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ELC-15-2849 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-247570 PermitNumber: ELC-11-15-2849 Scheduled Inspection Date: December 22,2015 Permit Type: Electrical- Commercial Inspector: Devaney, Michael Inspection Type: Final Owner: , Work Classification: Repair Job Address:10500 BISCAYNE Boulevard Miami Shores,FL 33138- Phone Number Parcel Number 1122300010500 Project: <NONE> Contractor: ADAN ELECTRICAL SERVICES LLC Phone: (786)285-3847 Building Department Comments 25 AMP WATER HEATER REWIRING Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed E2/ Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid December 21,2015 For Inspections please call: (305)762-4949 Page 13 of 33 r. , P�rI i .�L -' ' "$48491-1 Miami Shores Village P@ 6, cal tnmetelat 10050 N.E.2nd Avenue warkiassrtfi� ll'= Miami Shores,FL 33138 0000 hFAe Phone: (305)795-2204 u E Ptr .St#Iw.APllG Expiration: 06/08/2016 Project Address Parcel Number Applicant 10500 BISCAYNE Boulevard 1122300010500 Miami Shores, FL 33138- Block: Lot: ICUC HOLDINGS INC Owner Information Address Phone Cell ICUC HOLDINGS INC 10500 BISCAYNE Boulevard MIAMI SHORES FL 33138- 3009 N MAIN Street SANTA ANA CA 92705- Contractor(s) Phone Cell Phone Valuation: $ 500.00 ADAN ELECTRICAL SERVICES LLC (786)285-3847 Total Sq Feet: p _...... .... ..._r _,.., i'. Type of Work:25 AMP WATER HEATER REWIRING Available Inspections: Additional Info: Inspection Type: Classification:Residential Final Scanning:3 Review Electrical Review Electrical Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# ELC-11-15-57725 DBPR Fee $2.00 11/10/2015 Check#:1485 $50.00 $58.60 DCA Fee $2.00 Education Surcharge $0.20 12/11/2015 Check#: 1499 $58.60 $0.00 Permit Fee $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 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-named contractor to do the work stated. December 11,2015 Authorized Si ure:Owner / Applicant / Contractor / Agent Date Building Department Copy December 11,2015 1 VI��l� ,,�� Miami Shores Village Building Department NOV i 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 l 9 BUILDING Master Permit No. RlC-I PERMIT APPLICATION Sub Permit No. ❑BUILDING ] ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [—]RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS 0 JOB ADDRESS: C Aj o r City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction.Type: Flood Zone: BFE: FFE: OWNER:N2me(Fee Simple Titleholder): t l�S% (,�s�h r Phone#: 50S - g Q�7' ??--111 Address: 10(;M �J�5 �9/� �Jl✓G✓J 51 C r r/ City: o iAm i SN Qf 'S State: �� Zip: X 31 J7 t� Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: r� r 7^/l` So k c-,r er N Phone#: 136 a 2 6 y� Address: 7 6 ri City: ff�� State: �� Zip: L3"�C) �- S Qualifier Name: ® /G o� X® 4 yr Phone#: f,16� State Certification or Registration#: _Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 6 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New P Repair/Replace ❑ Demolition Description of Work: s� Specify color of color thru tile: Submittal Fee$ Permit Fee$ P®kp 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 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 ch posted notice, the inspection will not be approved and a reinspection fee will be charged. ; Signature Signature OWNER or AGENT �NTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of�e��C- ( 20 �— , by D0 day of A--0 20 I , by who is personally known to —?'GL-AAM—?'GL-AAM(J US] 6 Q:WhPV 1 10 iispersonally known to DLme or who has produced �a ,1� ° as me or who has producedFA �P 1 a to LEOF as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Print: Seal: F7,10 Pvs, (Votary Public Erste of Fronde Seal: �Y a4 Slndia Aivarcz ggoO Peer. Notary Public State of Florida QQ Q Q Sindia Alvarez PAy Commis or; 16 156750 Commission FF 156750 orvr.°r Expires 09/03,1016 o Y -IF o0 Expires 0910312018 �r ® / G/3 APPROVED BY �� l Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 2016 details - Business Tax Account ADAN ELECTRICAL SERVICES LLC - TaxSys - ... Page 1 of l J1: COUNT kdotos, TAxES AWS TnAsutt Records,Taxes&Treasury Div.Home Search Reports Shopping Cart ATTENTION TAXPAYERS:Please be advised of the NON-REFUNDABLE processing fees for credit and debit 3 card transactions.Credit cards are charged 2.55%of the amount charged($2.00 minimum fee).Domestic Visa Consumer Check cards will be assessed a fee of$3.95 per transaction If you select'Debit Card'.Thank you. 2015 Annual Tax Bills will be mailed prior to November 1,2015,and will also become available on this website November 1st for viewing,printing or online payment.Tax bills are mailed to the current mailing address of the property,as listed on the Property Appraiser website www.bcpa.net.We recommend that everyone verify their current mailing address listed for their property at www.bcpa.net—and immediately report any mailing address change by using the link at the bottom of your property record for reporting 1 errors. 1 2016 Defth , . . - t ADAN ELECTRICALSERVICES Business Tax Account#88917 Account details Account history 2016 2015 2014 2013 ... 2010 PAID PAID PAID PAID PAID Account number: 88917 Owner(s): ROLANDO ADAN Business start date: 06/01/2010 3001 SW 37 AVENUE Business address: ADAN ELECTRICAL SERVICES HOLLYWOOD, FL 33023 LLC Mailing address: ROLANDO ADAN 3001 SW 37 AVENUE 3001 SW 37 AVENUE HOLLYWOOD,FL 33023 HOLLYWOOD,FL 33023 Physical business location: HOLLYWOOD - Print account application (PDF) `' Print exemption application (PDF) Receipts p 'ons f 181 PAID 2015-07-08$27.00 CONTRACTORS 10/01/2015-09/30/2016 Units:2 Receipt#2CP-14-00000230 ELECTRICAL/Al—ARMS/CONTRACTOR Additional documentation required:EC 13004453 State Certification OR Broward Cert.of Comp.(each year) https://www.broward.county-taxes.com/public/business tax/accounts/88917 10/28/2015 ADAN ELECTRICAL SERVICES LLC Date: 10 h'-?JI2-d (S State of'Fl-dy-k-PA County of KMA I Before me this day personally appeared C)(r�N N who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at: J05Z Sworn to(or affirmed)and subscribed before me this 20 day of ( UOISCKe . 20 (S,by Personally know//11 OR Produced Identificationlrt 2-O-�2i; k4 cig c) Type of Identification Produced -L T)VJ ltd UGE�j5j�-- �gpycr° Notary Public State of Florida Sandia Alvarez V My Commission FF 156750 1 pF'. Expires 09/03/2018 Print,T Name of Notary on ♦5IT .KENN asp ?" Miami shores Village ira Building Department Rip 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. -0Signature: v 41 Owner State of Florida County of Miami-Dade Theforegoingwas acknowledge before me this �� day of 1 ,20�. By I—1M I lcC_ M I(J J who is personally known to me or has produced �t 1-1 FI3)- —Do TF-La 0� Identification. Notary: SERI �csrr o`er Notary PlAilic State o4 Florida Sindia Alvarez moa My Commission FF 186750 L g g