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EL-16-324 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-253876 Permit Number: EL-2-16-324 Scheduled Inspection Date: March 03,2016 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: STANDAERT, NATACHA Work Classification: Service Change Job Address:576 NE 97 Street Miami Shores, FL 33138- Phone Number (646)460-6061 Parcel Number 1132060171510 Project: <NONE> Contractor: VERES ELECTRIC INC Phone: 786-229-8294 Building Department Comments RELOCATE EXISTING SERVICE AND UNDERGROUND Infractio Passed Comments LINE TO POLE INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid March 02,2016 For Inspections please call: (305)762-4949 Page 39 of 44 nr . L- -1 -324 1s�jOs o,� Miami Shores Village ¢ ermr7ype Ei+ C�C; � Resllltitlf 10050 N.E.2nd Avenue NE Miami Shores,FL 33138-0000is It `o c� Phone: (305)795-2204 �� AM, 0 �,,APPROVED R1DP T Expiration: 08/06/2016 Issue Dais:2181��'i� �£, p Project Address Parcel Number Applicant 576 NE 97 Street 1132060171510 Miami Shores, FL 33138- Block: Lot: NATACHA=STANDAERT Owner Information Address Phone Cell NATACHA STANDAERT 576 NE 97 Street (646)460-6061 MIAMI SHORES FL 33138- 576 NE 97 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 3,850.00 VERES ELECTRIC INC 786-229-8294 _.... _ . ....._._ _._.:.._. Total Sq Feet: 00 Type of Work:RELOCATE EXISTING SERVICE AND UNDER Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning:1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $2.40 Invoice# EL-2-16-58577 DBPR Fee $3.38 02/04/2016 Credit Card $50.00 $191.16 DCA Fee $3.38 Education Surcharge $0.80 02/08/2016 Credit Card $ 191.16 $0.00 Permit Fee-Additions/Alterations $225.00 Scanning Fee $3.00 Technology Fee $3.20 Total: $241.16 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 str�LtIIUMB conformity wi the pia ,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assa responsib' for all ork done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, M CHANT L,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: certi that all fore ing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zonin . Futh ore,1 thori the above-named contractor to do the work stated. February 08, 2016 Authorized ature:Owner / Applicant / Contractor / Agent Date Building 6epartment Copy February 08,2016 1 Miami Shores Village g FEB 042,116 Building Department B n 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/y� BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. ❑BUILDING 0 ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION RENEWAL F-IPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑CANCELLATION ❑ SHOP 11 CONTRACTOR DRAWINGS N1 JOB ADDRESS: S-1 (0 I AV) Sj me't City: Miami Shores County: Miami Dade zip: 33 l 39 Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):Natacha Standaert Phone#:(646) 460-6061 Address:576 NE 97th Street City: Miami Shores state: Florida zip: 33138 Tenant/Lessee Name: Phone#: Email: natacha.standaert('Oorigisenergy.com T CONTRACTOR:Company Name: �e,�'e�sTE 1�.Tr1 c_ LInc-, Phone#: Address: K)000 SVJ 8S S_1_1 t City: ®i�� % I \g State: C�1O�i Zip: 1 Qualifier Name: UV\A(I f_s Phone#: State Certification or Registration#: �X00 6`U OS Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ N50-00 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑New Repair/Replace ❑ Deolition Description of Work: e_ ®cgAe. SCI S-H n S e f V 1 C_'0_ � ��(�e P v Specify color of color thru tile: Submittal Fee$S�'® /��Permit Fee$���"® cCF$ G CO/CC$ Scanning Fee$ G9 C�1Radon Fee$ S° ?e DBPR$ t Notary$ Technology Fee Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Re%dsed02/24/2014) 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$2500,the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs-seven (7) d �!s after the building permit is issued. in the absence of such posted notice, the inspection will not be approved and a reinspectiorfee will be charged. i i Signature J Signature OWN1 or - CONTRACTOR The foregoing instrument/4 4,, acknowledged before me this The foregoing instrument was acknowledged before me this day of 20 1 J by 3 day `ofd f-6 20�,by OIr-� '+-+-AA 9*(who is personal) known to Ch A(1QS VitI/QS who is personally known to me or who has d� "a�•, 1 i jel$ACHIEL ALSINA ;C-eu me or who has prod ��`" °" wN 01- _ Notary PuDlic-State o Florida •4 ACHIEL ALSJA identification an Arte t)ebho.Expires Nov 9,2017 identification and w o pe;= Commission re FF 037028 c 11try Public-StatNOTARY PUBLI '%.�,;� ;g••` Bonded 11uougb National ►Y A NOTARY PUBLIC: NY Comm.Expires� �.� Commission#►FFTBondedThroupbNitionp Sign: Sign: - Print: ,1.-r✓ ' Print: 1 s" Seal: Seal: em*r*x***r*r**s,r*res*********r��,r**�*�**�x+�+�,�***�*yes**r�r**,►*�***�**�w�*�r* APPROVED BY Ai/ "O la Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Local Business Tax Receipt Miami—Dade County,State of Florida THIS IS NOT A BILL-00 NOT pAy 1912766 LBT �ut�Nea ATto�1 IVEMP'T tao. VERES ELECTRIC INC EXPIRES 10000 SW 85 ST RENEWAE SEPTEMBER 30, 2016 MIAMI.FL 33173 1912766 Must be displayed at place of business Pursuant to County Code Chapter 8A-Art.9&10 OWNER SDC.TYPE OF BUSINESS VERES ELECTRIC INC PAYMENT RECEtuED C/O CHARLES VERES PRIES CONTRACTOR ELECTRICAL By TAX COLLECTOR Worker(s) 1 CONTRACTOR EC13006465 75.00 07/15/2015 CREDITCARD-15-036332 This local Buslaess Tax Receipt only cups peymept of fire local Bum Tax.The Receipt is not a license, permit or a mocation of the boidor's guallficadous,to do businew Bolder must comply with any governnremai or accomwameetal regalftq hms and rogeiremeats which apply to the busiaom Tba REC81pT N0.above rapt be dtaplayed eU commercialvehicles-Pdi�l-Dade Codo Sea&a 378. amore iMarowlen,visit STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION EC13006466 '.14SUtD: 12/04/2014 CERTIFIED ELECTRICAL.CONTRACTOR VERES,CHARLES' VERES ELECTRIC INC IS CERTIFIED under the provisions of Ch.489 FS. E.ap§ation data:AUG 31,2018 L141207SC •� 4 wc • JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER 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: 5!412015 EXPIRATION DATE: 5/3/2017 PERSON: VERES CHARLES FEIN: 591839581 BUSINESS NAME AND ADDRESS: VERES ELECTRIC INC 10000 SW 85TH STREET MIAMI FL 33173 SCOPES OF BUSINESS OR TRADE: ELECTRICAL WIRING WITHIN BUIL 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 11,at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or eartificate 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)413-1809 ACC>R" CERTIFICATE DATE(MMIDDtW W) �„_...� OF LIABILITY INSURANCE 02/03/2016 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 endomement(s). PRODUCER ELIEP1Ai_RODRIGUEZ YOUR FAMILY FIRST INSURANCE INC PHONE FaX" 1452 NORTH KROME AVE 104 MAIM° 501.2193 _..... La!+..NoJ. Z8B 339-.8.7D4 FLORIDA CITY FL 33034 A_.._DPWI!s EUCYU.URFAMILYFJRS.TINSURANCE COM _ ............ ..... INSURERjJ AFF1 Rkl O COVERAGE NAIC W I_-____RERa ARCH SPECIALTY INSURANCE INSURED _._._...... ..._.._ ._ NSU .._... -__.._.... ........... ..............__._. VERES ELECTRIC INC INsuRR e ......... _ 1000 SW 85 STREET INSURER C MIAMI,FL 33173 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. LTR; TYPE OF INSURANCE POLICY NUMBER Fj POLICY EFF Pa�DDY1YYxYY LIMITS [GENERAL LIABILITY EACH OCCURRENCE $ 1 DAMAGE TO RENTER U� X !COMMERCIAL GENERAL LIABILITY F FI CLAMS-MADE (X ,OCCUR MED EXP(Any one person) $...1.0.000,00.____,_ AGL0024535 00 04130I2O1 b 04/30/2018 PERSONAL&ADV INJURY 5 1 OOO 000 UO ...............___.........._,.... 1.0 r ____..,_._........_—...___._.................... GENERAL AGGREGATE S 2,909,000.00 GEN L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 1,000,000.00 ...,.,,,,.. POLICY i PRO:CTLOC $ AUTOMOBILE LIANUTY ' NE I L LI I 8 ardent) _.. ANY AUTO ..................... i BODILY INJURY(Per person) S - ALL OWNED SCHEDULED AUTOS _ AUTOS BODILY INJURY(Per amdent) S DAMAGE- HIRED AUTOS ; !NON-0WNED PRUFAtkTY DAMAGE 1 AUTOS g $ UMBRELLA UAB Y � : EACH OCCURRENCE.........,. $ S ........ -MADE LIAe AGGREGATE CLAIMS ................. S..........._....... _. _..... DED RETENTIONS WORKER$COMPENSATION WG STA7U .0TH. :AND EMPLOYERS'lIAe1LITY YIN. --- TQOY(,1M1T�S -.,, R ._._... ...... ......... ANY PROPRIETORIPARTNEMEXECUTIVE ! ! E.L.EACH ACC€DENT S OFRCEIMEMBER EXCLUDED? i N/A ! i (Mandatory in NH) D 9 It yes.describe under E.L.DISEASE-EA EMPLOYE NS MO. 4. E.L DISEASE•POLICY LIMIT S i if-,F` r I DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES(Attach ACORD 101,Addhtonat Remarks Schedule,N more space Is required) CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2ND AVE ACCORDANCE WITH THE POLICY PROVISIONS�� MIAMI SHORES,FL 33138 AUTHORIZED REPRESENTATIVE O 19 8 CO ORP ION,_All rights reserved. ACORD 26(2010/06) The ACORD name and logo are registered RD AC4UR0CERTIFICATE OF LIABILIW INSUPu4NCE ° 2JO3/2016 o2/U3/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THI CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIE BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZE REPRESENTAT NE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: I/the certifies holier Is an ADDITIONAL INSURED,"m Policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to th terms and conditions of the policy:certain policies may require an endorsement A Btaltement on this certificate does not confer rights to th certificate holder in lieu of such endonsemengs). PRODUCER YOUR FAMILY FIRST INSURANCE INC PHDNE ELIENAI RODRIGUEZ AX 1452 NORTH KROME AVE 104 aTw FLORIDA CITY,FL 33034 AFFORDING COVERAGE NAIC g INSURED INSURER A:ARCH SPECIALTY INSURANCE VERES ELECTRIC INC INSURER 8. 1000 SW 85 STREET 01SURER C: -- MIAMI,FL 33173RERD 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 PERi01 INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO VMICH THK 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. INSR LTRTYPE OF INSURANCEPOULMOYEFF POLICY aw _.....POLICY NUMBER LATS 6ENERAI.LIABLLrY EACH OCCURRENCE S 1 ,000,000,00 [!�Oom MERCIAL GENERAL LIABILITY PREM S 1 CL,Igm MAADE �OCCUR J�I,.._.: �GENERALAG=GRE.A�TE �exp I s 10 D00.00AGL0024535-0004/30/2015104130/2018JURY S 100000{x.00 i $2,000,000.00 GEN L POLICY AGGREGATE LIMIT APPLIES PER: Elm LOC I PRODUCTS-COMPIOPAGG S 1,000A0000 I S AU TOLE LW81LnY N I ANY AUTO ALL — BODILY INJURY(Per persaa) S AUTOS D AUTO LED BODILY INJURY(per 8ccidBttt) g HIRED AUTOS NON-OWNEDAUTOS R RI ' per ' � S ULIBRELLA UA9 EACH OCCURRENCE EXCESS L1Ae OCCUR i CLAIMS MADE $ AGGREGATE Ls OED r RETENTION. ViCIRIUM COMPENSATION AND i S OYERgLYWIRM PTU- ATN. ANY PROPRIE70RrPARTNERtE7(-CUTIVE Y)N E.L EACH ACCIDENT S — OFF1CflME6ASl�tEXCLU0E0? D�NIA7 j (6la awm In Nth It ye%dnefte un w E.L.DISEASE-EA EMPLOYO S E.L.DISEASE-POLICY LIMIT 5 I i r DESCRFnON OF OPERATIONS I LOCATIONS I VEHICLES(at1&Ch ACORD 101,Addkta31 Rema,xs Sctledure,x mare spas®Is re*wed) Operation: EC#13006465 CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2ND RIVE ACCORDANCE WITH THE POLICY PROVISIONS MIAMI SHORES,FL 33138 C' AUTHORIZEDREPRESENTATNE ©1988.2 CD b All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered RD VERES ELECTRIC , INC Date: 2/4/16 State Of : Florida County Of: Dade County Before me this day personally appeared 5 Ve Ce-S. who being duly sworn , deposes and says: That he or she will be the only person working on the project located at: N.E. 2-nd Ave.nve, �iC�ma Skore .$) R 3-�tS�) Sworn to ( or affirmed ) and subscribed before me this y day of Fe- tru f� 20 t�) , by ���� 1e s �e►� Personally Know Or Produced Identification Type of Identification Produced F- 7Pr*n7pSta&�p—Niinie ACHIEL ALSINA tary Public-State of Florida Comm.Expires Nov 9,2017Commission#FF 037026ded Through National Notary Assn. Pr•np p m Stamae of otary C���I :����ria ♦SNORES Gj s� ��► Miami shores Village RUN Building Department 10050 N.E.2nd Avenue �IORiNA 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 BEIjQW YOU ACK EDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: r State of Florida County of Mi m' ade The foregoing was acknowledge before me this day of 20—&—. By �m4 Mc. 1 ek 9`] flLn Le Y�_ who is personally known to me or has produced �-�c-eii&e as identification. ACHIEL ALSf11A Notary: ��`a ��` Noury Public•Oft Ary Comm.EXOM Ilov P,2017 SEAL: .,y�� Commla*n•FF 037M .n Iff4ed Thro*Nfienal Notary aaen 1 ITY FEB 8 4 2016 �Y: u r Yr cm D m u r ! ® � < ® D rr �O y N \' m ..... ... . ...... F 0 EF 1 P� rt)n�