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EL-15-1346 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-251730 Permit Number: EL-6-15-1346 Scheduled Inspection Date:January 28,2016 Permit Type: Electrical- Residential Inspector: Devaney, Michael Inspection Type: Final Owner: Pappa,Monica Work Classification: Alteration Job Address:747 NE 94 Street Miami Shores, FL 33138- Phone Number Parcel Number 1132060142010 Project: <NONE> Contractor: SOUTH COAST ELECTRIC OF DADE INC Phone: (786)879-3879 Building Department Comments REMODELING KITCHEN AND 1 BATHROOM 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 27,2016 For Inspections please call: (305)762-4949 Page 16 of 23 ICONTRAC DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES BNZM2101 01/26/2016 INQ CONTRACTOR KJ045 12:27:20 CCN NO. lOE000613 ISSUE DATE 12/07/2010 TEMPORARY LIC (Y/N) N EXAM OR BOARD APPROVAL DATE 12/07/2010 COMPANY NAME SOUTH COAST ELECTRIC OF DADE INC D/B/A NAME INSURANCE EXPIRATION DATE 07/17/2016 STATUS A LAST RENEWAL 09/29/2015 CONTRACTOR TYPE D_ DADE BUSINESS TYPE C CORPORATION ADDRESS 12940 SSP 82 PL PHONE 786 879-3879 FAX: CITY MIAMI STATE FL CLASS EXP DATE 09 30/2017 ZIP 33156 NAICS CODE 000000 WORK COMP DATE 12/28/2016 EMAIL: SOUTHCOASTELECTRIC@LIVE.COM WORK COMP EXEMPT (Y/N) Y -- Q U A L I F I E R --- SKILL CAT ST REG NUMBER EXP DATE TRDS 199403702 CLASS ELEC LEVEL M 0001 ER13014546 08/31/2016 NAME MORALES ORLANDO 0002 CLASS STATUS A 0004 EXP DATE 09/30/2017 _ SSN 000003070 PF3 = INQ TRADSMAN PF5 = AUDIT INQ PF6 = COMMENT INQ PF2 = INQ ALL QUAL PF7 = NEXT QUALIF PFS = NEXT TRDCLS PF9 = NEXT CAT NEXT SCREEN NEXT KEY NO MORE QUALIFIERS, NO MORE TRADE CLASS, NO MORE CATEGORIES `l i3y Y SOUTH12 OP ID:MARZ .4coRv� CERTIFICATE OF LIABILITY INSURANCE DAT2JI51D015 12/15/2015 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). PRODUCER CONTACT (Sure Insurance Brokers NAME: Maylin Martinez 8700 W.Flagler St.,Suite 270 P,vcNf o Ext:305-223-2533 pIC,No):305-220-0765 Miami,A. Fernandez ADDRESS:Certificates@ISureBrokers.com Javier A.Fernandez INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Ascendant Commercial Insurance INSURED South Coast Electric of Dade, INSURER B: Inc. 12940 SW 82nd Place INSURER C: Miami,FL 33156 INSURER D: INSURER E: 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. ILTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF MMIDDNY r LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAMS-MADE rx]OCCUR GL-45228-1 07/17/2015 07/17/2016 PREMISEs Ea occurrence $ 5 0,000 E TO RENT MED EXP(Any one person) $ 5,000 PERSONALBADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY 7 JECOT- LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB [d OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAMS-MADE AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? El N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Electrical Work-within buildings CERTIFICATE HOLDER CANCELLATION CITYMI1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Miami Shores ACCORDANCE WITH THE POLICY PROVISIONS. Fax:305-756-8972 10050 NE 2 Ave AUTHORIZED REPRESENTATIVE Miami,FL 33138 ©1988-_2.014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD x P. l�rS -,. ,, ell— Local Business Tax ReCai Itm . Miami—Dade County, State of �,Flori ar ; THIS IS NOT Ai BILL tit.}NOT PAY LB 1 6734231 13UMESS MAME&OCATION RgcEun NO. EMPIRES SOM COAST ELECTRIC OF DADE INC RDIEWAL SEPTEMBER 30,* 201 12MO SW 82 PL 7007750 Must be.cusoaved a.rfact v bus. PINECRE5T FL 33156 Pursuwtt ta Gsurty* Cr{iYN R SEC.'"PS OF 8t/MB" R�1YmEi1Er RElr'uM!D SOUTH COAST ELECTWC OF DADE INC 196 ELECTRICAL CONTE, SY IrAX CO"ECT R Worker(s) �aEaaa l � s t CREOITCA 15.0,51:y 1 Thfs Local ilusiness Tax Hseeipt anJy ceatirrns paymertl of etre Lvct�l ae�gox iho 1pl is �ticcxx pastniL ar a ceAircanlae of the holder's gaeliiicatioa��d de bu#�aas� llatdar nasal��i1�aa�g�wa�+d Qr nonpo+roromemat r"aw"laws and mqwmmwftwkkb apply to am bw mm Tt�REGEIPT'NQ.a6tive aa�be�pLtpeB as ell�nm+arcirl walucP�-MiruaiaDsit+loch�ralra- ,: `sgoss tMiami Shores Village !'eXrrflf 7jrpe 7E�Ltl�dal Re81 "a1 , �a 10050 N.E.,2nd Avenue NE � •• "'""' Miami Shores,FL 33138-0000 ?' ,P itStI; "APPi Qu r Phone: (305)795-2204 REx iration: 0211012 1 ImsDate;8114�ti1.� ,<< p Project Address Parcel Number Applicant 747 NE 94 Street 1132060142010 Monica Pappa Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell Monica Pappa 747 NE 94th Street Miami Shores FL 33138- 747 NE 94th Street Miami Shores FL 33138- Contractor(s) Phone Cell Phone $ 1,750.00 Valuation: SOUTH COAST ELECTRIC OF DADE 1 (786)879-3879 Total Sq Feet: p Type of Work:REMODELING KITCHEN AND 1 BATHROOM Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning:1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 Invoice# EL-6-15-55822 DBPR Fee $2.25 DCA Fee $2 25 08/14/2015 Credit Card $ 160.70 $0.00 Education Surcharge $0.40 Permit Fee-Additions/Alterations $150.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $160.70 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 AFFI T: I certify t II the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction an ng. Futherm I authorize the above-named contractor to do the work stated. August 14, 2015 Authorized nature:Owner / Applicant / Contractor / Agent ate Building epartment Copy August 14,2015 1 8 Miami Shores Village JUN ® 3 2015 Building Department _- 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 t� BUILDING Master Permit No. 12C__,15-- 13y`� PERMIT APPLICATION Sub Permit No. El—I S — I S-p ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP �y / CONTRACTOR DRAWINGS JOB ADDRESS: �`t 4V e 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: �t� OWNER:Name(Fee Simple Titleholder): HOW(A BAFT6, Phone#: T'86 3g Address: + �� city: State:--TL Zip: 33138 Tenant/Lessee Name: Phone#: Email: -PAPPQI10ti1CA 0, U I&C-il(_I0 • IT• CONTRACTOR:Company Name: 4.70.UAV 1 ��Oc% f Phone#: Address: C 'ba City: State: --� ��^u Zip: 25�I5 Qualifier Name: OrkVIJ6 xfbai 66 Phone#: 6 - State Certification or Registration#: Certificate of Competency#: I b E-04V6 13 DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ a Square/Linear Footage of Work: ,—Type of Work: ❑ Adcditri ❑ Alte ation ❑ New [ Repair/Replace ❑ Demolition Description of WorkU 44s a! �i�7 �l1A2� Specify color of color thru tile: Submittal Fee$ 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$ a (jJ (Revised02/24/2014) ' W ` 1 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. SignatureSignature flitv RRAW=,4L� JU OW N ER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this Z day of _ 20 I J byday fof ZE 20- J by W�U"l�u� 1 n who is personally known to Orb i"I®P&Ates ,who i ersonally know o 71 me or who has produced Cq— t ID cA as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY P LIC: Sign: '9r %Sign: o ® � Print: = '�� �_ ¢"; , print: Seal: =�Seal: r MV COMMISSION#FF218W EXPIRES FWril 07.2019 �i"/� Cz+ ••� a ,{i,/ 14.:+1'!u fMr.�Yo�ryServ�cO.CWn 'moi ®�••........••. `\ " APPROVED B ✓� ✓ Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) • *� w R td �,,,T1FIC TE C?E �[IF'E i - U sti�T goo 3 N tt3h � 2 S 3 t x q Z owl In i1 S �A�MWy f� oil� els "N 1 N y i Las 5 � . ' 1S�e � _ � e �" ABC, r r Fn ; ��3 `' S' a 3£ z f h .�' i* �, a 1 3 E ,ce .f r. _ mot �' �rvJY y KK�° ✓ ,H {rµ� d a Y si k :;'IP" ��4VIIII slim Rl Zvi, BIT rTzyon, INS i 77 X04 ,.. SM 1 HACK RaASY � Kid LAWffj3 GRETAR a , PTA asT14tt },t}lii!?A r ,,77777,7 �e OAT j,v E r s� ar u 9 rd��" s! E 6 il k "� i a RIM bl �. .. Awall w te . F. K .. i IMPORTANT: Udw certificate holder Is an:ADDITIONAL INSURED,the policy(las)must be endorsed. USUBROGATFONISWAI'VED,subjeckto e term and conditions ,,f thepolicy.certain ',• may re"ire an endorsement A stats- .,a 'i'°..aab does not confer rights to the cartificato holder In lieu of such rz PROtMER Isure Insurance Brolmrs 8700 W.Flagler St.,Suite 270 iili!,�Tl 'Miami,FL 33174 ?h•'1E. Mayfin Martinez MOURED South Coast Electric of Dads, .els"• 1 SW 82nd H. a P"i WRAIIIIWAI r t € r •` e s :. ! E-.a.:�' L:iEi_lS1�tJl �'IS?:i'filiiJYlf,1 noong MOE Nm �, 1,�--.r� s- >.:4 d --.C•3C .p Y. 1}..',_ (., ..! fiq ai at r 7� a E V R 7 @i � ■�!! ... :7:: r.R`b: k'ti City of Miami Shores 1 r r. I ------------- 10050 NE 2 Ave Miami,FL 33138 •��me JEFF ATWATER CHIEF FINANCIAL OFFICER 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 has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 12/29/2014 EXPIRATION DATE: 12/28/2016 PERSON: MORALES ORLANDO FEIN: 274159341 BUSINESS NAME AND ADDRESS: SOUTH COAST ELECTRIC OF DADE INC 12940 SW 82 PLACE MIAMI FL 33156 SCOPES OF BUSINESS OR TRADE: LICENSED ELECTRICAL CONTRACTOR Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt...apply only within the scope of the business or trade listed on the notice of election to be exempt.Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if,at any time after the filing of the notice 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 a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 Miami Shores Village Building Department 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. f: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: J9Qu Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this VK I day of JX— ,20 l By 1 r \caw t �— P—,,w, who is personally known to me or has produced ion. Notary:Notary: SEAL: ��11111�1111� r t } South Coast Electric of Dade, Inc. 12940 SW 82 Place Pine crest FL, 33156 Ph.: 786-879-3879 786-280-1008 License #JOE000613 Entail:southcoastelectricglive.com Date: 06/0212015 State of Florida County of Dade Before me this day personally appeared Orlando Morales who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at 747 NE 94 ST Miami Shore FL 33138. Sworn to (or affirmed) and subscribed before me this �- day of -TV V1 20-E by Personaly Know d Or Produce Identification Type of Identification Produced ;•+'" �;_ AME7• BARRIOS •- MY CrV:NUSSION#FF218/37 f� „ 0 • Exp ARES Apfi!07.2019 �i,7,i4::u"� f4r•MIWN,a•y.SBrvw:h.Cam nt, Type or Stamp Name of Notary