EL-15-1565 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-245096 Permit Number: EL-6-15-1565
Scheduled Inspection Date: October 07, 2015 Permit Type: Electrical - Residential
Inspector: Devaney, Michael
Inspection Type: Final
Owner: , Work Classification: Low Voltage
Job Address:652 NE 105 Street
Miami Shores, FL Phone Number
Parcel Number 1122310120140
Project: <NONE>
Contractor: BILLY'S ELECTRICAL SERVICES INC Phone: 305-947-7102
Building Department Comments
INSTALLING LOW VOLTAGE CABLES AND DEVAISES 18 Infractio Passed Comments
SPEAKERS AND 8 CAMERAS 4 DOOR BELL CABLES. INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
October 06,2016 For Inspections please call: (305)762-4949 Page 48 of 60
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Miami Shores Village
g` 10050 N.E.2nd Avenue NE
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"" Miami Shores,FL 33138-0000 U
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hie Phone: (305)795-2204it ;
Expiration: 12/27/2015
Project Address Parcel Number Applicant
652 NE 105 Street 1122310120140
Miami Shores, FL Block: Lot: KILUAN, INC
Owner Information Address Phone Cell
KILUAN, INC 652 NE 105 Street
MIAMI SHORES FL 33138-
150 SE 2 Avenue
MIAMI FL 33131-
Contractor(s) Phone Cell Phone Valuation: $ 6,500.00
BILLY'S ELECTRICAL SERVICES INC 305-947-7102
Total Sq Feet: 0
Type of Work:INSTALLING LOW VOLTAGE CABLES AND D Available Inspections:
Additional Info: Inspection Type:
Classification:Residential
Review Electrical
Scanning:3
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $4.20
Invoice# EL-6-15-56094
DBPR Fee $3.41 06/24/2015 Check#: 1129 $50.00 $205.52
DCA Fee $3.41
Education Surcharge $1.40 06/30/2015 Check*1128 $205.52 $0.00
Miscellaneous Fee $1.00
Permit Fee-Additions/Alterations $227.50
Scanning Fee $9.00
Technology Fee $5.60
Total: $255.52
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,PLUMBIN NICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify 11 the oregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoni e,I orize the above-named contractor to do the work stated.
June 30,2015
;Z=nt
/ Applicant / Contractor / Agent Date
Buil Copy
June 30,2015 1
Miami Shores Village
Building Department JUN 2 4 209
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 «_._— -
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION UNE PHONE NUMBER:(305)762-4949
FBC 2® 03
BUILDING Master Permit No. RC-4-15-833
PERMIT APPLICATION Sub Permit No. ELIS — I5(oS
❑BUILDING ® ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
PLUMBING ❑ MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 652 WE 105 St.
City: Miami Shores County: Miami Dade Zip: 33138 -
Folio/Parcel#: 11-2231-012-0140 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): Klluan Inc. Phone#:
Address: 652 N.E. 105 St.
city: Miami Shores state: Florida Zip: 33138
Tenant/Lessee Name: N/A Phone#:
Email: / ,I
CONTRACTOR:Company Name: ( R, l S L P-e"f lei C-4(1 5 c�116s _1^5 hone#: q S 7'q(!0 3 D I
Address: �� L.11° c--'I.4✓n It AJ tb If J�
City:p'O / —State: Zip: 3
Qualifier Name: FDw"' ' o ESO kAtt So.-, Phone#:7g6 3 L 7 9---?
State Certification or Registration M 46�C / 3 iq D /SS/ Certificate of Competency#:
DESIGNER:Architect/Engineer: A& I Associates Phone#:
Address: 370 N.E. 101 St. City:Miami Shores State: FI° Zip: 33138
Value of Work for this Permit:$ 611,900 ®� Square/Linear Footage of Work:
Type of Work: ❑ Addition Q Alteration ❑ New ❑ Repair/ eplace ❑ Demolition
Description of Work: :1701-S�&Ze_/A.� 1-0 f0`J VO
k L15F-rLs 12L ;L5
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee 5 Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
Bonding Company's Name(if applicable) N/A
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable) N/A
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.
Mar i Director Kiluan, Inc)
Signature Signatur'-��;44�-
%
OWNER or AGENT CONTRACT
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
A day of �YLQ., 20 ,Jr by day of����� 20 `� by
1" YLJzz i ,who is personally known to ��W/GZG`�tr��✓'� � ho 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 PUBLIC: NOTARY PUBLIC:
Sign:
Print: LUP.,G C• I Sg51 Print: r
dam,YP�, oo, '��'���� RUBY M®.71AJ
Seal: , ' •,pec: LUCIA G ISASI Sea!: ;Ue MY COMMISSION#EEJMY COMMISSION#FF182828 %" 'o�o.�, arch 20,o�• . .> >. .. ,. ,EXPIRES:MEXPIRES December 10,2018
���a���M� � 9fidye�� AI�;L4�Etprse.� �aa��+��,�et�a�sa ►«aaa�r�sa�eaes*ee�s��ee+►sa�a�waar�+►kw®+aeee�e,x.aee►a®en
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
JEFF ATINATER
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 below has elected to be exempt from Florida Workers'Compensation law.
EFFECTIVE DATE: 2/16/2015 EXPIRATION DATE: 2/2512017
PERSON: FARQUHARSON EDWARD
FEIN: 650754251
BUSINESS NAME AND ADDRESS:
BILLYS ELECTRICAL SERVICES INC
620 WEST CHAMINADE DRIVE
HOLLYWOOD FL 33021
SCOPES OF BUSINESS OR TRADE:
LICENSED ELECTRICAL ELECTRICAL WIRING
CONTRACTOR WITHIN BUIL
Pursuant to(meter 440.05(14 F.S.,an officer of a corporation who SMAS exemption 6om this dvq ter by ShV a certtfkate of elec&m under this se0on
may not recover benefits or awnpensatlon under 90 chapter.Pursuant to chapter 440.0.5(12).F.S.,ceititicates of election to be exempt..apply only
wghtn the scope of the business or bade Bated on the notice of election to be exempt Pursuant to Chapter 440.05(13).F.S..Notion of election to be
exempt and oerfficates of election to be exempt shag be subject to revocation If,at any time after the Hing of the notice or the Wu mce of the cardficata,
the person named on the notice or oertirttaste no longer meets the its of tide section for issuance of a oerflflcate.The departnerd shall revoke a
DFS-F24)WC•252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1509
001206 _ -
Local Business Tax Receipt
Miami-Dade County, State of Florida
THIS IS NOTA MLI. - DO NOTPAY LBT
5087432
austNESS NAMEn OCATION RECEI"NO- EXPIRES
BUYS MCfRIC&Sff&qM INC nuaw" SEPTEMBER 301 2015
DOING BUS IN DADE CO 6313838 Must be displayed at place of business
MMM FL 330iM3 Pursuant to County Code
Chapter BA-Art.9&10
OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED
BHlY5 8KMCAL SERVICES INC 196 ELECTRICAL CONTRACTOR BY TAX OLLECTOR
Worker(s) 3 EC13001551 $82.50 10/29/2014
CREDITCARD-15-002042
This Local Bosilneas TaxAeceipt ooiP tna limas pop gam of the local Basinees Tax.Tie Receipt Is not a&cease,
permit are
wagaiIavenanenu atigory lasts rtae n % hely to tielmsloeas. iy any 9
oveininaw
The RECEIPT N0.above must be dtsplepai on a0 commercial rebicles-llUMI-Dads Cate Sec 11-M
For Mme hdonnation,visit MAOLMbawaileAMARKWIRAW
ACQEUX CERTIFICATE OF LIABILITY INSURANCE DAT22Z2 D/YYYY)
2015
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
A&D ALL-LINES INS ASSOC INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
5600 SW 135 Ave Ste 106 ALTER THE COVERAGE AFFORDED
Miami, FL 33183
(305) 463-6781 INSURERSAFFORDING COVERAGE NAIC#
INSURED BILLY'S ELECTRICAL SERVICES, INC. INSURER LLOYDIS OF LONDON
620 WEST CHAMINADE DR. INSURER B
HOLLYWOOD, FL 33021 INSURERC:
954-963-0161 INSURER D:
INSURER E
COVERAGES
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 SUBJECTTO ALLTHE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR NERD POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
COMMERCIALGENERALLIABILITY $ 100 ,000
CLAIMSMADE a]OCCUR MED EXP(Anyone person) $ 5,000
A CIBFL0001219 06/15/15 06/15/16 PERSONAL SADVINJURY $ 1 00 0
GENERAL AGGREGATE $ 2.000 ,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 1,000,000
POLICY M PRO LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
ANYAUTO (Ea accident) $
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person) $
HIRED AUTOS BODILY INJURY
NON-OWNEDAUTOS (Peraccident) $
PROPERTY DAMAGE $
(Peraccident)
GARAGELIABILITY AUTO ONLY-EA ACCIDENT $
ANYAUTO OTHER THAN EA ACC $
AUTOONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR M CLAIMSMADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ $
WORKERSCOMPENSATION AND VC AT - OTH-
EMPLOYERS'LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $
It es,describeunder
E.L.DISEASE-POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
ELECTRICAL CONTRACTOR
CERTIFICATE HOLDER CANCELLATION
Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
10050 NE 2 Ave DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN
Miami Shores Village FL 33138 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ON 7 NSURER,ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTA
ACORD 25(2001108) A RD CORPORATION 1988
RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY
STATE dF Lb
G �iMT,0f s � Rt1
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U ,, Ctmr>~t�N�'�
L
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The ELECTR NT
ti Namejd` i rwpyIS-04
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FAR�fly/UId;`EDWARD S
A `� M
94 �VIII.I. :, ^�-� ! `SMI i
&SUM. 0824!2014 DISPLAY AS REQUIRED BY LAW SEQ# L1408240004462
litSILLY'S ELECTRICAL SERVICES, INC.
G20 WEST CHAL41NADE DRIVE a HOLLYWOOD,FL 33021
PHONE(305)947-7102•(954)90;3-0161
Fax(954)963-6203
RADE CC 97E000278•BROWARD 97-CME1661X
EC13001551
Date: 0
State of Flo r J O
Countyof �iumi Imo, d�
Before me this day personally appeared Uwa'' 544es (" who, being duly sworn,deposes and
says:
That he or she will be the only person working on the project located at: Nc !fl S
/►n 133
k�
Sworn to(or affirmed)and subscribed before me this a� day of 20\S, by
Personally know
OR Produced Identification F Lov- . brivet Lu""—'
Type of Identification Produced i-(7Z�-Z3�'S
,7
Print,Type or Stamp Name of Notary
LUIS JAVIER LAVALLE
NOTARY PUBLIC
STATE OF FLORIDA
Comm#FF060296
Expires 1/1/2018
♦5Ns'c'R'z`s D�
Miami shores V
.n. googol
Building Department
R 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:
caner
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me this day of JvY- ,20 I�.
By Y(,0 6 ZZ I who is ersonally kno o me or has produced
as identification.
Notary: Zwi,2o_L,�, _�Iaat_
SEAL: o�►"Y _ LUCIA G ISASI
MY COMMISSION#FF182628
' t _
�'•- �°
EXPIRES December 10 2018
(407)398.0153 Floridallot Servlce.com