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EL-15-1982 7-C 5 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-240841 Permit Number: EL-8-15-1982 Scheduled Inspection Date: October 22, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: CAMPOS, EVELYN Work Classification: Addition/Alteration Job Address:5 NE 96 Street Miami Shores, FL 33138- Phone Number (786)457-1325 Parcel Number 1132060130820 Project: <NONE> Contractor: UNLIMITED ELECTRICAL SOLUTIONS LLC Phone: (786)554-3269 Building Department Comments ELECTRICAL WORK FOR KITCHEN RENOVATION Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed IF YOU CAN LET IT FOR THE LAST INSPECTION OF THE DAY. EVELYN (786)457-1325 Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. October 21, 2015 For Inspections please call: (305)762-4949 Page 8 of 55 Miami Shores Village � "Ye I3 I & + � 10050 N.E.2nd Avenue NE \ of }� 7rT�� . Ill�t�tt On ' Miami Shores,FL 33138-0000 \ \ , `4 Phone: (305)795-2204 � ���� � Expiration:03/01/201 Project Address Parcel Number Applicant 5 NE 96 Street 1132060130820 Miami Shores, FL 33138- Block: Lot: EVELYN CAMPOS Owner Information Address Phone Cell f EVELYN CAMPOS 5 NE 96 Street (786)457-1325 MIAMI SHORES FL 33138-2723 Contractor(s) Phone Cell Phone Valuation: $ 150.00 UNLIMITED ELECTRICAL SOLUTION (786)554-3269 Total Scl Feet. 0 Type of Work:ELECTRICAL WORK FOR KITCHEN RENOVAT Available Inspections: Additional Info: Inspection Type: Classification:Residential Final Scanning:3 Meter Box Alteration Relocation Fire Alarm Service Change Review Electrical Underground W.W. Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# EL-8-15-56630 DBPR Fee $225 09/03/2015 Credit Card $ 115.10 $50.00 DCA Fee $2.25 Education Surcharge $0.20 08/07/2015 Check#:4601 $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,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 constru er re, I authorize the amed contractor to do the work stated. September 03, 2015 Authorized Signatu e:Owner Applicant / Contractor / Agent ate Building Department Copy September 03,2015 1 Miami Shores Village Building Department AUG Q ' 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305)795-2204 Fax: (305)756-8972 ��r INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 BUILDING Master Permit Noe` -SI-1.5196s PERMIT APPLICATION Sub Permit No. l.� �- � 1 Z— ❑BUILDING dELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑ CANCELLATION ❑ SHOP //��// �^ CONTRACTOR DRAWINGS JOB ADDRESS: 15—/V 4- 49& .�f/"GG74' City: Miami Shores County: Miami Dade Zip: 3_313r Folio/Parcel#: J I Z0(o —©1 3"C)3e2a Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): "IQ (?�+�-yrryoS Phone#: VP-44 S-7 -t 3 2S Address:4; N F-1 q CG City: w layyI i SHO--c% State: c_.. Zip: Tenant/Lessee Name:N//�A t...,.,, Phone#: Email: yylL T1 iq' iqO' ha t�+cCt I . CO1n CONTRACTOR:Company Name: CAOA- 9 y �J- 14 Phone#: Y"�674T y '.3-;6 fes'' Address: ?N�&1/ it!`t/ l�d�d rte• City: h�z- State: Zip: Qualifier Name: .S'iss.s•►� �.�Z- Phone#: 'peja r• -4-216 .7 State Certification or Registration#: Certificate of Competency#: 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 Pq Repair/Replace ❑ Demolition Description of Works-01,0 y6X- S re:T! L� tsl Com, K! 7Z-W_-&Q _8,AXI &PLA S H 77-4 (= C.T(�•G LR.O c.�.` ,�.: D Slti�t TG °R E c r6v,gs' ,. ,v.� �1�c .'« .t^faFt e is"7 Specify co ile: A �x " ,nr 1 Submittal Fee$ o,U` Permit Fee$ C '"` C, , Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ l TOTAL FEE NOW DUE$ A (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 r. 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. 1 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. Signat re _ Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20 /.r by day of^ ��9"� 20 1J' by f t,�.l CJEi+ who is personally known to 1L+ �WCA1A0Z who is personally known to me or who has produced �L �.' /L"�/^l►/-�i � 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: Print: qfe of Florid = CaaM.Fat ► Seal: NoWy Paf►Ec-7Av"l Seal: commission de FF OIM�luea Mf►Col0a.ExFin ,� dComminion 6 6flooded Tb uP NNihpn. ************** * * * ********************************************************************** APPROVED BY / 5� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ♦SNoREs 7- .•• (� .....M Miami shores Village rEs Building Department 'LORIDp'` 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRA TOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. OPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. t COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSU CE* (Workers Compensation EXEMPTION must h ve NOTICE TO OWNER f m and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF NCY: 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: �� ��I7% C�' � /v7�' s L G C BUSINESS ADDRESS: �6 Q/ /y c� /J�k e/o_CITY i STATE I2 ZIP 3261-1— BUSINESS 261S'BUSINESS PHONE: -3-6 f FAX NUMBER(—3 CELL PHONE ( ) a 7 QUALIFIER'S NAME: Vsi'--17 QUALIFIER'S LIC NUMBER: <'�''� �' � -Ooo / ..� STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION g. ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395 f � ..r 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 SUAREZ, OSMANY UNLIMITED ELECTRICAL SOLUTIONS LLC 7601 NW 182ND TERRACE HIALEAH FL 33015 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, a '. 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 EC13004141 ISSUED: 07/24/2014 serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information CERTIFIED ELECTRICAL CONTRACTOR about our divisions and the regulations that impact you, subscribe SUAREZ, OSMANY to department newsletters and learn more about the Department's UNLIMITED ELECTRICAL SOLUTIONS LLC initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, IS CERTIFIED under the provisions of Ch 489 FS. and congratulations on your new license! Exaratcndate a,uc31 2C1e u407,240001e85 DETACH HERE RICK SCOTT; GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD 'r EC13004141 , The ELECTRICAL CONTRACTOR » Named below IS CERTIFIED' Under the provisions of Chapter 489 FS. Expiration dater AUG 31, 2016 • %Lei 0 SUAREZ, OSMANY �= " UNLIMITED ELECTRICAL SOLUTIONS LLC 7601 NW 182 TERRACE HIALEAH FL 33015 r ISSUED: 07/24/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1407240001885 )06026 Local Business Tax Receipt Miami-Dade County, State of Florida —THIS IS NOTA BILL — DO NOT PAY 6428346 toTl BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES UNLIMITED ELECTRICAL SOLUTIONS LLC RENEWAL SEPTEMBER 3v0, 2015 7601 NW 182 TERR 6696596 Must be displayed at place of business MIAMI FL 33015 Pursuant to County Code Chapter 8A—Art.9&10 OWNER SEC.TYPE OF BUSINESS UNLIMITED ELECTRICAL SOLUTIONS 196 ELECTRICAL CONTRACTOR PAYMENT RECEIVED EC13004141 BY TAX COLLECTOR Worker(s) t $75.00 08/11/2014 CHECK21-14-047847 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, permit,or a certification of the holders qualifications,to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles—Miami—Dade Code Sec 8a-276. For more information,visit www miamidadq go Agxcollector To: Page 1 of 1 2015-08-06 15:11:41 (GMT) efax From: Domingo Cano .mac >rr CERTIFICATE OF LIABILITY INSURANCE DATE 08/06/15` NY' PRODUCER Amtrust Insurance Group THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 8100 SW 81 Drive,Ste 280 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Miami,FL 33143 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone (305)275-0810 Fax (305)275-0890 INSURERS AFFORDING COVERAGE NAIC# INSURED Unlimited Electrical Solution, Llc. INSURERA: Granada Insurance Company 8+4 7601 NW 182 Terrace INSURER 13: INSURER C: Hialeah, FL 33015- 1 Fax:305-698-6877 I INSURER D: INSURER E: COVERAGES . ._ .... .....1 111. ........... .._ ... .1 ....111................................................ ........................................................... .. 111.1........ - ........_._--------.. ........_ .....1..11 - 111 1 1111.. . .. ..............._.. _. 1111... THE POLICIES OF INSURANCE LISTED 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 15 SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AD RD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE �POLICV€XPlRAT(ON DATE MMfDDlYYYY-DATE MMIDD1YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE 1,000,000 ©COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED "'_...._..... _,. 0185FL00012219 12/06/2014 12/06/2015 PREMISES Ea occurrence 100,000 A ❑ El CLAIMS MADE 0 OCCUR MED EXP(Any one person) 5,000 Contractual Liability PERSONAL&ADV INJURY 1,000,000 .........................................................................1111................. Q Broad Form PD i GENERAL AGGREGATE 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP{OP AGG 2,000,000 Q POLICY ❑PROJECT ❑ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ❑ ANY AUTO 0185FL00012219 12/06/2014 12/16/2015 (Ea accident) 1,000,000 ❑ ALL OWNED AUTOS A ❑ ❑ SCHEDULED AUTOS BODILY INJURY © HIRED AUTOS (Per person) Q NON OWNED AUTOS BODILY INJURY(Per accident) © Primary and............................... ........ .i Non-Contributo r y PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT ❑ ANY AUTO i OTHER TITAN _FA ACC_ AUTO ONLY: _............... -1111-. AGG EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE. .........._.............................._................-............... .._...- ---- ❑ ❑ OCCUR ❑ CLAIMS MADE I AGGREGATE ❑ DEDUCTIBLE ❑ RETENTION $ WORKERS COMPENSATIONA111... ......... 1 . . .. _........... 11.11 .......... EMPLOYERS'LIABILITY Y{N ❑TORY LIME S E] OERH ANY PROPRIETOR t PARTNER 1 EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.EACH ACCIDENT (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE If es,describe under SPECIAL PROVISIONS below E.I....DISEASE-POLICY LIMIT OTHER _....... _................................_-.._..........-_.. ................._.._.................................._...-...._............................................................ ...._.....-.......... - .............._...._....._...._...._......-...__....................._....... __......................_.__...._.__...._...................................__�_... DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES t EXCLUSIONS ADDED BY ENDORSEMENT i SPECIAL PROVISIONS Electrical work CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL Miami Shores Village Building Department _30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO 10050 NE 2nd Ave THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY Miami Shores, FL 33138 OF ANY KIND UPON. .. THE INSURER,ITS AGENTS OR REPRESENTATIVES. --.._..._................._........._...... _.__.......... ...................._..__.........._...-11.11... AUTHORIZED REPRESENTATIVE Fax 305-756-8972 ACORD 25(2009101)GIF ©1988-2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD PLEASE CUTOUT B N OU CARD BELOW AND RETAIN FOR FUTURE REFERENCE IMPORTANT STATE OF FLORIDA '� Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation DEPARTMENT OF FINANCIAL SERVICES ' who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or DIVISION OF WORKERS'COMPENSATION OF compensation under this chapter. CONSTRUCTION INDUSTRY EXEMPTION CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA L Pursuant to Chapter 440.05(12),F.S.,Certificates of election to WORKERS'COMPENSATION LAW D be exempt...apply only within the scope of the business or trade EFFECTIVE DATE: 2!512015 EXPIRATION DATE: 214,2017 listed on the notice of election to be exempt. PERSON: SUAREZ OSMANY f'I Pursuant to Chapter 440.05(13),F.S..Notices of election to be FEIN: 262558375 E exempt and certificates of election to be exempt shat{be BUSINESS NAME AND ADDRESS: R subject to revocation if,at any time after the filing of the notice UNLIMITED ELECTRICAL SOLUTIONS LLC E 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 7601 NW 182ND TERRACE a certificate at any time for failure of the person named on the HIALEAH FL 33015 certificate to meet the requirements of this section. SCOPES OF BUSINESS OR TRA ELECTRIC LIGHT OR POWER LINE C DFS-F2-DWG-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 UNLIMITED ELECTRICAL SOLUTIONS, LLC 7601 NW 182ND TERRACE HIALEAH, FL 33015 State Lic#EC 13004141 State of Florida County of Miami Dade Before me this day personally appeared who, being duly sworn,deposes and says: That he wiil bethe only person working on the project located at:5 NE 96 ST Miami Shores, FL 33138 Sworn to(or affirmed )and subscribed before me this 0 dayof , 2015. by erso�know OR Produced Identification Type of Identification Produced r,, MyC ubl ,St 11�ARFI Thraoff o�2p1� Print,Type or Stam v9bpatN�Fay�a # \ 1 � . \ y� r �»» � ♦S�uREs Gr t� .,, ,,,,, Miami shores Village ��� Building Department I�LOR' 1DA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation Insurance Exemption ;f 3 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. Signa Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of 1---Y/ 20 By re1W -7 C r�r/JoS who is personally known to me or as produced 104- JZ Jida ification. •�..���...,, BINO ,•r"'' �e'� 'FNotary: N Pu055iw sem, o: Commission #FF 01SEAL: ' ;oc d•'� Bonded Through National Not