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EL-15-2151 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-242048 Permit Number: EL-8-15-2151 Scheduled Inspection Date: January 26, 2016 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: YORK, BRADLEY Work Classification: Addition/Alteration Job Address: 1291 NE 94 Street Miami Shores, FL Phone Number Parcel Number 1132050100101 Project: <NONE> Contractor: VOLT ELECTRIC CORP Phone: (305)200-7967 Building Department Comments KITCHEN ELECTRICAL RECEPTACLES AND LIGHT infractio Passed Comments OUTLETS AS PER PLAN 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 25,2016 For Inspections please call: (305)762-4949 Page 5 of 41 Permit NQ S. -IS-21 6f `SNORes�� Miami Shores Village FS/T17y Electrical �id�lti� 10050 N.E.2nd Avenue NE t01 n WOrkC)assffil o$On addit)©�,�a�t�r�lt ; Miami Shores,FL 33138-0000 P ED Phone: (305)795-2204 " 1102tf�5 Expiration: 02/28/2016 Project Address Parcel Number Applicant 1291 NE 94 Street 1132050100101 BRADLEY YORK Miami Shores, FL Block: Lot: Owner Information Address Phone Cell BRADLEY YORK 1291 NE 94 ST MIAMI FL 33138-2946 Contractor(s) Phone Cell Phone Valuation: $ 7,200.00 VOLT ELECTRIC CORP (305)200-7967 Total Sq Feet: 0 Type of Work:KITCHEN ELECTRICAL RECEPTACLES AND Available Inspections: Additional Info: Inspection Type: Classification:Residential Final Scanning:3 Meter Box Alteration Relocation Fire Alarm Service Change Review Electrical W.W. Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $4.80 Invoice# EL-8-15-56822 DBPR Fee $3.78 08/24/2015 Credit Card $50.00 $231.36 DCA Fee $3.78 Education Surcharge $1.60 09/01/2015 Credit Card $231.36 $0.00 Permit Fee-Additions/Alterations $252.00 Scanning Fee $9.00 Technology Fee $6.40 Total: $281.36 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 ning. Fu7&� thori the above-named contractor to do the work stated. September 01, 2015 Authorized i at :Owner / Appli6at / Contractor / Agent Date Building Department Copy September 01,2015 1 Miami Shores Village Building Department 7BY: s 2 4 0,5 { 90050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 - -- —:, _5A FBC 20 i q BUILDING Permit No. EL- t 5= 215( PERMIT APPLICATION Master Permit No'�_RC— t 5_— 1 "1Gq'? Permit Type: Electrical JOB ADDRESS: / 2-0/ F��4: 7 City: Miami Shores County: Miami Dade Zip: 3 31 3 5), Folio/Parcel#: //- 32 o�:-- O! D — oto / Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder): /J - r6 Yt>o2 c Phone#:605') of�S 9133 Address: / Z 9 /Y/ G QY �T/L�Cf City: ��/ !/ • P s lfd/Z-/.575 State: �L _ Zip: 3 3 1 3 8 -r-- Tenant/Lessee Name: / Phone#: Email: �iA � � /� p P SOy 7-4 d1 -e CONTRACTOR:Company Name: VOLT ELECTRIC CORP Phone#: 305-200-7967 Address: 831 W 53RD TERRACE City: HIALEAH State: FLORIDA Zip: 33012 Qualifier Name: ODONIS RODRIGUEZ Phone#: State Certification or Registration#: Certificate of Competency#: 13E000539 Contact Phone#: 305-200-7967 nEmail /Address: INFO@VOLTELECTRIC.US DESIGNER:Architect/Engineer: ! GPIFI t V A el 1)C ri 6IIJ Phone#: el'S ` 7ei G� Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑Address Ll/Aheration ❑New ❑Repair/Replace ❑Demolition Description of Work: KITCHEN ELECTRICAL RECEPTACLES AND LIGHT OUTLETS AS PER PLAN ***************************************Fees******************************************** Submittal Fee$ Permit Fee$ z- CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ 231 3 f Y 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 chment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection is occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not b ap ved and a rei ection fee ill be charged. SignatureSignature -- -=- Owner /AV'//t Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 20 day of &jL) 20 J-J,byBr�d� .k �0( (� day of 08 120_,by ODERAY OROPESA who is personally known to me or who has produced who is personally known to me or who has produced "0-f,I K As identification and who did take an oath. as identification and who did take an oath. NOTARY PUB C: NOTARY PUBLIC: Sign: Sign: Print: r� V 'r: Print: My Commission Expires: t?f° g My Commissionxp, ,060') ,#E 5 Or,�p�� FEep :""'°�:'•. TERESA NUNEZ•APONTE ., • • _ � ,x 61�R1F�N4Mirldae ***********x***************************** * o, My Comm.Expires Jan 26,2018 Appy, B-yCommission N FF 086355 Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/102009)(Revised 3/15/09) ♦S��I �Cf R,,, Miami shores Village Building Department OR 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: I. 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 ' a coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW U ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Owner State of Florida County of Miami-Dade ll The foregoing was acknowledge before me this day of-V I 20 By �l ), who is personally known to me or has produced fll�' 0 �5 L <-e as identification. �pPY PUB �� . •.e% NANCY GOLDRING *40, * MY COMMISSION I EE 860780 Notary: EXPIRES:February 15,2017 SEAL: P Bonded Thru Budget Notary Services ltElectr)C VOLT Electric Corp 08/20/2015 PH 305-200-7967 831 W 53rd Terrace Hialeah, FL 33012 Job Address: 1291 NE 94`h ST Miami Shores FL 33138 1 declare on this letter that I will meet the workers compensation law when labor is I provided to the job located at 1291 WE 94TH ST Miami Shores FL 33138. Only two officers from corporation and exempt from workers compensation will work on this job site 1. Odonis Rodriguez 2. Maikel Valdivia I have attached to this letter the certificate of election to be exempt from Florida workers' compensation law for the two offices of corporation listed above Name of company qualifier: Odoni Signature of Qualifier Oderay Oropesa aot'QF�.P�eL�'s Commission#FF 09016E az a. 20a .gig, .off, s ExpireNND pRticam Notary public name �''� °F�� NWW Qate 08/20/2015