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EL-15-2886 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-249143 Permit Number: EL-11-15-2886 Scheduled Inspection Date: December 11,2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: LANSER, CHRISTIAN Work Classification: Alteration Job Address:175 NW 100 Street Miami Shores, FL 33138- Phone Number (305)772-4313 Parcel Number 1131010230320 Project: <NONE> Contractor: APA ELECTRIC INC Phone: (305)225-8964 Building Department Comments MOVE ELECTRICAL INSTALLATION OF A/C. Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed Re-inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. December 10,2015 For Inspections please call: (305)762-4949 Page 42 of 42 I Miami Shores Village ! NOV OV 2015 Y BuildingDepartment 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 j INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20H BUILDING Master Permit Nou(°��' DSgc: ' PERMI it APPLICATION Sub Permit No;t�L , — ❑BUILDING .4, LECTRIC ❑ ROOFING ❑ REVISION EXTENSION ❑RENEWAL ❑PLUMBING ! ❑ MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS:_� "�j iy'4) too S�l City: Mia(ni Shores County: Miami Dade Zip: 3315' Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: �L OWNER: Name(Fee S*mple Titleholder): 1 �5� — Phone#: � J7 ( Address: t o o �l(fi City: ( �v 1�.c� State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Compan Name: �� fEL6�zr ers L Phone#: ,�OS'3®Z -S7�, Address: `�P S �� y Z 4 N City: t Al% State: )'"''L Zip: Qualifier Name: VP fec'gV a. Phone#: State Certification or Registra ion#: Certificate of Competency#: DESIGNER:Architect/Engineer:% Phone#: Address: Nk City: State: Zip: Value of Work for this Permit:$ �9e Square/Linear Footage of Work: Type of Work: ❑ Addition ® ,Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: M o u 1- ` f'O U o Specify colorr�of color thru tile: Submittal Fee${L_AJ l„�-_j Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ " _ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address City i State Zip Mortgage Lender's Name(if applicable) i 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 o.-installation has commenced prior to te issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jur sdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBWIG, 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 �:ompliance with all applicable laws regulating construction and zoning. {! I "WARNING TOOWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. i IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BE F ORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As P condition to the issuance of a building permit with an estimated value exceeding$25, 0, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be slivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must a posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of uch posted notice, the inspection will not be approved and a reinspection fee will be charged. Signatu L2 Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of �p1®_y�t -�- ,20 15 by day of 1/ 20 I , by 2l Sm(-'�1,3 9--- ,0w'-ho is personally known to �C � °!�Jt�`1S REA s personally known to me or who has produced ��, � ucje t "mss me or who has produced Tk-M � I��s identification and who did take an oath. identification and whVdid take an oath. NOTARY PUBLIC: NOTARY PUBLI Sign: Sign: ` r Print: Ce:�.t E Print: Seal: Seal: tvR�Zvi Notary Public State of Florida °vat Notary Public State of Florida Sindia Alvarez Sindla Alvarez My Commission FF 156750 My Commission FF 156750 dAOf�o�� Expires 09/03/2018 Expires 09/03/2018 APPROVED BY � Plan Examiner Zoning d ?ructural Review Clerk (Revised02/24/2014) Miami Shores Village Permit_ R i�ttt( 1 10050 N.E.2nd Avenue NW IM rk Oessift (teatio11 o Miami Shores,FL 33138-0000 Phone: (305)795 2204 1per�f-5ltattt�APPI �lORtvp' r 01 =11121 Expiration: 05/18/201 Project Address Parcel Number Applicant Ll5 NW 100 Street 1131010230320 CHRISTIAN LANSER ami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell CHRISTIAN LANSER 175 NW 100 Street (305)772-4313 MIAMI SHORES FL 33150- 175 NW 100 Street MIAMI SHORES FL 33150- Contractor(s) Phone Cell Phone Valuation: $ 600.00 APA ELECTRIC INC (305)225-8964 (786)256-9093 Total Sq Feet: Type of Work:MOVE ELECTRICAL INSTALLATION OF A/C Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning:1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 DBPR Fee Invoice# EL-11-15-57770 $2.00 11/16/2015 Credit Card $50.00 $58.60 DCA Fee $2.00 Education Surcharge $0.20 11/20/2015 Credit Card $58.60 $0.00 Permit Fee-Additions/Alterations $100.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $108.60 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 AFFI edify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constructio oning. Futherm I authorize the above-named contractor to do the work stated. November 20, 2015 thoriz Ignat . wrier / Applicant / Contractor / Agent Date Buildi epartment Copy November 20,2015 1 2016 details - Business Tax Account APA ELECTRIC INC - TaxSys - Miami-Dade Cou... Page 1 of l miamidade.Go` Tax Collector Home Search Reports Shopping Cart Please do not include any special characters in the name,address,and e-mail field such as#,&,hyphens,comma; dashes. We have moved.Our neve address is: i 200 NW 2nd Ave,Miami,FL 33128 i The information contained herein does not constitute a title search or property ownership. 2015 Tax Bills are Payable on Sunday,November 1,2015. ' INC Business Tax Account#5795662 Account details Account history :F_[_ 2016 201.5 ..... - 20.1.4........_..... ..3._... ,.. _........._ 2010 PAID PAID PAID PAID PAID Account number: 5795662 Owner(s): APA ELECTRIC INC Business start date: 05/01/2006 16531 SW 52 LN Business address: APA ELECTRIC INC MIAMI, FL 33185 16531 SW 52 LA Mailing address: APA ELECTRIC INC MIAMI,FL 33185 ROQUE JORGE D Physical business location: UNIN DADE COUNTY 16531 SW 52 LN MIAMI, FL 33185 Flags: Home Business Print account application {PDF} Receipts And Occupations. Receipt 0043210 PAID 2015-07-27$75.00 Contracting 10/01/2015 NAICS code: Receipt#CREDITCARD-15-038468 <.s'Print ELECTRICAL —09/30/2016 23821 this bill CONTRACTOR Units: 1 Documentation Required by Occupation: State/County License or Certificate Document Received: EC13005806 https://www.miamidade.county-taxes.com/public/business tax/accounts/5795662 11/16/2015 APA ELECTRIC INC Date: ` I , �J 2jo I� State of County of 1- Before me this day personally appeared.l'O�R-1) J�-Ivs �00 h, being duly sworn,deposes and says: That he or she will be the only person working on the project located at: Sworn to(or affirmed)and subscribed before me this KO day of 1 "C� . 20-Lb by Personally know OR Produced Identification T4 n 73-39 Type of Identification Produced l- s°4oAY pue� Nota'y Public State oP Florida Sindia Alvarez My commission FF 156750 ��kcQ Expires 09/03/2018 Print,Type or Stamp Name of Notary S�oR�s 6 ' Miami shores Village - �� Building Department RN 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: (�a caner State of Florida County of Miami-Dade The foregoing was acknowledge before me this I day of W°kSAEMq� ,20 15 . By N7EJ sT l()a �\• LX4\F_� who is personally known to me or has produced as identification. Notary: SEAL: ogo Pue4 Notary r'ublic State of Florida r Sindia At o My Commission FF 156750 o�� Expires 0970312018 .Nov. 16. 2015 10: 13AM No, 8271 P. 1 DATE"I'm CERTIFICATE OF LIABILITY INSURANCE THIS CERTIEICArE 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 Certineats holder i$an ADDITIONAL INSURED,the poltcy(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 YANET PAORON Almay Insurance Services,Inc. pyp qty: (305)633-3781 30 AIS FAX No; ( 5)fi 3-0926 2331 N.W. 31th Ave. $S: yanetpadronol®aol.com PhoneMiami,FL 305) :" INSURE S AFFORpIN©COVERAGE V NAIL 9 INSURE (305)633-3781 Fax (305)633.0926 INSURER A! ASCENDANT UNDERWRITERS LLC INSURED- -!— ,. INSURER B- APA Electric Inc — INSURER C. : '• _ 16531 SW 52 Lane INSURER D;. miaml,FL 33185- (305)225-8964 INSURER E! •• _ - COVERAGES INSURER F: CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTE=D 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 017 SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR T ADD L4UBR TYPE OF INSURANCE POLICY EFF POLICY EXP 1, POLICY NUMBER AIM/ppp LIMITS GENERAL W18ILITY -- Q COMMERCIAL GENERAL LIABILITY AMAGEACH CCURRpE 1,000,000.00 ED ❑ ❑ CLAIMS-MADE ® OCCUR ER15MISES We Occurrence -L-100,000.00 -_ A ❑ Y GL-36168 10/05/2015 10/05/2016 MED EXP(Any one arson) $ 5,000.00 PERSONAL&ADV INJURY S 1,000,000.00 ❑ - GENERALAGGREGATE $ 1,000,000,00 061ft AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 1,000,000.00 El POLI ❑ PRO• Ll LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ❑ ANLL YAUTO OWNED SCHEDULED BODILY INJURY(Per par5an) S AUTOS ❑ AUTOS ' HIRED AUTOS NON-OWNED BODILY INJURY(Per accltlen $ ❑ „• ❑ AUTOS '•i. POPE DAMAGE $ _ $ ❑❑ UMBRELLA LIAR ❑OCCUR -- EACH OCCURRENCE $EXCESS LIAB ❑CLAIMS-MADE i. AGGREGATE S DED RETIiNTIONS _ - WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY ❑TO Y LIIM- ❑OTH- ANY PROPRIETORlPARTNERlEXECUTIVE YIN - OFFICERIMEMBER EXCLUDED? ❑ N/A E.L.EACH ACCIDENT S (Mandatory in NH) ll'yes,describe"' E.L.DISEASE-EA EMPLOYel $ DESCRIPTION OF OPERATIONS be - E.L.DISEASE-POLICY LIMIT $ ^ DESCRIPTION OF OPERAT[CNS!LOCATIONS f VEHICLE$(Atrach ACORD 107,AdtliUoneI Remarks Schadul%If more space is required) ELECTRICAL WORKS LICENSE:F-C13005806 it CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE OVEIES BE MIAMI SHORES VILLAGE BLDG DEPT THE EXPIRATION DATEETTHEREO S 1 I EPO L BE DELIVERED NEO BEFORE 10050 NE 2 AVE ACCORDANCE WITH TH P OVI SL MIAMISHORES,FL 33138 AUTy0Al2Ep REPRE TATIVE - --' ACORD 25(2010/05)QF - 7 ACORD CORPORATION. All rights reserved. The ACO D name and logo are registered marks of ACORD