Loading...
EL-15-1792 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-247472 Permit Number: EL-7-15-1792 Scheduled Inspection Date: November 10, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: INVESTMENTS, INC, LUCKY 13 HOME Work Classification: Alteration Job Address:3 NE 110 Street Miami Shores, FL 33161-7043 Phone Number (305)219-8267 Parcel Number 1121360040310 Project: <NONE> Contractor: RAY WILLIAM ELECTRIC , INC Phone: (305)582-6142 Building Department Comments ELECTRICAL WORK AS PER PLANS FOR INTERIOR Infractio Passed Comments RENOVATION INSPECTOR COMMENTS False Inspector Comments Passed --� - Failed Correction ❑ Needed Re-Inspection a Fee No Additional Inspections can be scheduled until re-inspection fee is paid. November 09, 2015 For Inspections please call: (305)762-4949 Page 40 of 43 Miami Shores Village 10050 N.E.2nd Avenue NE k may' � i Miami Shores,FL 33138-0000 y " Phone: (305)795-2204 k Expiration: 02/17/2016 Project Address Parcel Number Applicant 3 NE 110 Street 1121360040310 LUCKY 13 HOME INVESTMENTS Miami Shores, FL 33161-7043 Block: Lot: Owner Information Address Phone Cell LUCKY 13 HOME INVESTMENTS, INC 8004 NW 154 Street (305)219-8267 MIAMI LAKES FL 33016- 8004 NW 154 Street MIAMI LAKES FL 33016- Contractor(s) Phone Cell Phone Valuation: $ 2,000.00 RAY WILLIAM ELECTRIC, INC (305)582-6142 ... .. .._.»,,,.,,. .. Total Sq Feet: 0 Type of Work:ELECTRICAL WORK AS PER PLANS FOR IN Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning: 1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 Invoice# EL-7-15-56379 DBPR Fee $3.38 08/21/2015 Check#: 1517 $ 187.96 $50.00 DCA Fee $3.38 Education Surcharge $0.40 07/17/2015 Cash $50.00 $0.00 Permit Fee-Additions/Alterations $225.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $237.96 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 foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above- ed contra t r to do the w Lk stated. C August 21, 2015 Authorized Signature:Owner / Applicant / Contractor Agentv Uate Building Department Copy August 21,2015 1 Miami Shores Village w° Building Department JUL 17 2015 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 I BUILDING Master Permit No. 1z1_( 13 PERMIT APPLICATION Sub Permit No. a� 17992 BUILDING EfELECTRIC ❑ ROOFING ❑ REVISION EXTENSION RENEWAL ❑PLUMBING ❑ MECHANICAL [—]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: �� N E_ 110+"" -,-3- . City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type:Gi 0(_K. Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): X7'n%4es t-rneMAhone#: Address: a&)4 N i 5`f th s 1- city: r)�O&nS L a%<es State: FY-- zip: 330 / Tenant/Lessee Name: Phone#: Email: �7 CONTRACTOR:Company Name: i` `1 w: ti + cA rn s =v, C Phone#: -30S' - 6 V Z Address: 497 C> 5 . Chi U C City: `-h>o V t C_ State: FL Zip: 33,33 Q Qualifier Name: 4 S Phone#: State Certification or Registration#: E C> I-&00-Z 4) Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 'a000 ' Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: Qi I PA e,-.+tL'c c C DP-^r k S Specify color of color thru tile. .s o� � o Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ q TOTAL FEE NOW DUE$ I Q374 . C?� (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 V� c�'L. Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of `I(p 20 %,S by -T-0- day of 20 5� by -, _ C In Gird E 'f pr'C. ,who is rsonally known t�t C✓ l S � ho' ersonally know o 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: V1. 6��q `JU9) Sign: Print: � ✓� y �L J Y1�1_C f'�(� Print: Sa-t,-Lq4/- e- Seal: - - Seal: SANDY ROMERO SANDY ROMERO E s Notary Public-State of Florida "' 1 ! Natary Public -State of FloridaMy Comm. Expires Jul 26, 2015 = TM� �= M�Comm E��i�es �� Mmission # EE 116040 APPROVED BY T�0,1%,L r XA Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) SNORES Lf! t 9 p,,, ,,,,,l" Miami shores Village L2 •��� Building Department ORlDp' 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 CONTENTS. Signature f\ C.��. Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of 2015 . By J"a 2J fte(/ YL_- who is pe onally known a or has produced as identification. Notary: w"AH (Ze)'� SEAL: SANDYROMERO Notary public.State o :.' My Cumm. Expires Jul 26,2015 ;;;;;•`' Commission#E E 116040 r ' 166.CCERTIFICATE OF LIABILITY INSURANCEFt D8/1/9//1515 8/1 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(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 NACOME:NTACT Gregg Ditzian Get Smart Insurance Inc. PHONE Etl: (305)653-7977 ac No): (305)654-0293 20286 N W 2 AveE-MAILADDRESSO info@insure-smart.com Miami,FL 33169 INSURERS AFFORDING COVERAGE NAIC# Phone (305)653-7977 Fax (305)654-0293 INSURER A: Accident Insurance Company INSURED INSURER B Ray E Williams Inc License#EC13002989 INSURER C: Commerce&Industry Insuramce Company 4820 SW 134 Ave INSURER D: Amtrust Insurance Davie,FL 33330 (305)582-6142 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 CONTRACTOR 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 TYPE OF INSURANCE ADD UBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM DD MM DD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 AMAGE TO RENTED 0 COMMERCIAL GENERAL LIABILITY PREM SES(Ea occurrence) $ 100,000.00 ❑ F-] CLAIMS-MADER] OCCUR CPP0009523 03 MED EXP(Any one person $ 5,000.00 A 171Y Y 08/08/2015 08/08/2016 PERSONAL&ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000.00 ❑ POLICY © PRO ❑ LOC BI/PD Deductible $ 500.00 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ❑ ANY AUTO BODILY INJURY(Per person) $ ❑ ❑ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident, $ F—] HIRED AUTOS ❑ NON-OWNED PROPERTY accidentDAMAGE $ AUTOS Per ❑ ❑ $ ❑ UMBRELLA LIAB ©OCCUR EACH OCCURRENCE $ .5,000,000.00 �/ EXCESS LIEBU012853642 C CSAB CLAIMS-MADE Y Y 08/08/2015 08/08/2016 AGGREGATE $ 5,000,000.00 ❑ DED ❑ RETENTION $ WORKERS COMPENSATION ©WC STATU- ©OTH- AND EMPLOYERS'LIABILITY Y/NTORY ER ANY PROPRIETOR/PARTNER/EXECUTIVE AWC1045659 E.L.EACH ACCIDENT $ 1,000,000.00 D OFFICER/MEMBER EXCLUDED? N/A Y 03/16/2015 03/16/2016 (Mandatory in NH) Y E.L.DISEASE-EA EMPLOYE $ 1,000,000-00 f yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMITI $ 1,000,000-00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Miami Shores THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2nd AVE. ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village,FL 33138 AUTHORIZED REPRESENTATIVE 5 t, e itzi a1.^I 069230; ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05)OF The ACORD name and logo are registered marks of ACORD