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ELC-14-2134 (x'&: Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-237702 Permit Number: ELC-9-14-2134 Scheduled Inspection Date: June 30, 2015 Permit Type: Electrical - Commercial Inspector: Devaney, Michael Inspection Type: Final Owner: , Work Classification: Addition/Alteration Job Address:9501 NE 2 Avenue Miami Shores, FL 33138- Phone Number (305)756-3711 Parcel Number 1132060133920 Project: <NONE> Contractor: CARIBE ELECTRICAL CONTRACTOR INC Phone: 786-412-0067 Building Department Comments REMODELING TO A GYM Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-220622. Label panels . Failed Correction Needed ❑ Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid June 29,2015 For Inspections please call: (305)762-4949 page 19 of 39 ' Miami Shores Village Building Department artment ` 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 SEP 3 o Tel:(305)795-2204 Fax:(305)756-8972 ; INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 to BUILDING Master Permit No. - I�1 — PERMIT APPLICATION sub Permit No. ® m ❑BUILDING ELECTRIC ROOFING REVISION Ej EXTENSION RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP �' CONTRACTOR DRAWINGS JOB ADDRESS: _l n�� 1/V G � �� fiV�' City: Miami Shores County: Miami Dade Zip:V Q? Folio/Parcel#: 11-3 a o6- 013- Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flo od Zone: BF E: FFE: OWNER:Name(Fee Simple TitleholderPrim� I �1 Phone#: Address: dy1_ a hcc14yi City: r41,01f, s tlo r e,S State: rL Zip: Tenant/Lessee Name: Phone#: Email: g CONTRACTOR:Company Name: COW_6\9je_ u ftm o CGi� CollL. Phone#: Address: 2W yvS4 2-i y4yet� City: N 1 A'e4� State: TL Zip: 3 3 a(l7 Qualifier Name: L 11510 0. t 6QQ_ _044 Phone#: j j?(0 q I Z 00(ol State Certification or Registration#:cc 1.32905 �� Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ O 0 O` O Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work:9'e r`" I'► l� eJ 38 2014 Specify color of color thru tile: Submittal Fee$ .2 •� _Permit Fee$ ��°�� CCF$ CO/CC$ Scanning Fee$ J• ��n1 Radon Fee$ —( r�� DBPR$ d-� Notary$ Technology Fee$74PFJ Training/Education Fee$ I JIN Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ �J�)• ICJ (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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature � Signature • OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 10 day of S e ,20 J-4 ,by day of ,20 , by tyally kno 1 9 �4- d-- ����(' ,who is ersonw to P—)t' o�' 0. who is ersonally know to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: �®-' Sign• Sign: Print: 1TV,,, Print.• r a ISRAEL GARCIA a°, - ISRAEL GARCIA * ``' Seal: * ``' Seal: _• i Notary Public-State _. *,E Notary Public-State of Florida =9; `o;S My Comm. of Florida My Comm.Expires Jul 17,2015 of F�,a�• Expires Jul 17,2015 '•.,�;;;°�` Commission# Commission#EE 77863 EE 77863 - - - --* * Pal I APPROVED BY Plans Examiner Zoning r Structural Review Clerk (Revised02/24/2014) CERTIFICATE OF-LIABILITY INSURANCE - 07/17/14 I III$C1 J21ICAT'@ IS ISSUED AS A MATTEROF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDEK THIS CeanETC�i E DOE6 NOT AFFIRMATN®.Y OR NEGATIVELY AMEND,E1(TEND OR AL.TM THE OOVERAGE AFFORDED BY THE POLLCIES HELOIN. T f S CER'11ACATE OF INZURAAICE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERM,AUTHORIZED REPRMNI ATIVE OR PRDMICEP,AND TW CERTIMATE HOLDER. IMPORTANT: Find,610-1 he"rffl=ta holder Is aQ ADtlr110NAL INGUFtM the pca�ies?pwiA bo anamraed, ff wjwt0m-uola'Is WAIVSA,suldeatto ;ha terms and Aatatam6eton this Celuftm a does not maserrights to the 0 at such endorsemeng4 PRODi1C�R F[tst Class ItLs AAaric� a (306)441-2997 9=6443. 001 NW 9th tree kfine�Boi�rn IWami.FL 331 tHeuRea AFPOROII�covewbe T Narc s PI1Gn9 CM30S 7.2997 Fex (3 .1.8443 I ATLANTIC INSURMCE COMPANY Iast>ID • -.1 ' w-** PROMWASIVE INSURANCE COMPANY CARIBE EWc uum CONTRACT01;$INC. I RER C: CASTLS PW INSURANCE COMPANY 2811NEST 27 IN HIAFAH,FL 33010 • I E tntsUtR F: COVEM09SI CERTIFICAT'E•NUMBEFC • REVIQON NLWBFR- TI115 JS TO C TIFYTHATTNE PCN aqa OF RANCE LJM: BELOW 11AvE'BFE+1 Is8ueD TO THE INSURED MANED ABOVE FORTH@ POLICY PERIOD INDICATEO, OTwnMTANDWGANY REQUIRdME NT•TERMOR OON0111ON OF ANY CONTRACT OR OTHER DOCLJII!!@14 T UVIIH�{E$p@CT TO WHICH THIS CEIifIFJCAT Y BE ISSUED OR MAY PHtTAtN.THE INSURANCEAWORDED BY THE POLICIES OESCR"O HgRJEN IS SUBJECT TO ALL THE Tq#IVIS, EXCLUMONS D CONDrrIONILOF SUCH?OLICIF�e.LIMITS SHOWN MAY HAVE MEN RECIUC90 BY PAID O AFA L R SbP�BURANGE POLICYlazis� PO CYJ�F PCIS F%P LINus EACH Dc=pMcE 100p,000,00 . 9 Corm uLO�itALLtnr.ILITY - s D g 100.000.QO A.' ❑ ❑ v kW ® °Gct N L039003246 Mw atP are p ' s 6.000.00 ❑ 07115/ 014 p7/15Iz07F PERSO A-aAa INJUW a 1,000,000.00 GMEPAL AGMQAA78 a 2 000,000.00 OFNLA G4iEL1110TMPLIEePE{� PRO -GDImP/OPA©a a 2,000,000.00 ❑POUG ❑ P ❑ LOC AIINMt) LfAelulY INeD91I�iLBIIMIT ❑ ANYA b air 1;000,0 .00 ED ScHnuLED 80D�Y IAfJURY(parpwsonl a 13 ❑ Wi NO 07351787 02/08/2014 OP10S/2015 B=LV IN.IIWP-1dwo 8. ❑❑ ISD uros ❑ nlrros P6 El ❑ UMOR LWg C7 OWAJR. a ❑1 EK LLU ms4wa Baca acculsnaBNCE s El DED AWUSATR' a LuumnY YIN ®WG ATU. t3 �pR IDMEyaSn�dR�eSt�'7y1 OF OPERATfCM18TJVfC.P7C- c FP�E 7477700 eLEeHACOt E370125!2013 10126214 f 6aov j, ELDISEASE,EAEMPLOYEJC_T1,0000q0.DD0M0..00.00 ' -T ILL DISFJIaF-POLICYLSdtF $ 1,0N.00&00 P'rION OF P6RA71ONS 1 LCCA-RQNs!VW CI.BS(pua�l AeoRQ 901,Adt�Tana[R+amalk8 8CH89uIB,IP mae tpara la ezgtq�pl ELECI'PLICAL NTRACT©R,,; CERTIFICATE 0LO8 k CANCELLAMON Miami Shires Village, Building' paltment' , SHOULD ANY OF THE ASOVE DESCRMIwD pOLICi+C B J3E CANCI:LI J B)^FORE 10050 IV 2nd-Ave -, ~ : " . •• THE DAWE wIDm 7mE PouATZ avti Bovis BE DELtVEM IN Miami Sh fes,FI 33138 . ��rra-t?ys• ACORD 25(20 0106)QF ►1868 2010 AODM CORPORATION. All rIM"ire{ The ACORD name end logo are MigQared marks of ACOM a a 'logo p.,.� Miami Shores Village %7*2!�Two& Building Department tOR10050 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 Mabe personally liable for the worker compensation injuries 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: I �`'L 9, Print Name: F_ 1 5�b o r r_ 15 L, 5 Signature: Signature: - State of Florida) State of Florida) County of Miami-Dade) County of Miami-Dade) Sworn to and subscribed before me this 8 Sworn to and subscribed before me this day of (4t IN day of j? Aft,20t r' ,111111 By p*��1,/�, L GARCIA By .r=o'a°gym •;C7- j=.I6A k r-GARCIA My Comm.Expires Jul 17,2015 '-'« •'° 17, (SE '��i�FOFFI�p� Commission#EE 77863 (SE AL) '-;91E o�O•'� MyCommissionr#EEes I77863015 Type Type o t f City of Hialeah . Business Tax Receipt 2014=15 p mayor Carlos Hernandez No: 238210-58 (OLD--1731-717) Amount: $ ISO.00 Tho porson,firm or corp.listed here has paid the business talc required to engage in or operate the business specified subject to the regulations and restrictions of the City of Maleeh,Florida ' Owner' BI.IGxO 0 FZGUE�tOA Type ojBusiness:Electrical Contractors and other Wiring :X"talizLtion Contractors CARIBE ELECTRICAL CONTRACTOR INC. 261 W '27 ST Business Location: HrnTMAX, , .FL 33010 261 W 27• ST Validating No.: 343259 Upires September 30,2015• 7VAS26SNOTA XEL a ,