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EL-15-1942 h� f Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-251374 Permit Number: EL-7-15-1942 Scheduled Inspection Date: January 22,2016 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: CEDENO,JOSE Work Classification: Alteration Job Address:157 NE 101 Street Miami Shores, FL Phone Number (857)998-0376 Parcel Number 1132060131951 Project: <NONE> Contractor: MAXIMO ELECTRIC Phone: (305)283-2418 Building Department Comments INSTALLATION OF A AHU AND CONDENSING UNIT 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 January 21,2016 For Inspections please call: (305)762-4949 Page 32 of 40 p �ad � 1;i. s Miami Shores Village � qR I K"i� ntisall ' M Miami Shores,FL 33138 0000 `c>r las air ri A t ration �a 10050 N.E.2nd Avenue NE Permit Phone: (305)795-2204 5tatrS APPI" R} „ 81131 '1l"i Expiration: 02/09/2016 Project Address Parcel Number Applicant 157 NE 101 Street 1132060131951 JOSE CEDENO �� Miami Shores, FL Block: Lot: Owner Information Address Phone Celt LJOSE CEDENO 157 NE 101 Street (857)998-0376 MIAMI SHORES FL 33138- 157 NE 101 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 1,800.00 MAXIMO ELECTRIC (305)283-2418 (305)238-3755 _..,..., _ _ _.... _....._,. Total Sq Feet: 00 Type of Work:INSTALLATION OF A AHU AND CONDENSIN Available Inspections: Additional Info: FInspectionScanning:3 Type: Classification:Residentialew Electrical Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 DBPR Fee Invoice# EL-7-15-56560 $2.25 08/13/2015 Credit Card $ 116.70 $50.00 DCA Fee $2.25 Education Surcharge $0.40 07/31/2015 Credit Card $50.00 $0.00 Permit Fee-Additions/Alterations $150.00 Scanning Fee $9.00 Technology Fee $1.60 Total: $166.70 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information ' d that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above- e c or to o the work stated. August 13, 2015 Authorized Signature:Owner / Applicant / ontrac or / Agent Date Building Department Copy August 13,2015 1 Miami Shores Village ep-mrD Building Department JUL 3 1.2015 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY: ') Tel: (305)795.2204 Fax: (305)756.8972 90 INSPECTION'S PHONE NUMBER: (305)762.4949 FBC 20 BUILDING Permit No4C//_'_ Z 9yF_ PERMIT APPLICATION Master Permit No. 464- -7- Permit Type: Electrical JOB ADDRESS: / S 7 /Ve57 /,0 5' V4 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Flood Zone: � d / OWNER:Name(Fee Simple Titleholder): �®�� 2 cz ea 6,? Phone#: (R,�- Address: 7 A/ City: 5-16-®eta S, State: ate/ Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: Phone#C�a 3,0 Address: 5 ee/ /4 �e-_7 City: ^ kir�c4e66--_ NOW State: Zip: f7 7 Qualifier Name:— .44&x®1!W 442,- 'fiate-1 Phone#: State Certification or Registration#: AeSc:f /3 0062r-019 Certificate of Competency#: Contact Phone#�� /9 Email Address: ��m DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$ /4 (R©®r e"P Square/Linear Footage of Work: Type of Work: ❑Address OAlteration ❑New ,N�,epair/Replace ❑Demolition Description of Work: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ I 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 ELECTRICAL WORK,PLUMBING, SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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 /'ll not be appr ved and a reinspection fee will be charged. SignatureSignature — 66 Owner or Agent Contractor The foregoing instrument was acknowledged before me this 31A4 The foregoing instrument was acknowledged before me this—Sltpp* day of ,20 !S.by' n s�_ 4 J E o f day of T,/se 20!, Y' —<A�IKIF A-- J !7 �z who is personally known to me or who has produced who is perso me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY P C: Sign: Sign: Print: PA Print: "�� BA-YMY 282 My Commission Ex �pMNi15SION#,,217282 My Co ission A EXPO Jlully 11,2019 EXPIRES:July il,2019 av, t-stl000l $:�g:gask sk sk:R sk�sRkkkksk+ksk ksIesk$c$:gs�sk k skde�a$$ea$$�e&aksic=k��ge sk�Sakskskskksk�kkk�k sksk sk$e g:$c$cgeskzk=kkHa:kBa$e$aok gtek�k'k�HeakI=$e$a$s�k k�sk H�$s$:ga$e��$e$c sg kk=k�9k� APPROVED BY k�-C/A Y/, Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) �sz Local Business Tax Receipt Miami-Dade County, State of Florida THIS IS NOTA BILL - DO NOT PAY \1LBT _j 5616744 eUSMESs NAMMOCATION RECEIPT NO. EXPIRES MA)(IMO ELECTRIC INc RENEWAL SEPTEMBER 30, 2015 16931 SW 141 CT 5858189 Must be displayed at place of business MIAMI R.33177 Pursuant to County Code Chapter BA—Art 9&10 OWNER SEC. D RECEIVE TYPE OF BUSINESS PAYMENT MAWO ELECTRIC INC 196 ELECTRICAL CONTRACTOR BY Tax RECE E Workers) 1 EC13005618 OR $75.00 07/28/2014 CHECK21-14-037041 This Local Business Tau Receipt only coal=payment of the Local Business Tau.The Receipt is ant a license. peMdL Or a CBIhBCatloa of the bohier s pWfficadens,to do bWnws.Holder mud Comply with any gagmamemal Of nvugavemmemBI regdetory laws and regairameats which apply to the business. The RECEIPT N0.above mare be displayed an all commercial vehicles—Nomi—Dade Code Sao Be-=. For mare iotarmation,visit www.adamidade giii taucollcator RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD , ZU EC13CON18 r The ELECTRICAL CONTRACTOR Named below IS CERTIFIEDa� Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 MARTIN, MAXIMO ERNESTO I. • MAXIMO ELECTRIC, INC 16931 SW 141 COURT 4. MIAMI fL 33177 ISSUED: 06/2?J2014 DISPLAY AS REQUIRED BY LAW SEa# L140622CM1607 IYY A CERTIFICATE OF LIABILITY INSURANCE DATE 07//3030//22015015 ) 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(les) 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). GONTAuT E David Gil,Sr. PRODUCER NAM Gil&Associates Insurance PHONE : (305 279-7665 FAX No): (305)279-9705 9485 S.w 72 St Suite A-120 ADDRESS: dgil@gilinsurance.com INSURERS AFFORDING COVERAGE NAIL# Miami FL 33173 INSURER A: AMTRUST INSURANCE INSURED INSURER B: Maximo Electric Inc INSURER C: 16931 SW 141 Ct INSURER D: INSURER E: Miami FL 33177- 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 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 OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD MM/DD X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO-RENTED 1 OO,000 CLAIMS-MADE 1-1OCCURPREMISES Es occurrence $ MED EXP one person $ 5,000 A WPP1389385 07/29/2015 07/29/2016 PERSONAL BADV INJURY $ 1,000,000 GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY D JECT F LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: COMBINED ING LIMIT $ AUTOMOBILE LIABILITY Ea accident BODILY INJURY(Per person) $ ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS -PROPERTY DAMAGE NON-OWNED (per HIRED AUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ WORKERS COMPENSATION ST TUTE ERH AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N 1 A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space to required) LICENSE#EC13005618 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Vilias Building Department AUTHORIZED REPRESENTATIVE 10050 NE 2nd Avenue Miami Shores FL 33138 ► _ --- ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD >n JEFF ATWATER C18EF F04RNCIAL OFMAR STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION •"CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW• CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 6112015 EXPIRATION DATE: 5/31!2017 PERSON: MARTIN MAXIMO FEIN: 201480521 BUSINESS NAME AND ADDRESS: MAXIMO ELECTRIC INC 16931 SW 141 CT MIAMI FL 33177 SCOPES OF BUSINESS OR TRADE: LICENSED ELECTRICAL CONTRACTOR Pursuard to chapter 440.05(14).F.S.,an officer of a corporawn who elects exemplim hon Oft chapter by OW a cartMcate of election wWer this section RW trot recever bet or car► mh w"W Oft cfmpter.Print to Chapter 440.05(12),F.S..Ceritikates of election to be exempt..apply ordy wmm the scope of the business or trade Isted on the notice of election to be exempt.Pursuant to Chapter 440.05(13),F.S..Notices of election to be exempt and motes of ekaw to be exempt shag be mitred to nerocatim if,at any time after the filing of the nauce or the Issuance of the cer ficeK the persmr named on the nctNe or a no longer meets the re*dmff rds of this section for iawmrxw ora ate.The deparb wd shat revoke a e at DFS-F24)WC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)4134809 MAXIMO ELECTRIC, INC 0 ELECTRICAL CONTRACTOR STATE CERTIFIED EC13005618 7/30/15 State of Florida Country of Miami Dade Before me this day personally appeared Maximo Martin who,, being duly sworn, deposes and says: That he will be the only person working on the project located at : 157 NE 101 St. Sworn to (or afftr9edand scribed before me this 3 / day of � 20 by Personally know Or Produced Identification Type of Identification Produced ""!. ELVIS BAYONA My°!y�'s�►'�b 17282 EXP1R&SSJ*11 ION it 219 wa Print, ype or Stamp Name Notary . t►♦ REeggs S tr aloof" Miami shores Village 'h -" Building Department � RipA 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: j Owner State of Florida County of Miami-Dade 1;-ByThe foregoing was acknowledge before me this _7/ day of r7�1 cr ,20 /1;- By L- - p � E�- O who is versonall�to me or has produced as identification. Notary: SEAL: RIMAMA ELVIS BAYONA My COMMISSION#FF217282 EXPIRES:July 11,2019