EL-15-1305 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-235804 Permit Number: EL-6-15-1305
Scheduled Inspection Date: July 29, 2015 Permit Type: Electrical - Residential
Inspector: Devaney, Michael
Inspection Type: Final
Owner: NEGREVERGNE,JULIA Work Classification: Pool - Private
Job Address:429 NE 99 Street
Miami Shores, FL 33138-2461 Phone Number
Parcel Number 1132060170400
Project: <NONE>
Contractor: ON CALL ELECTRICAL CONTRACTORS INC Phone: (786)388-5880
Building Department Comments
NEW ELECTRIC FOR POOL Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed E�l
Failed
Correction ❑
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
July 28,2015 For Inspections please call: (305)762-4949 Page 4 of 31
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Miami Shores Village
T}t E( Gtt#iiReefditla�
10050 N.E.2nd Avenue NE Work cla$4 I_Privattie [
Miami Shores,FL 33138-0000 .,
er� et a:
APPROVED
=s' a� Phone: (305)795-2204
ficO1t4P Expiration: 1112801
Issue bate:$12015 P
Project Address Parcel Number Applicant
429 NE 99 Street 1132060170400
JULIA NEGREVERGNE
Miami Shores, FL 33138-2461 Block: Lot:
Owner Information Address Phone Cell
JULIA NEGREVERGNE 429 NE 99 Avenue
MIAMI SHORES FL 33138-
429 NE 99 Avenue
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: _ $ 400.00
ON CALL ELECTRICAL CONTRACTOI (786)388-5880 Total Sq Feet: 0
Type of Work:NEW ELECTRIC FOR POOL Available Inspections:
Additional Info:
Inspection Type:
Classification:Residential Final
Scanning:1 Light Niche
Bonding
Review Electrical
Alarms
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60 Invoice# EL-6-15-55773
DBPR Fee $4.50
DCA Fee $4.50 06/01/2015 Credit Card $50.00 $263.60
Education Surcharge $0.20 06/02/2015 Credit Card $263.60 $0.00
Permit Fee-Additions/Alterations $300.00
Scanning Fee $3.00
Technology Fee $0.80
Total: $313.60
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 ].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 accura and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the above-named ntra to do t e work stated.
June 02, 2015
Authorized Signature:Owner / Applicant / Contractor Vent Date
Building Department Copy
June 02,2015 1
Miami Shores Village
Building Department JUN 0 z015
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 By:
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 KS
BUILDING
-
BUILDING Master Permit No��p 1, I
' I
PERMIT APPLICATION Sub Permit NXU5—`��J
BUILDING ® ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION EJRENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip: -4,31 38
Folio/Parcel#: it ".3 01 C,�- f✓r -L� ®C� Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): t fa � a< C_Q(Lr
4'Ar f Phone#:
Address: /V C 9 51 S i
City: M I A-M I S(+0'!C5 State: FL- Zip: 3 13
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: wcw" gle_C_ wy e' Phone#:
Address: 100 W0. 44+% mow. , irk M
City: State: Zip: -,.317-u
Qualifier Name: kLV11t,1 l'A►IliS Phone#:
State Certification or Registration#: CC �ocy, 9117 Certificate of Competency#:
DESIGNER:Architect/Engineer: Keto Ke'i Phone#:
Address: � 7 J 4 _5Lj Rob Lev)c= City: allh, / State:—Zip:3-3
Value of Work for this Permit:$ 400.
®a
— Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ® New ❑ Repair/Replace ❑ Demolition
Description of Work: vii--ti fie..,, -ja>¢, fX01
Specify color.of color thru tile.
Submittal Fee$ •w Permit Fee$ 7t� 0 CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ • �Ol
(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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. in the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
OWNEFrorAGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
E ST day of p7Ci'L 20 5 by UJS day of Wik%k 20 %S' , by
,1 ,14 V1ie�;c 2v t o Q 1 P who is personally known to 1G4.%1%Vj tev; 1$ ,who is personally known to
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 PUBL : NOTARY PUBLIC:
..s
Sign: Sign: a
,�� MARILYN SC R 19
Print: UUMb Print:
`<= EXPIRES•January 10,201 �+
Seal: '' �;�� Bonded Thru Notary Public Undenvrlters Seal: MY COMMISSION FF 0�J383
0` EXPIRES:March 22,2018
j Bonded Thor Notary Pubft undemrb's
APPROVED BY �46E-�� -
Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
s
On Call Electric Co.
License,EC0000947&Insured
05/21/2015
STATE OF FLORIDA
COUNTY OF MIAMI-DARE
Before me this day personally appeared Jorge A. Grijalba who,being duly sworn,deposes and
says:
That he/she will be the only person working on the project located at: 2 9 NC" 9 9 5 T
Sworn to(or armed) and subscribed before me this 21 day of May,2015,by Jorge A. Grijalba.
Personally Known
Or Produced Identification
Type of Identification Produced
.INE
MY Daum 8g pgg=
tufo tie
(SEAL) Signature 76MM is
7400 North West 7th Street,Unit 111.Miami,Florida 33126
Office. 786.345.8001 ( Cell. 786.597.7574 1 Fax,866.635.0722
Email.jorge@oncallelectric.net I Web site,www.oncallelectric.net
1
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Miami Shores Village
Building Department
tOR 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to Owner — Workers' Compensation Insurance Exemption
rvnT 77 777 7
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 TKIS 14OTICE AND UNDERSTAND ITS
CONTENTS.
Signature: (it
0kner
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me this ` day of nQ ,20_L'S .
By ,�3-t,.� Q1®00ff2e!�:Xq ne� who is personally known to me or has produced
as identification.
Notary:
LYN SCHMMR
SEAL: * �*^- OMMISSION#EE 123566
`:•. EXPIRES:January 10,2016
Bonded Thru Notary Public Underwdtets