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EL-15-1708 9:C ILI -- 3 3 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,Fl- Phone: LPhone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-247284 Permit Number: EL-7-15-1708 Scheduled Inspection Date:January 07,2016 Permit Type: Electrical- Residential Inspector. Devaney, Michael Inspection Type: Final Owner: TATE, BRANTLEY&CLAUDINE Work Classification: Alteration Job Address:874 NE 99 Street Miami Shores,FL Phone Number (786)420-5950 Parcel Number 1132060142410 Project <NONE> Contractor. BM POWER PRO ELECTRICAL INC Phone: (786)657-2668 Building Department Comments ADDITION TO EXISTING HOME 1 ROOM, OUTLETS AND Infractio Passed Comments SWITCHES RECESSED LIGHTS INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-247194. Hi hats are not l C. rated Smoke/carbon monoxide detector wiring not installed. Bedroom wiring not completed.HALL BATHROOM RECEPTACLE ON 20 AMP. CU.. Failed nEED LOW VOLTAGE PERMIT. Correction 1,17 Needed Re-inspection Fee Y No Additional Inspections can be scheduled until re-inspection fee is paid. January 06,2016 For Inspections please call: (305)762-4949 Page 6 of 34 Peet No. EL 7-15-1708 ea, Miami Shores Village M Permit Type:Electrical Residential 10050 N.E.2nd Avenue NE � ' Work Classification:Alteration Miami Shores,FL 33138-0000 PerPermit Status:APPROVED Phone: (305)795-2204 ��o� gibate.Not l6saed Expiration: 01/06/2016 Project Address Parcel Number Applicant 874 NE 99 Street 1132060142410 Miami Shores, FL Block: Lot: BRANTLEY&CLAUDINE TATE Owner Information Address Phone Celt BRANTLEY tai CLAUDINE TATE 874 NE 99 Street (786)420-5950 (786)518-5042 MIAMI SHORES FL 33138- 874 NE 99 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 1,200.00 BM POWER PRO ELECTRICAL INC (786)657-2668 Total Sq Feet: 0 Type of Work:ADDITION TO EXISTING HOME 1 ROOM,O Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning:2 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 Invoice# EL-7-15-56274 DBPR Fee $2.25 07/09/2015 Credit Card $50.00 $113.70 DCA Fee $2.25 Education Surcharge $0.40 07/10/2015 Credit Card $113.70 $0.00 Permit Fee-Additions/Alterations $150.00 Scanning Fee $6.00 Technology Fee $1.60 Total: $153.70 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 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 an zonin . F e ore I authorize the above-named contractor to do the work stated. 4194 July 10,2015 A razed Sig er / Applicant / Contractor / Agent Date Building Department Copy July 10,2016 1 e Miami Shores Village7n � Building Department i Ja 9 ul5 ; 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 YT: Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(30S)762-4949 FBC 20 10 BUILDING Master Permit No. -" iy'a b3� PERMIT APPLICATION Sub Permit No. E U ❑BUILDING E3/ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL PUBLIC WORKS [:] CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: �' st— -7 City Miami Shores County: Miami Dade Zip: J 3 1 Folio/Parcel#: I 1 — 32 0 b Q I y N 10 Is the Building Historically Designated:Yes NO Occupancy Type: SGL Load: Construction Type: Flood Zone: BFE: FFE: rlfr1LK ,,��JJ OWNER:Name(Fee Simple Titleholder): ') �C��ajfi).�z� Phone#:�/�� ���,T 6�a— Address: 9 -7 L/ 1)Q C1 C1 �� �7-, City: rl�wv►� S 40,f-C-1 State: �i Zip: L 5J)3 Tenant/Lessee Name: Phone#: Email: ll i_ CONTRACTOR:Company Name: (7G(fA QJ I�Cf l{a I Phone#: Address: iOV City: 1 m f State: ZIP::.��317g Qualifier Name: en, Phone#: 17-7y3g State Certification or Registration#: Certificate of Competency#: DESIGNER: ! h Architect/Engineer: o^14 �i + ,y Phone#. 3-or7Cl� ` F417 J Address: -"` 0 L'i K? c��'" City: Yl ,G,L2G� —State:�Zip: Value of Work for this Permit:$ 119200 Square/Linear Footage of Work: Type of Work: 00"'Additi n ❑ Alteration [:1 New El Repair/Replace r❑ Demolition Description of Work: AU4,6i\ <5 hp 0 D r 1 4IeT 6 .S 44 he4 Specify color of color thru We: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ ao TOTAL FEE NOW DUE$ ' (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 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. Signature ��2tSignature OWNER or AGENT CONTRACTOR The foreBioIng instrument was acknowledged before me this The foogoing instruwq"as acknowledged befoy this • day of �J�t/'!1 ,20 ,by 17vv``'-- day of Ja1v by &41t>4jgY T ,who i ersonally know to Z w o rsonally known to me or who has pro me or who has produced as 1-1:1.1A VALUbb identification and m ho WQIrtMIt.STATE OF FLORIDA identification and who did take an oath. COMMISSION#EE123129 NOTARY PUBLIC: MY COMMISSION EXPIRES 08/18615 NOTARY PUBUC: Sign: Sign: Print: Print: Seal: Seal: RAYuA' Ndry/,&N Pdf.8111b of Floft Comms FF 1237 My oomm.nOm,time Z 2018 APPROVED BY /S Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Miami shores Village Building Department jpR�pP► 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305)756.8972 Notice to Owner- Workers' Compensation Insurance Exemption '77"777777777:7, 7. 777 77, 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 comp members are allowed to be exempt. Construction exemptions are valid for a period of two y 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: Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of�V ,20 I By at 1 o is personally known me or has produced as identification. ._.__.------ .�'pY•Yve � SAMANTHA M DIAZ Notary: c` MY COMMISSION#FF160079 September 16.2016 SEAL: ",Q!6,�dt;• EXPIRES (4M jj;;0153 MoridallotaWService.c" BM POWER PRO ELECTRICAL A CONNECnON You CAN COUNT Ort! 686 NE 193 TERRACE MIAMI, FL 33179 PHONE: 786-657-2668 July 8, 2015 State of Florida County of Miami-Dade Before me this day personally appeared Benito Martinez who, being duly sworn deposes and says: That he will be the only person working on the project located at 874 NE 99 Street Miami Shores, FL 33138 Sworn to and subscribed before me this cl day of .20 15 by �►r�z— Personally know OR Produced Identification `!�l_%vrvZ., Type of Identification Produced i CD owy3�O;••�� Print, Type or Stamp NamA4 P4btaq soon Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305)756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER fo and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLL Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES,FL 33138 Certificate must specify the description of operations or contractor license number. BUSINESS NAME: N TbGl a Pip Eleckn e-4-1 BUSINESS ADDRESS: O( N N E� 173 Ter CITY �A m'1 STATE �L ZIP-33 1 BUSINESS PHONEc � )C[��' I—�000Q FAX NUMBER(� CELL PHONE 43(P .QUALIFIER'S NAME: rl i+0 C'.Z QUALIFIER'S LIC NUMBER: A410 .0 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 07/08/2015 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 NAME Brian Reilly Best Rate-Insurance Exchange Of America PHONE (866)616-0065 Nc; (305)403-0801 8600 NW 17th Street ADDRESS; ieaunderwridng@bestrate-insurance.com INSURERS)AFFORDING COVERAGE NAIC A Miami FL 33126 INSURER A: PREFERRED CONTRACTOR'S ASSOC INSURED INSURER S BM Power Pro Electrical Inc. INSURER C: 686 N.E.193rd Terrace INSURER D: INSURER E: Miami FL 33179 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. INSR TYPE OF INSURANCE ADDL BR POLICY NUMBER PMIDD/YYYY MMIDD EJQ' LIMITS LTRlum 20a X COMMERCIAL GE14ERAL LL481LITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAJMS-MADE X OCCUR PREMISES Ea occurrence $ 50,000 MED EXP(Any one person) $ 5,000 A PCIC5009-PCA525190-02 07/08/2015 07/08/2016 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 X POLICY❑JECOT F-1 LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS E AUTOS Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ AND EMPLOYERS'LIABILITY WORKERS COMPENSATION STATUTE ER TH Y/N ANY PROPRIETORIPARTNER/EXECUTIVE ❑NIA E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 0describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space Is required) Electrical Contractor License #ER13015003 -#14E000331 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave AUTHORIZED REPRESENTATIVE Miami Shores FL,33138 ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD JEFF ATWATER CI*EF 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: 7/17/2014 EXPIRATION DATE: 7/16/2016 PERSON: MARTINEZ BENITO FEIN: 471289165 BUSINESS NAME AND ADDRESS: BM POWER PRO ELECTRICAL 686 NE 193 TERRACE MIAMI FL 33179 SCOPES OF BUSINESS OR TRADE: ELECTRICAL WIRING WITHIN BUIL Pursuant to Chapter 440.05(14).F.S..an olrroer of a corporation who elects exemption from this chapler by filing a certificate of election under this section my not recover benefits or compensation under tilt 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 Rated on the notes 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 f0ing 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 cerBRc als.The department shall revoke a certificate at any time for fal ure of the perm named on the certi6cete to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)413-1609 TYP SINESS PAYM' RECEIVED ER PRO E CONTRACT BY _. 18.75 07/0 ITO MARTI 0221- 71 • t ct Fbr 14 r ��� ,� � ,`�"'•� rinN'�� �-+�'r,�1'°a ��i�p 1i.7�4� ���t Yk���s �r ��, �� �-�z t i ro"'H �' tia art Y�4 r �;b�' BM POWBR' ELEciRiC 196 rs 4 iCAL ���Kr� °y}, Cro ENff( r+t zPREs ,, F cTo t�,* it 7s 00 f anln0l4 u 1400041, " 4_1 163 4 f > P � or ti NO. � Wd_C'-'p_ t fr§ CTQB onstruction Trades Qualifyinq Board BUSINESS CERTIFICATE OF COMPETENCY li]D.BCA.: 14EO00331 BM POWER PRO ELECTRICAL INC ARTINEZ BENITO Is certified under the provisions of Chapter 10 of Miami-Dade Courty VALID Ft)kC€ tTi UNTIL-4-6