EL-15-2449 Inspection Worksheet
Miami Shores Village 2C
10050 N.E.2nd Avenue Miami Shores,FL 2 ��
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-255787 PermitNumber: EL-9-15-2449
Scheduled Inspection Date: March 30,2016 Permit Type: Electrical- Residential
Inspector: Devaney, Michael
Inspection Type: Final
Owner. VILLARREAL, LEANA Work Classification: Alteration
Job Address:163 NW 101 Street
Miami Shores,FL 33150-1213
Phone Number (786)553-1534
Parcel Number 1131010230150
Project: <NONE>
Contractor: SOUTH DOM ELECTRIC INC Phone: (305)626-5904
Building Department Comments
ELECTRICAL WORK FOR KITCHEN REMODEL Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction r �
Needed ❑ ��
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
March 29,2016 For Inspections please call: (305)762-4949 Page 30 of 39
Miami Shores Village
10050 N.E.2nd Avenue NW
kc a ryS ak t t !:
Miami Shores,FL 33138-0000 £h
Phone: (305)795-2204
r�r rs3t� g a( eS
P3
y Expiration: 04104/2016
Project Address Parcel Number Applicant
163 NW 101 Street 1131010230150
LEANA VILLARREAL
Miami Shores, FL 33150-1213 Block: Lot:
Owner Information Address Phone Cell
LEANA VILLARREAL 163 NW 101 Street (786)553-1534
MIAMI SHORES FL 33150-1213
163 NW 101 Street
MIAMI SHORES FL 33150-1213
Contractor(s) Phone Cell Phone Valuation: $ 1,800.00
SOUTH DOM ELECTRIC INC (305)626-5804 TM �wW Total Sq Feet: 00
Type of Work:ELECTRICAL WORK FOR KITCHEN REMODEL Available Inspections:
Additional Info: Inspection Type:
Classification:Residential
Review Electrical
Scanning:3
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20 Invoice# EL-9-15.57214
DBPR Fee $2.25 09/25/2015 Credit Card $50.00 $116.70
DCA Fee $2.25
Education Surcharge $0.40 10/07/2015 Credit Card $116.70 $0.00
Permit Fee-Additions/Alterations $150.00
Scanning Fee $9.00
Technology Fee $1.60
Total: $166.70
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 and zoning. Futhermore,I authorize the above-namedipontractor to do the work stated.
October 07,2015
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
October 07,2015 1
- t Mildliii ariUrCJ viiid6C
Building Department
1W50 N.E.2nd Avenue,Miami Shores,Florida 33138 SEp 2015
Tei:(305)795-2204 Fax:(305)756-8972
INSPECTION UNE PHONE NUMBER:(305)762-4949 ��; 61a��'Q
F /y
BUILDING Master Permit No..M 6 , 7 ) 1
PERMIT APPLICATION sub Permit No. Lj I s-- 2LI�l J
BUILDING LECTRIC M ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL
[]PLUMBING ❑ MECHANICAL [PUBLIC WORKS [:] CHANGE OF ❑CANCELLATION ❑SHOP
IC
CONTRACTOR DRAWINGS
I� 2��JOB ADDRESS. 1 L(7I `''I ST
City:, Miami Snores County: Miami Dade Tia:
Folio/Parce*. Is the Building Historically Designated:Yes NO
Occupancy Type: Load: _ Construction Type: Flood Zone: BFE: ��,/ FFE: �2
OWNER:Na e(F
Sie Titleholder): w�-^r 'V, �r Phone#: q��—f L r
Address: W 10
City: State: Zip: � �'
Tenant/Lessee Name: Phone#:
Email: hgcL eya 6Px-py-0—s 41/i c<C •60M
CONTRACTOR:Company Name: & Phone#• ft-0016
Address: l Iz - S /
City: l9-F��c � Statee :E�
Qualifier Name: ��ff ._,Phone#: �f�Q
State Certification or Registration#: �71( (l ��Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Unear Footage of World
Type of Work: ❑ Addition ❑ Alteration ❑ New ' epair/Re lace Demolition {
Descrip Work: ( L �h
Specify color of color thru tile:
Submittal Fee$�U�Q._Permit Fee$ 1�&emW CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUES (�.
I
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,
FL*NACES,BOILERS,HEATERS,TANKS,AIR CONDITIONERS,ETC.....
"v.
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$2500, the applicant most
promise in goad faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection occur even (7) days after the building permit is issued. in the absence of such posted notice, the
inspection will not be pprov and inspection fee will be charged.
l
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of /Q_ ku s� .20—t 'S ,by day of � _ .20 /, .by
�--�A 14 A V1�A �i CTivho is persionally known to �1 f� �( ,who is personally known to
c-L
me or who has produced VCfe 6501:�7 as me or who has produced — as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
A4&Sign: Sign
t
a���
Print: nt:
Seal: DAIVA R.SAL
y PuI>ao,l3tate of Seal: Notary Public State of Florida
COry�FF 58218 Joanna M Feliciano
ZAN OOI m a pka$�A M17 '� �` Ex Commission FF 082753
qA Expires 0l/12/2018
APPROVED BY f0/ Plans Examiner Zoning
Structural Review Clerk
September 25,2015
County of Miami Dade
South Don Electric, inc
5860 NW 192 Street
Miami, FI 33015
Before me this day personally appeared Jose Del C Matos who, being duke sworn,deposes and says:
That he or she will be the only person working on the project located at 163 NW 101 St
Sworn to(or affirmed)and subscribed before me this September 25,2015 by
-W �A i2 "
Personally known--✓K
Or produced identificatio
Type of identification produced--- '
Print,type or stamp name of Notaryq� Notary Public State of Florida
Joanna M Feliciano
My commission FF 082753
�fr�ai��1'r> Are
1
♦5��was
goal Miam'11' shores village
RrmBuilding Department
tpR ► 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
��k--C40' ccd Fax: (305) 756.8972
Notice to Owner — Workers' Coation Insurance Exemption
N
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 3to 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 loyees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will
be the only perso alio to work on your project.In these circumstances,Miami Shores Village does not require verification of
workers'com on' ce coverage fro a contractor's company for day labor,part-time employees or subcontractors.
BY SIGNIN BE Y A DGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
0
Signature:
Owner
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me this,?-!� day of 20 /
Byz ea— / 1 f I' l��z r"'<0t-/, who is personally known to me or has produced
as identification.
Fio�
Notary.
PuW�S""�
pays, 40&01!Mme,FF 082,,53
SEAL: : } MV Emsp1►iaa°'s
aw
MIAM
MIAMI-DADE COUNTY -STATE OF FLORIDA N/A October 07,2015
Ms LOCAL BUSINESS TAX RENEWAL
5355755 2015 -2016 APPLICATION RECEIPT.4732062
STATE#04E000560
DBA/BUSINESS NAME: BUS.COMMENCEMENT DATE:06/01/2001
SOUTH DOM ELETRIC INC SEC TYPE OF BUSINESS
BUSINESS LOCATION: ELEC ELECTRICAL CONTRACTOR
5860 NW 192 ST 1
MIAMI,FL 33015
OWNERICORP. APPLICATION DETAILS
SOUTH DOM ELECTRIC INC FEE AMOUNT
PHONE# 305-626-5904 Receipt Fee 30.00
UMSA Fee 30.00
5860 NW 192 ST Beacon Council Fee 15.00
MIAMI,FL 33015 Bingo Permit Fee 0.00
Nightclub Permit Fee 0.00
Mutts-Municipal Contractor Fee 0.00
Restricted Contractor Fee 0.00
Library Fee 0.00
Transfer Fee 0.00
NAICS CODE: 23821
Doing Business without a License Penalty 0.00
Late Penalty 0.00
Collection Cost 0.00
NSF Fee 0.00
Prior Years Due 0.00
Amount Recently Paid - 75.00
TOTAL AMOUNT DUE: 0.00
If no longer in business,please notify us in writing. To pay online go to www miamidade.satov/taxcollector
I
Review and correct the information shown on this application. To pay by mail,make check payable to:
Mlami-Dade County Tax Collector
A 25%penalty will be assessed to anyone found operating Business Tax
without a paid local business tax, in addition to any other 200 NW 2nd Avenue
penalty provided by law or ordinance(Sec 8A-176(2)). Miami FL 33128
To pay in person go to:
A Certificate of Use and/or City Business Tax 200 NW 2nd Avenue
Receipt may also be required. (305)270-4949,fax(305)372-6368
A service fee of not less than$25.00 up to a minimum of 5%
will be charged for all returned checks.
+ RETAIN FOR YOUR RECORDS +
.................................................................................................................................................................................................................................................................................................................
MIAMI-DADE COUNTY- + DETACH HERE AND RETURN THIS PORTION WITH YOUR PAYMENT + N/A October 07,2015
STATE OF FLORIDA
LOCAL BUSINESS TAX RENEWAL
2015 -2016 APPLICATION STATE#04E0 0560
5355755
BUSINESS LOCATION:
5860 NW 192 ST
MIAMI,FL 33015 BUS.COMMENCEMENT DATE:06/01/2001
SEC TYPE OF BUSINESS
OWNERICORP. ELEC ELECTRICAL CONTRACTOR
SOUTH DOM ELECTRIC INC 1
APPLICATION IS HEREBY MADE FOR A LOCAL BUSINESS TAX RECEIPT OR PERMIT FOR THE BUSINESS PROFESSION
OR OCCUPATION DESCRIBED HEREON.I HAVE BEEN INFORMED OF ALL ZONING RESTRICTIONS IMPOSED ON THIS RECEIPT.
I SMEAR THAT THE INFORMATION IS TRUE AND CORRECT.
SOUTH DOM ELECTRIC INC
JOSE MATOS PRES
ST SIGNATURE REQUIRED SEE INSTRUCTIONS ABOVE
5860 NW 192
MIAMI,FL ST Please pay only one amount after
The amounts due Sept 30th include penalties
per FS 205.053.
/f Received By Oct 31,2015 Nov 30,2015 Dec 31,2015 Jan 31,2016
Please Pay $0.00 $0.00 $0.00 $0.00
7000000000000000000000004732062201600000007500000000000002