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EL-15-3154 t Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-251987 Permit Number: EL-12-15-3154 Scheduled Inspection Date: February 02,2016 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: SOUTHWELL, DAVID Work Classification: Alteration Job Address:560 NE 103 Street Miami Shores, FL 33138-2458 Phone Number (305)822-8161 Parcel Number 1132060170890 Project: <NONE> Contractor: B.L.F ELECTRICAL INC Phone: (786)380-2509 Building Department Comments REPLACE EXISTING OUTLETS AND SWITCHES AT Infractio Passed Comments Kitchen INSPECTOR COMMENTS False Inspector Comments Passed Ea Failed ' Correction ❑ Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid February 01,2016 For Inspections please call: (305)762-4949 Page 27 of 32 �� l�� ,� �� C� �� s ,mom �� z Pe �e+�ORos , Miami Shores Village ,gritType-Electrit -Rb*i40rlt1a# 10050 N.E.2nd Avenue NE i�!�rrkGl �s �a�,l�tltet'at�!t[;- Miami Shores,FL 33138-0000 ••`�' � Phone: (305)795-2204 Perri $tativs.'PROVED �oRlo� t� j ate:lll�t� Expiration: 7/11/2016 Project Address Parcel Number Applicant 560 NE 103 Street 1132060170890 Miami Shores, FL 33138-2458 Block: Lot: TRUST ADVISORS CORPORATII Owner Information Address Phone Cell TRUST ADVISORS CORPORATION 5781-B NW 151 Street (305)822-8161 MIAMI LAKES FL 33014- Contractor(s) Phone Cell Phone Valuation: $ 1,000.00 B.L.F ELECTRICAL INC (786)380-2509 _.. ........ .. ___ Total Sq Feet: 160 Type of Work:REPLACE KITCHEN CABINETS Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning: 1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 DBPR Fee Invoice# EL-12-15-58128 $2.25 12/22/2015 Check#:2552 $50.00 $109.10 DCA Fee $2.25 Education Surcharge $0.20 01/13/2016 Credit Card $ 109.10 $0.00 Permit Fee-Additions/Alterations $150.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $159.10 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 a rate,and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-name trac to do the work stated. January 13, 2016 Authorized Signature:Owner / Applicant / Cont r / Agent Date Building Department Copy January 13,2016 1 Miami Shores Village Building Department DEC 2 2 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 S FBC 20 BUILDING Master Permit No. fz-C--es PERMIT APPLICATION Sub Permit No. PLI 5 --3 ISS ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL F-1 PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: - co Ole (®3 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:_ _ r 1 - 3`Zt6- 0 o`Z90 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):��%, � T2s A )Xus-T%-:De Phone#: 3c ZZz- l6/ Address: , -0( ('�-( T City: L P,V-� State: AFL. Zip: 33�14 Tenant/Lessee Name: Phone#: �- Email: Sal CONTRACTOR:Company Name: � �/� �� Phone#: Address: / 2—sy-3 City: /-�- State:_ Zip: -35012— Qualifier 3501ZQualifier Name: �G�aw) L-,/J/�.24-�� Phone#: State Certification or Registration#: Xe f_300 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$_1,o00 Square/Linear Footage of Work: /C,0 Type of Work: ❑ Addition ElAlteration ElNew ElRepair/Replace ❑ Demolition c Description of Work: z er,+� le-Ts 0"'A '-sL0'TQ" ^-f ►�CPI O- C' Specify color of color thru tile: Submittal Fee$ QZ5 Permit Fee$ -4 0 c PW CCF$ 6,0 CO/CC$ Scanning Fee$ Radon Fee$ Q c;)-S DBPR$ Notary$ Technology Fee$ Training/Education Fee$ (3 Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ I� • �! (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 fait at a cop of the notice of commencement and construction lien law brochure will be delivered to the person whose property i subject to attac ment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first in ection which occ rs e (7) days after the building permit is issued. In the absence of such posted notice, the inspection wil not be approved a d re' spectio will be charged. Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 'Z day of �0 C�`+�� ,20 1 , by 1 day off (-c,cam- -cG 20 1,,C- by �Pr.it CX 5NoJ CO who is personally known to , --30 �1a�rho 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: Sign: Print: Print: E LORELI MENDEZ Seal: >aY° Seal: •"""" LORELI MEL19 �� In •�p0.Y°��/�� Commission H FF 205211 Commission N F z• ._ My Commission Expires aP•e My CommissionExpires March 02, 2019 /'M • March 02, '/ APPROVED BY 2 2 C:JPal ns Examiner Zoning Structural Review Clerk (Revised02/24/2014) BLF ELECTRC, INC 1750 W 46 ST,#337 Hialeah, FI 33012 Dec 21/15 State of Florida County of Miami—Dade Before me this day personally appeared Vladimir Labrada who, being dully sworn deposes and says: That he will be the only person working on the Project located at: 560 NE 103 St, Miami Shores, Florida. Vladimir a ada BLF Electric, Inc Cell 786-380-2509 Sworn to and subscribed before me this 21 of December of 2015, by Vladimir Labrada Personally known Produced Identification Type of Identification Produced LORELI MENDEZ `,ao axr abB�n�� Commission#FF 205211 aq pa�. My Commission Expires March 02, 2019 Print, type or Stamp Name of Notary M � 5 ORES ' Miami shores Village Building Department 10050 N.E.2nd Avenue LORiDMiami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption I 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 ininimum 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 tiled 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 em eeso subcon tors for your project.The contractor has provided an affidavit stating that he or she will be the only persona wed to wor o our roject. In these circumstances, Miami Shores Village does not require verification of workers' compens ion insurance era g from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING ELOW YOU CK OWLE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. S;,gnature: _ Owner State of Florida County of Miami-Dade rr ,2.20 1 i J The foregoing was acknowledge before me this_��day of b CZ4_ �- By -bA4-i w _who is personally known to me or has produced as identification. Notary: f-0�1149t? I JLAL: LORELI MENDEZ -' Commission#t FF 205211 �� My Commission Expijes