Project: <NONE> Contractor: JJ ELECTRICAL OF DORAL LL Phone: (305)305-1620 tiunamg uepartment comments LOW VOLTAGE INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. May 20, 2015 For Inspections please call: (305)762-4949 Page 31 of 42 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 PERMIT APPLICATION ❑BUILDING _11LECTRIC ❑ ROOFING APR 092015 BY. 1 FBC 20 Master Permit No. _M09— Sub M09Sub Permit No. �c�is— ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP C� ,C CONTRACTOR DRAWINGS JOB ADDRESS: _I I �� ® 0 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: OWNER: Name (Fee Simple Titleholder Address Construction Type: Flood Zone: BFE: FFE: Jffl 2 _1� /V' �t U one#: '� 05— / /0— 55rl City: _/j :z 4 Z� State: Zip: 53 Tenant/Lessee Name: Phone#: Email d CONTRACTOR: Company Name: _ — C _ (? _�7C (>:�"-�'/Phone#: Address:� "L, w C I _T-)�. City: /��' ' -ix;), /4 State: T L Zip: f4' ' Qualifier Name: f? �� / U Phone#: State Certification or Registration #:(!!_ft? nC) Certificate of Competency #: 173 a O pa DESIGNER: Architect/Engineer: e#: Address: City: State: Value of Work for this Permit: $ O Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace Description of Work: LUw Specify color of coW t ru vile: Submittal Fee $ Permit Fee $ 10 ,0`0419 r® Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews (Revised02/24/2014) Zip: ❑ Demolition CCF $ CO/CC $ DBPR $ 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 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 comme cement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In th bsen such posted notice, the inspection will not beappr ved a;areins7pecdonwill be charged. Signature Signature OWNER or AGENT CoT O The foregoing instrument was acknowledged before me this 12— day of ly?410h , 20 J by wi ersonall k to me or who has produced as identification and who did take an oath. The foregoing instrumeni,was �nowlec%ed before me this day of 20 15— , by =14A6-P'oe— who is personally known to me or who has produced r ---L v), as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: rint. e�r-2�n�� Seal: Seal: Seal: LIANA MARTINEZ �® e�� Notary Public State of Florida * MY COMMISSION 8 EE 224401 - e Joanna M Feliciano Nr P EXPIRES: September 8, 2016 o My Commission FF 082753 9rFo�Flo�`O BondedThniBudgetNoinServices oFF►o4 Expiresol/12/2018 APPROVED BY �/�'P2/Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) V Miami shores Village Building Department CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. ........................................................................................... BUSINESS NAME: BUSINESS ADDRESS: BUSINESS PHONE: () CELL PHONE (__) QUALIFIER'S LIC NUMBER: CITY FAX NUMBER (--) QUALIFIER'S NAME: STATE ZIP P,37C2AC--TtjL ��5-T FYZ �Fvr CERTIFICATE OF LIABILITY INSURANCE109 CATepula"M 04/2015 PROMKM PREMIER FARMERS AGENCY- MANUEL ACEVEDO 7669 NW 50th STREET, MIAMI. FL 33166 PHONE:305-599-1349 FAX:305-599-1359 email: pmmieftrmers@bollsouth.net THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOTAMEND, OR ALTER THE COVERAGE AFFORDED BY THE POILICIMES i INSURERS AFFORDING COVERAGE NAICIS RtSiIREo JJ ELECTRIC OF DORAL, LLC 7865 NW 109 PL DORAL, FL 33178 I wwm A- ENDURANCE AMERICAN SPECIALTY INS. CO. MUICM NOQMMMMDRLlABUMDFAWXMUPON THE PWRMTIS AGENTS CR A tEJ XTATM MEURER E: I THE POLICIES OF INSURANCE LffnM BELOW HAVE BEEN ISSUED TO THE "MRED NAMED ABOVE FOR THE POLICY PWOD INDICATED. NOTWITHSTANDING MY REOUIREMENT, TERM OR COMMON OF MY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCA POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAR) CLAM SHOULDANYOFTWASM DESCRIMM POLK= BECANCELLED BEFURETMEOMIMN NoM TYPEGFUJURANCE FMXV Nu BER TDARWA-6wIJIBTB 10050 NE 2fid AVE MUICM NOQMMMMDRLlABUMDFAWXMUPON THE PWRMTIS AGENTS CR A tEJ XTATM GENERAL LUUUL17Y CMWERCIALGENERALLIASHM CLAIMS MAM R] OCIRM AGGREGATE LIMr!"APPLIESPM, POLICY MPROJECT F Loc CBC10001857001 02113/2015 02/13/2016 ECH0CMJlRl1ENM PRlMW(r,=vuiS 1 Imm"a MED EXP (ft ons puson) 3 1 uwto PERSONAL a MW INJURY s GENERALAGGREVATE 5 PRODUCTS-COWWPAGG 5 Alm)MORMELIANUff MYAM ALL OWNED AUTOS SCHEDULED AUTW HIRED AUTOS NM44OWNED AUTOS W.MM)INGLELIM 5 PUP—y") W HB EV NJRY S %*.FcERTYlI)AMAGE I GARAGE LIARIM ANY AM AUTO 0KY-EAACCIDENT S EA ACC 3 MRow.- AM S EKCEMMRM.LA LIABILITY OCQJR CLAM AMME ri DM=tMLE RETOVIMN FAM CCCURRENM s AGGREGATE JUMM&OL710NAND ANV21�jr=.MWME OFF MOOMBONS below T1 R -A F1 ER - E.L. EACH ACC DENT s ELMSM-EAEMONE is EL rASEM - Pom Lmrd 5 OTHER MMhMq= OF OPERAIMNS I 13=711511179=us I ExcLuslow AWED By ENDURSEMEN I I WSMAL RMION11 BUSINESS CERTIFICATE OF COMPETENCY 13EOMSS VCR I #PH n I C MIJwCK RAM M I ATJ M 6=-.,-, - L—'x "— L'. "k -, I �� SHOULDANYOFTWASM DESCRIMM POLK= BECANCELLED BEFURETMEOMIMN MIAMI SHORES VILLAGE 30 DAYSMIRITFEN BUILDING DEPARTMENT tioT=lroymmnm cERmcATenwmwToTmLeFr.mrrFmA=lmodsoamL 10050 NE 2fid AVE MUICM NOQMMMMDRLlABUMDFAWXMUPON THE PWRMTIS AGENTS CR MIAMI SHORES, FL 33138 tEJ XTATM AlmORIM REPREMWATIVE FAX : 305-756-8972 6=-.,-, - L—'x "— L'. "k -, I �� VIMB. JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL 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: 2/3/2015 EXPIRATION DATE: 2/2/2017 PERSON: JURADO JAVIER A FEIN: 462115130 BUSINESS NAME AND ADDRESS: JJ ELECTRIC OF DORAL LLC 7865 NW 109 PL MIAMI FL 33178 SCOPES OF BUSINESS OR TRADE: ELECTRICAL WIRING WITHIN BUIL 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 compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. 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 DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)113-1609