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ELC-16-1 Inspection Worksheet Miami Shores Village 10080 N.E.2nd Avenue Miami Shores,FL Phone:(308)798-2204 Fax:(308)786.8872 Inspection Number. INSP-250272 Permit Number: EI-C-1-16-1 Scheduled Inspection Date: March 14,2016 Permit Type: Electrical-Commercial Inspector Devaney,Michael inspection Type: Final Owner: ,SHORES SQUARE INVESTMENTS Work Classification: Addition/Aiteration Job Address:9017 Biscayne Boulevard Miami Shores,FL 33138-0000 Phone Number Parcel Number 113206011007047 Project <NONE> Contractor. APC ENGINEERING ENTERPRISES INC Phone.(308)2194267 Building Department Comm ALL ELECTRICAL WORK AS PER PIANS h*uctlo Passed rnents INSPECTOR COMMENTS Faire Inspector Comments Passed � Failed Correction Needed Re-inspection Fee No AddMonai inspecUons can be scheduled until re4nspecdon The Is paid Manch 14,2016 For inspections please calk(30762-4949 Page 17 of 40 Muni Shores VNO 10050 N.E.2nd Avenue Miami Shores,FL 33138.0000 Phone: (305)795-2204 Expiration:07/09f2016 ProjectAWress Parcel umber Applicant 8017 Biscayne Boulevard 113206011007047 SNORES SQUARE INVESTMENT Miami Shores, FL 33138-0000 Block: Lot: Owner information Address P110110 Cell SNORES SQUARE INVESTMENTS 3880 BIRD Road MIAMI FL 33146- i Contrac�r(s) Phone Cell Phare :To:ftWeI87qF8M9t =�:��00 j APC ENGINEERING ENTERPRISES IN (305)218-8287 ype of Work:ALL ELECTRICAL WORK AS PER PLANS Available tpectlons: Additional Into: Inspection Type Classilication:Commercial Final Scanning:3 Motor Box Alteration Relocation Fire Alarm Service Change Review Ere i"n i", Underground W.W. Fees Due Amount Pay Date Pay Type Amt Pald Amt Due CCF $3.80 Invoice# ELC-146.58206 DSPR Fee $3.80 01/11/2018 Check#:1581 $449.80 $80.00 DCA Fee $3.80 Education Surctarpe $1.20 01/048016 Credo Card $50.00 $0.00 Penh fee $240.00 Scanning Fee $3.00 Teduhdogy Fee $4.80 Work wbout Permit Fee $240.00 Totak $488.80 i In consideration of the Issuance to me of this permit, I agree to perform the work covered hereunder In compliance with all ordinances and ;;ulwoffi pertaining thereto and in staid conformity with the plans,drawings,statements or spedtic adons submitted to the proper authorities of Miami Shores Village. In j accepting this permit I assume resp lily for all work done by either myself, my agent, servants, or employee. 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 at applicable laws regulating construction and zoning. Futhermore,I authorize the above-named contactor to do the work stated. January 11,2016 prized 81griftwellOwner c-'/ Applicant / Contractor / Agent Date Building Department Copy January 11,2016 1 I Miami Shores Village g JAN 0 4 2015 Building Department BY: 10050 N.E.2nd Avenue,Miami shores,Florida 33138 Tel:(305)795.2204 Fax:(305)756-8972 INSPECTION UNE PHONE NUMBER:(305)7624949 FBC 20/� BUILDING Master Permit No/w,/L�2�6/?_,_/� PERMIT APPLICATION Sub Permit No.a ZA--I ❑BUILDING �CTRIC ❑ ROOFING E] REVISION EXTENSION [RENEWAL ❑PLUMBING [-]MECHANICAL (PUBLIC WORKS [-] CHANGE OF [CANCELLATION [ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: �D!7 - / B/SGS y/!P.. B�a®• City: Miami Shores County: Miami Dade Zia: FoUo/Paraai#: is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): g2 o+ !90vqg-g- j r+jjc Ld.4Phone#:As)ns ffgff Address: 164!e !f f &' ST city: K. m(afill State: F_� Zip:.�.��f'e� Tenant/Lessee Name: Phone#:_ Email: CONTRACTOR:Company Name: j%ft � ,G� + Phone#:L&,r941-hod-6 7 Address:Z t SD 0° 10+* Gl ve° City: 8i a/zA h state: FG Zip: 334Of10 Qualifier Name:�3QMW.C, P. &r.(I&Ac f Phone#• State Certification or Registration M E C C 3 dD(s7 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for thb Permit:$ Square/Unear Footage of Work: Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: A4 1g&&ldi cf l lye e k- Q S O&OL Ply h . Specify color of color thru We: Submittal Fee$ -46 Permit Fee$ /e� �9• CCF$, 3 ° 60 CO/CC$ Scarming Fee$ Radon Fee$_ 3° 6 v mm$ R -2 ) Notary!' 09 Tedmology Fee$ �LC0 Trahring/Edumdon Fee$ ,• Double Fee$ a 40.Q Structural Reviews$ Bond$_ TOTAL FEE NOW DUE$ %4 0 (RevbeMn4/2014) 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 AFFIDAW: 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$250, 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 in on fee will be charged. Signature Signature Ow R GENT CONTRACTOR The foregoing instrume knowiedged before me this The foregoin instrument was acknowledged before me this 0. _day of 20 f� ,by day of a'� 20 by in I� .who Is personal known to MLS S ?j&&94 C ,who i ersonall know 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: 1%V ��!►� Seal: eo«aean�arsoya�2017 Seal: APPROVED BY �40!-' Plans Examiner i „ Zoning Structural Review Clerk (ReWseMZ/24/2014) .''•••'n� C Engluarift Eaterprhms, . 2150 West 100 Ave Wakak FL 33010 Pb: 71 Fnxz 305405-M3 January 4,2016 St�o of County of Wam Before me dfls day pmonally, appewed. whoi Being duly su►orn, and says: That he or At"1 pmon wow on the projea loc. . : at: 104liar -id �. Sworn to(or aftned)and su mai .,t1a1s *tda y of 420JV by PersoaWly Know . OR Produced Idenfification Type of Identification Pa duced. a No i A!n�w �. r. HMOSMi FL 3=00 1a )M073 a fa011i Pte 1 of 1 Miami Shores Village -- Building Department tOR1p�► 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tei: (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,parttime employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature. , wt!=� Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this� day of ,20 It. c Bylnim 4e1Pc1&y4ez who is personally known to me or has produced as idea ification. Notary: SEAL: m ,y ggRos8R0 Rotary per.. God 1' s 6e�Mld =Noy