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EL-15-1011 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-238393 Permit Number: EL-4-15-1011 Scheduled Inspection Date: July 07, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: LOWMAN, MARCI Work Classification: Service Change Job Address: 75 NE 101 Street Miami Shores, FL 33138- Phone Number (305)981-4477 Parcel Number 1132060131550 Project: <NONE> Contractor: FARADAY ELECTRICAL CONTRACTOR INC Phone: (954)980-6128 Building Department Comments Infractio Passed Comments UNDERGROUND SERVICE ENTRANCE FROM FPL INSPECTOR COMMENTS False CHANGE OVERHEAD EXISTING SERVICE TO UNDERGROUND. Inspector Comments Passed Failed Correction (70❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. July 06,2015 For Inspections please call: (305)762-4949 Page 33 of 33 P remit Iv x Lei Miami Shores Village a E� trial-Row-e F� 10050 N.E.2nd Avenue NE {7�f Gja5S1 �860t7 Seryid M- ID] Miami Shores,FL 33138 0000 or h�B—fie Phone: (305)795-2204 = FtoR1oA tssu t3a��1 '�2t11 Expiration: 11/1512015 X,., Project Address Parcel Number Applicant 75 NE 101 Street 1132060131550 MARCI COWMAN Miami Shores, FL 33138- Block: Lot: Owner Information AddressPhone Cell MARCI COWMAN 75 NE 101 Street (305)981-4477 MIAMI SHORES FL 33138- 75 NE 101 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone .._.. _._..._,_ .M $ 500.00 FARADAY ELECTRICAL CONTRACTC (954)980-6128 Valuation:Total Sq Feet: 0 Type of Work: UNDERGROUND SERVICE ENTRANCE FROM F Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# EL-4-15-55363 DBPR Fee $2.25 DCA Fee $2.25 05/19/2015 Credit Card $ 115.10 $50.00 Education Surcharge $0.20 04/29/2015 Credit Card $50.00 $0.00 Permit Fee-Additions/Alterations $150.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $165.10 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 pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PL BING, MECHANICAL,WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVJT': I c rt' that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and z ing. Fftia ermore, I authorize the above-named contractor to do the work stated. i 1 l May 19, 2015 Autho�lze i ature:Owner / Applicant / Contractor / Agent Date Building Department Copy May 19, 2015 1 �aa 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 i ITIS.£C€of es that the Individt.fal fisted below has elected to be exempt f,orn Rorida Workers'Compensation law, EFFECTIVE HATE: 4/27;=015 EXPIRATION DATE: 4/261./2017 PERSON: jEAN-CHARLES FRIT/2' M FEIN: 3005.13280 BUSINESS NAIr>FfE AND ADDRESS- FARADAY ELECTRICAL CONTRACTOR INC, 10640 LAG()WELLEBY DR, SUNMSE FI_ 33351 SCOPES OF BUSINESS OR TRADE: LICENSED ELECTRICAL C.()NTR,*, TOR i`r;r r:;.=.r:t 10 C;ha;,ter 44:1.05(14).F S.,an ofMc:or of a corcc:raVor,Who exec°s exemption,iror this chtapte;by Filing a certificate of election under this section n:ay stet rr:c.ovg-benefi!s or,^,ortpertsation un:fa>:r this chapser.t>;ircuant to GI7<�pYer 44b.E):iii2).F.S..Ce^iiic�fes.^.t s:ectirn :s be exatt�pt...apply cnly avit rip the sropt:of'I;e b;:sir:ess or Yra[1e ttster:or,the notice of election;to be exempt.Pursuant to Cha ter 440.051.i 3; S ,F, t> .,Notices(:ICF.$Uf QtP.f.'ttUn 1.0 be a=np;zre certitscates of etaction to be exornpt , a1.(ce sut>ect So revo ati^,n if.at any limn a".er the f'slin of(he nctira nr ttie i;s,�ance of the ceRificafe, the;a>rson named or:the.r.ntice.or certificate no longer mews the r^,ui emerm of tris section for issuance of a certifir.ote.Tk:e department shay rovoxe a 0FS-F:2-0VVC,-252 CERTIFICATE OF ELE=C.I(ON TO BE EXEMPT REVISED 08..13 QUESTIONS?(£+501)413-IC09 6\ ���� , Miami Shores Village oRECFt�r .�. M Building Department APR 29 2015 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY Tel: (305)795-2204 Fax:(305)756-8972 — -- INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 2010 BUILDING Master Permit No. D�—(S' 01 I PERMIT APPLICATION Sub Permit No. ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: �� , `' 101 Yfre( City: Miami Shores CountV: Miami Dade zip: 33)3 8 Folio/Parcel#: Is the Building Historically Designated:Yes NO V Occupancy Type: .SFU Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): oyc I �Wmd-\ Phone#:.J0-S' 9FLII�T Address: City: M 1 M, I7�rtJ State: Zip: Tenant/Lessee Name: ,A Phone#: Email: M e k ►w^� a��llo6.lrna►�t. Cont � r CONTRACTOR:Company Name: 'XQ C X hone#: Address: C Q City: //State: f� f Zip: /S~ Qualifier Name:��z �'�a,,� Lh �^/� S Phone#: —71'67-4/ 2 z's State Certification or Registration#: ,�/(/ {`f �i Certificate of Competency#: �c(� L� ' i rcfG V DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ ©® Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: .,«r►Q/g �-,C r ol.7Z -sy 6-(JL C'A g j.� F�YL LJ r ` L Specify color of color thru tile: Submittal Fee$-' W Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ • O (Revised 02/24/2014) e s ` Bonding Company's Name(if applicable) Bonding Company's Address City State Zip 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 ch posted notice, the inspection will not be approv and a reinspection fee will be charged. Signature Signature _ ;5�\rft,� I[ f / OWNER or AGENT CONTRACT The foregoing instrument was acknowledged before me this The foregoing instrume it was acknowledged before me this ' 33 day of I ' I�G 20 S by 23 day of 20 , by W G L., W�� who i ersonally known o "I 0-0AL- ,-��jJ who i persona y nown o me or who has produced A as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLI Sign: Sign: Print: Crini :e Print: a% Seal: Seal: e ONFEA DAVID80N * MYCOMMISS*N#EE191597 ussVAJEIONIEuOiltN4�%"JgiPaPuo9 * EXPIRES;January 19,2016 LLg800:W#ul"'wwo0 _ s; unr 18103,ww0 AW n NlanHlvw z11a1 APPROVED BY L� n�ZQ���L Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Report Viewer Page 1 of 1 r i A E-1 i 1 � ilioaeia F 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 e. CONSTRUCTION INDUSTRY EXEMPTION a This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 5/6/2013 EXPIRATION DATE: 5/6/2015 PERSON: JEAN CHARLES FRITZ M [ FEIN: 300548280 t BUSINESS NAME AND ADDRESS: € FARADAY ELECTRICAL CONTRACTOR INC 10640 LAGO WELLEBY DR SUNRISE FL 33351 SCOPES OF BUSINESS OR TRADE: { ELECTRICAL WIRING WITHIN BUIL Pursuant M Chapter 440 05(14),F.S.,an officer of a corporation who elects exemption from this chapter by riling 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 i 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 ceraf ate.The department shall revoke a certificate al any time for failure of the person named on the certificate to meet the requirements of this section. F DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)413-1609 1 I I01fiv8f STATE OF FLORIDA DEPARTMENT OF BUSINESS AND 4P .t- PROFE � L" tEGULAT{ON .$�,. } 8z ER13014251 Lam: 07/27/2014 REG ELECT TRA JEAN-CHAR TOR INC i 203.28 NW. 2tifj; FARA /I" DAY ELS GAL (� ) � (INDIVIDUAL f M'B ` G tr, F 3;J Sr: FPS i (IN I I I U REO LL f tOR TO CONTRACTING ►t{ Y MEA) HAS REGISTERED under the provisions of Ch_489 FS. Expiration date : AUG 31,2016 11407270003035 CTQB Construction ECing Board BUsSS CERTIFICATE OF COMPETENCY CERTIFICATE OF COMPETENCY 09E000348 BR,` NVARD FARADAY ELECTRICAL CONTRACTOR INC D.B.A.: FRITZ M JEAN-CHARLES F� JEAN RFILES FRITZ M MASTER ELECTRICIAN CONTRACTOR AR ►DAA ELECTRICAL CC3NTF1ACTOF flhlC." Is certified under the provisions of Chapter 10 of Miami-Dade Y # -- CC#09-CME-14873-X Ref. 20956650 Expires 8/31/2016 Ctrl#16-12966 ,rer.asl ,�o 10 Qc 004990 Local Business Tax Receipt Miami-Dade County; , State of Florida —THIS IS NOTA BILL - DO NOT.PAY 6456180 BUSINESS NAME/LOCATION RECEIPT NO. 'EXPIRES" FARADAY ELECTRICAL CONTRACTOR INC RENEWAL G/� 4652 NW 3 AVE a 672'4570, s�'PTEMB�R 30, 2015 MIAMI`FL 33127 ;'Must be displayed at place of business Pursuant to County Cade Chapter 8A—Art.9&10 OWNER SEC.TYkE'OF BUSINESS' FARADAY ELECTRICAL CONTRACTOR INC 196'ELECTRICAL CONTRACTOR PAYMENT RECEIVED 09E000348 Worker(s) 2 BY TAX COLLECTOR$45.00 07/31/2014 CHECK21-14-040250 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, permit,at a certification of the holders qualifications,to do business. Holder muAcomply with any governmental or nongovernmental regulatory laws andsequirements which apply to the business. The RECEIPT°N0.above must be displayed orrall commercial vehicles-Miami:Dade.Code Sec 8a-276. For more information,visit www.miainidade govhaxcollector CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 04!22!15 i THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS i 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(ies)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 CONTACT—JEAN R MESADIEU NAME: All Universe Insurance PHONE AIC No): 305 653-7359 FAX (305)653-7343 two E>�; ( ) 20328 N.W.2nd Ave. A DREss: jrmesadieu@gmail.com Miami Gardens,FL 33169 _ INSURERS AFFORDING COVERAGE NAIC# Phone (305)653-7359 Fax (305)653_7343 _ INSURER A: WESTERN WORLD INSURANCE GROUP 1217069 I INSURED INSURER B: FARADAY ELECTRICAL CONTRACTORS,INC. INSURER C: 10640 Lego Welleby Drive INSURER D: _ SUNRISE,FL 33351- (954)980-6128 INSURER E:---J I 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 HAVEBEEN REDUCED BY PAID CLAIMS. INSR ADDL UBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INR I WVD POLICY NUMBER1MMIDDNYYY1 (MMIDDIYYYY) GENERAL LIABILITY EACH OCCURRENCE $ 300,000.00 DAMAGE TO RENTED 50 000 0 ❑ COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ ❑ ❑ A CLAIMS-MADE © OCCUR NPP1217069 04!13/2015 04/13/2016 MED EXP(Any one person) $ 5,000.00 PERSONAL&ADV INJURY $ 300,000.00 ❑ GENERAL AGGREGATE $ 600,600.60 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s 300,000.00 _ ❑ POLICY ❑ PRO ❑ LOC I AUTOMOBILE LIABILITY MBINED SINGLE LIMIT EaCOaccident $ ANY AUTO BODILY INJURY(Per person) $ ❑ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ❑ AUTOS NON-OWNED PROPERTY DAMAGE $ ❑ HIRED AUTOS ❑ AUTOS Per accident i— ❑ El — $ i ❑ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB CLAIMS-MADE `AGGREGATE $ ❑ DED ❑ RETENTION$ _ $ WORKERS COMPENSATION ❑TV RYT M T ❑OR AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETORIPARTNER/EXECUTIVE N!A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED (Mandatory in NH) El E.L.DISEASE-EA EMPLOYE $ If yes,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) !.....ELECTRICAL WORKS,,,,, I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING DEPARTMENT 10050 NE 2ND AVENUE AUTHORIZED REPRESENTATIVE MIAMI SHORES,FL 33138 i FAX:305-756-8972 JEAN R MESADIEU ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05)QF The ACORD name and logo are registered marks of ACORD Faraday Electrical Contractor inc. 04-22-15 State of d6k Countyof Before me this day personally appeared �, ho,beingduly sworn,de oses and says; that he or she will be the only person working on the project located at �� I��I sworn to (or affirmed) and subscribed before me this _of y ) 2015'-_, by Fersonally know Or produce i enti ication Type of identification pro uced Y prin t e or stamp name of notary FAITt MA"WM Notify PON-stat!0t V10r1de My Gomm,h0he Jun 10,1017 QOfl1ffl18�i®R#ISP AA®077 ti�� 1111 u0h ^ik�a i Ntary Assn. ` GGt�ORE' �,W C.1932 G1 .. evil ,,,,,- Miami shores Village Building Department ORIDp' 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 YO ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: er State of Florida County of Miami-Dade a The foregoing was acknowledge before me this 2Z'� day of Apr, ( 2015 ByM 4 Y b L0( (f)CAO who isIzerso� Wally known to me or has produced as identification. Notary: JoJEWAFERDAVOM * MY COMMNSSION 1 EE 1817 EXPIRES:January 19,2018 SEAL: ,rf4Nd�tlN SOF T5 � for strut (Address) C ITY 3 - THWN CU COPY TO FPL -2,m° AMP METER •••• ••••�• MAIN Z,o d AMP •• PANEL •••• •• A-2P AIC ....., • ,..... 3-4 THWN ' 1-�GRD. •• rF'� P� �� VtCQ 14 to CWP & (1) 5/8 X 8' GRD ROD Print PER APPROLED BY#: �_ Miami Shrresl/illa a Sign 7 Ik DATE Notary zoNiNGDEPT _,.• Sworn to and subscriber befor me this ``�ay ofXte 20 1S A.D. !DG DEFT (SEAL) O C(-tMPI MCE W M AlA FEDERAL `2oti'�Pie�,,' FRIT2 MATHURIN MY COMMISSION EXPIRES ANT)REGULATIONS orate of Florida V �So�N al(I K nOlnls� "; cmc MY Comm.Expires Jun 10,2017 %.;Fov v.o?••' Commission#FF 008677 """' Bonded Through National Notary Aeon