EL-14-2617 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-238636 Permit Number: EL-12-14-2617
Scheduled Inspection Date: July 28, 2015 Permit Type: Electrical - Residential
Inspector: Devaney, Michael Inspection Type: Final
Owner: PATEL,JAGRUTI & HEMENDRA Work Classification: Addition/Alteration
Job Address:89 NE 109 Street
Miami Shores, FL 33161-7039 Phone Number
Parcel Number 1121360040550
Project: <NONE>
Contractor: VOLT ELECTRIC CORP Phone: (305)200-7967
Building Department Comments
NEW FIVE OUTDOOR POLE LIGHTS BY DRIVEWAY. Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP-233991. CREATED AS
REINSPECTION FOR INSP-233750. CREATED AS REINSPECTION FOR
INSP-233434. CREATED AS REINSPECTION FOR INSP-232844.
CREATED AS REINSPECTION FOR INSP-224229. Need the contractor on
Failed ❑ site with plan and permit.
8 july 15
Receptacles on poles not G. F. I. protacted.
24 apr. 2015
Correction ❑ Need the electrical contractor with the plans and permit on site.
Needed 4 may 2015
Receptacles on the poles not G. F. I.
protected and have open ground.
Re-Inspection ❑ r ���
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
July 27,2015 For Inspections please call: (305)762-4949 Page 20 of 44
.,: Pert � . -1 -26 �
Miami Shores Village ` Perm "Y1 �1;1G `#0111 00 lti .
10050 N.E.2nd Avenue NE � ' ��`� �� � '
IMvrCia�Catlatt:Addition/Alt � £ is
Miami Shores,FL 33138-0000
Phone: (305)7952204 ParritSlBtu
�GORIDP
issud'631271 1a Expiration: 09/23/2015
Project Address Parcel Number Applicant
89 NE 109 Street 1121360040550
Miami Shores, FL 33161-7039 Block: Lot: JAGRUTI &HEMENDRA PATEL
Owner Information Address Phone Cell
JAGRUTI&HEMENDRA PATEL 89 NE 109 Street
MIAMI SHORES FL 33161-7039
89 NE 109 Street
MIAMI SHORES FL 33161-7039
Contractor(s) Phone Cell Phone Valuation: $ 1,250.00
VOLT ELECTRIC CORP (305)200-7967
Total Sq Feet: 0
Type of Work:NEW FIVE OUTDOOR POLE LIGHTS BY DRI Available Inspections:
Additional Info: Inspection Type:
Classification:Residential Final
Scanning: 1 Meter Box
Alteration
Relocation
Fire Alarm
Service Change
Underground
W.W.
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20
DBPR Fee Invoice# EL-12-14-53739
$225 03/27/2015 Check#: 1793 $ 110.70 $50.00
DCA Fee $2.25
Education Surcharge $0.40 12/02/2014 Check#: 1685 $50.00 $0.00
Permit Fee-Additions/Alterations $150.00
Scanning Fee $3.00
Technology Fee $1.60
Total: $160.70
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, PLUMBING, MECHANICAL,WINDOWS, DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregdtnq information acc to and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above-nam ontract r to do the work stated.
March 27, 2015
Authorized Signature:Owner / Applicant /� Contractor / Agent Date
Building Department Copy
March 27, 2015 1
Miami Shores Village a
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
FBC 20(b
f ' �
BUILDING Master Permit No. w –` `-D- 1431-�
PERMIT N Sub Permit No.
❑BUILDINGELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: O .3; 7
City: Miami Shores County: Miami Dade Zip: 33136
Folio/Parcel#: / /34 !9O '5;119 �5O Is the Building Historically Designated:Yes NO
Occupancy Type:L�—Load: Construction Type: C 5 Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): �7 < 1 D � �'� T �- Phone#: -3 O5 75-3 % l SI
Address: 9-/ /V 6 - I O q s j
City: k`I//t}-/ / 5{f0/Z s State: Jrz_ Zip: 3-5
Tenant/Lessee Name: Phone#:
Email: 2� n
CONTRACTOR:Company Name: G Phone#: 3DS ZaC r)4¢' t
Address: $ LU 5';�'>
City: 4ko` �4e� State: E L, Zip: -3 /QualifierName: (0WAVJ*?t-S �D Q�hhuS l t,C2 Phone#: n
State Certification or Registration#: R ��V -/ Certificate of Competency#: 1 3 E OOU �3 3
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
i
Value of Work for this Permit:$ / Z 5 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition
Description of Work:
_Ale, SAJ r /\4 C Oy•T Ndd rZ FZ(-e Lf S
��1� hfL�.w C.l_J1I
Specify color of polor'.tftru tile: W2.
Submittal Fee$5() Permit Fee$ 15 c3� C�L� CCF$ '' i° COICC$
x
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
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 of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
OWNER or AGENT NTRACTOR
The foregoing instrumen was acknowledged before me this The foregoing instrumenas ac owledged before me this
day o-/ 20 , by _day,0j1-, ! I//wf 20 'L by
�e n&e4, Zeal,who is
personally known to��,-� 02'0N f S A tv�b &I (d gY4ho is personally known to
me or has produced r S�yJas V me or who has produced as
identi catio and who did take an oath. identification and who did take an oath.
NOTA Y P LK: NOTARY PUBLIC:
Sign: Sign:.
Print: [�Wlk�`p� kY Print:
Seal: KURLINE �� Seal: *0 PAIL[Oli3l�U
* * MY COMMISSION#FF 103607
VJCNOWp&k Sfi w of Raida
EXPIRES:Ma mb 18,2018
ComnJeebniE
FF 81175 +'+,� o� BMM Tin awo Nduy se vim
******* ** ** V;jp0Ip*#ft* *# *7 ********************************************************************
APPROVED BY G Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395
WS 1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
RODRIGUEZ, ODONIS
VOLT ELECTRIC CORP
831 W 53RD TERR
HIALEAH FL 33012
Congratulations! With this license you become one of the nearly
one million Floridians licensed by the Department of Business and _
Professional Regulation. Our professionals and businesses range STATE OF FLORIDA
from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMENT OF BUSINESS AND
and they keep Florida's economy strong. PROFESSIONAL REGULATION
Every day we work to improve the way we do business in order to ER13014936 ISSUED: 05/29/2014
serve you better. For information about our services,please log onto
www.myfloddalicense.com. There you can find more Information REG ELECTRICAL CONTRACTOR''
about our divisions and the regulations that impact you,subscribe RODRIGUEZ OD6NIS
to department newsletters and learn more about the Departments VOLT fLECTRfC CORP
initiatives. (INDIVIDUAL MUST MEETALLLOCAL
Our mission at the Department is:License Efficiently,Regulate Fairly. LICENSING REQUIREMENTS PRIOR
We constantly strive to serve you better so that you can serve your TO CONTRACTING IN ANY AREA)
customers. Thank you for doing business in Florida, HAS REGISTERED under the provisions of Ch.489 FS.
and congratulations on your new license! exp'ration date:AUG 31,2016 L,1406290003160 - .—
DETACH HERE
RICK SCOTT, GOVERNOR KEN LAWSON,SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD
ER13014936
The ELECTRICAL CONTRACTOR
Named below HAS REGISTERED `' 'WF
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2016
(INDIVIDUAL MUST MEET ALL LOCAL LICENSING
REQUIREMENTS PRIOR TO CONTRACTING IN ANY AREA)
v � a
RODRIGUEZ, ODONIS
VOLT ELECTRIC CORP
831 W 53RD TERR
HIALEAH FL 33012 '
ISSUED: 05/29/2014 -RISPLAY AS REQUIRED BY LAW SEQ# L1405290003160
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OWNER SEC.TYPE tJJF BUSINESS PAYMENT RECEIVEt3
VOLT ELECTRIC CORP 196 ELECTRICAL 8y TAX cot71 ECTtx;
QD ODONIS RODRIQ0E2 PRES (°NTRACTOR
400 07/24/2014 "
Vvd ter(s) 1 13ED00539 025-14-OD4972
This Local lheiaess Tax Ree•iptenly coallow payment of the Local Bssiaess Tax.The ktceipt is rata lieenne,
Hermit,er gtli6eatiensfgarholder's 466"causes,teiebtsisess.Helperamcomply Wilk any'
�ier�ss
"sr neagersts�rustal regnlsUry laws and rMaireaeste which apply to the(k sinesn.
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THIS CE'RT'IFICATE IS ISSUED AS A,MATTER gf,'INFOROATM 'ONLY.'AND CONFERS NO RIGHTS.iJPOI!t,TOEE'RTIOOA`F.'HOLDtR.THIS.
CERTIFICATE DOES NOT A FIi�AIIATNEI,Y:OR NEGA71VELY''�AiftlltPi13. E1C1 ENO,OR,ALTER lbji .COVER'hGE AFFOI�E�:BX Ike ty.bucle8
BROW. THIS CERW ICATE OF If�tSURANC�;066 ''NQT CONSTITUTE'iA f �TAACT:BE-fWLEN.THE:ISSUING I.NSIIRER(S); AUTI�IOWEf3 .
REPRESEPITATiVE OR PRODUCLK,A�14.THF,'Ct,R`nFitC�ii,H.W PER
11NPORI`ANT- If the ceriiftcete'noldet'Is,8ti:i0.0Di710NA� IIiE9tiRED,.She'poflcy(te:3)riwat fw ®ridors�dc'If.,Stil3itaC�ATIOM:lS yVAtV6D,strb)ect to
the terms and condltiaos,of the Wlcy,rsrt$in.' )icles,may.F9qulre an iasemendo? A 06tvisnt'an this rertifloate;dCes:nQt confiir rights to the
cerci&ata hblder iri:lieu of such andotakher (s ;.
PRODUCER NAMES i;afelis 5atiatela "
APLUS INSUP.ANC GROUT'INC PHONE 3t15r260-3864 Fi° �: .305 46552
3480 84th St Suite 202,1 aDffi infD:aplErtiir18ur2UCIC yafioo.corn
INSUt�R(5}AFFVRJ�NG,lCOVERAGE NA;c M
Hlaleah Gardens .FL '33018 nesUMRA: A$CF-ND,ANT UNDERIMRITERS,"C.
INSURE=D ;INSURER'S:
volt E ectriC Corp ttt3UR$R 4:..
831 W 53 RD TERR INSURER v,:
. .. INSURERS•
Hialeah FL 330,12: INsuRsB F
COVERAGES CEkTIFl 4TE.NEIdAE3 R: .. 'REVISION`NUMBER:
THIS IS TO CVATiFY,THAT THE.P.OLICIES'OF'IiNSURANCE'LltTk ,BEi6w_.HAV,.E BEEN ISSUED TO THE INSURED NAFFED AOOVE FOR THE POLICY PERIOD
INDICATED. NO-RMTIis-rANDfNG-AN'Y REQUIREMENT.TFRM GIS CONDITION OF ANY CONTRACT:OR OTHER'DOCUMENT'WITH RE6PECT TO,WHICH TI-lis
CERTIFICATE MAY BE'ISSUEROR M,'Y PERTApY,•TH,E INSURANCE'AFFORDED:BY.THE i?OLiGfES:DESCR)BED HEkEiN:JS.SUBJECT TO ALL Tilt TERM$,
EXCLUSIONS AND CONDITIONS OF SUCH POUCIE&�LPMI[TS,SfibWN MAY HAVE BEEN REDUCED BY PAID,CLAIMS
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TYPE OF u13uI1AliCE P'OIJCY NUWB� iMllA/
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OOMMEROAL GENERAL'LUI UTY p(�EMIg a ocuvrence S. 1.#�O,ROtf
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GEN',AGGREGATE LIMIT APFLIES PER: , PRODUCTS-COWIOP AGO S 1,flO0,000
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DED I RETENTIONS _
WORK fiR9 COMPENSATION, VVC STAFU-
AND EMPLOYERS'IJA"LITY '
ANY PRfETORl+'� Y l N
OPRC E.I,EACH AOGDENI
IOFFICER/MEMBEAFXCLUDED? t1lA
(MAY to Nil) F-L. -FA EL& IE E
If yes.deem1be under
DESCfup n TIONS below EL DISEASE:POJ3 IT S.
DE9@Rll'TICDf OF OPERATIONS)[,OQAMONS f VEHWLES•tApmeh&CORD 4K Aadfllonil RaloadmL 9f*0ule,If more apace Is mmUTd).
ELECTRICAL CONTRACTOR
CERTIFICATE HOLDER CANCELLATION'
SHOULD ANY OF THE AsovE,D�SCRISIED POUCIES BE CANCELLED BEFORE
Tit
}(VIRATION DATE. ThFKEOF, NOYTCE'-YALL BE '(*L VERED IN
CITY OF MIAMI SHORE VILLAGE AGCORDANGE WITH THE POLICY PROVt$IOM3.
10050 NE 2nd AVT= AUTHOMMO ARPAMSENTATNE
MIAMI SHORE FL 33136
ACORD 25(2010106) .1988. ACOftA YI .Af!rights reserved
TheACORA nalae.and logo Bre regWWred rna of.ACORD
SAORFs
1�iC.1932
sell Miami shores Village
yN �„d Building Department
ORNA 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 may be
personally 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 Contractor
Print Name: $A" 1014 7-C e- Print Name: Q
Signature: Signature:
State of Florida) State of Florida)
County of Miami-Dade) County of Miami-Dade)
Sworn to any s bscri ed before me s Sworn to and subscribed before me th's�
day of P. ' day of ,►�► u
(qpp �r,� * •� * MY COMMIS ON t FF 103507
BY E ES:March 18,2018
Mlt t1t W t Oct. 8, 2017 a Budget Notary Services
(SEAL) (SEAL) �.
Type of Identification produced ( Z - Type of Identification prod ced