EL-16-523 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-256363 Permit Number: EL-2-16-523
Scheduled Inspection Date:April 07,2016 Permit Type: Electrical- Residential
Inspector: Devaney,Michael Inspection Type: Final
Owner: MOLINA,MYRA Work Classification: Repair
Job Address:174 NW 104 Street
Miami Shores,FL 33150- Phone Number
Parcel Number 1121360131490
Project: <NONE>
Contractor: CITY LIGHTS ELECTRIC,INC. Phone: (305)495.3198
Building Department Comments
SERVICE REPAIR- 150 AMP. Infractio Passed Comments
INSPECTOR COMMENTS True
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP-253616. CANCELLED BY
Ff CHRISTIAN
Failed
Correction
Needed =�
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
April 06,2016 For Inspections please call: (305)762-4949 Page 42 of 47 /
I
Miami Shores Village ,
10050 N.E.2nd Avenue NW
Miami Shores,FL 33138-0000 ��
Phone: (305)795-2204 _ _ :.. ,•,r �3n
Expiration: 08129/2016
Project Address Parcel Number Applicant
174 NW 104 Street 1121360131490
Miami Shores, FL 33150- Block: Lot: MYRA MOLINA
Owner information Address Phone Cell
MYRA MOLINA 174 NW 104 Street
MIAMI SHORES FL 33150-
174 NW 104 Street
MIAMI SHORES FL 33150-
Contractor(s) Phone Cell Phone Valuation: $ 1,200.00
CITY LIGHTS ELECTRIC, INC. (305)495-3198 Total Sq Feet: 0
Type of Work:SERVICE REPAIR-150 AMP. Available Inspections:
Additional Info: Inspection Type:
Classification:Residential Final
Scanning:3 Review Electrical
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20 Invoice# EL-2-16-58825
DBPR Fee $2.25 02/25/2016 Credit Card $50.00 $121.70
DCA Fee $2.25
Education Surcharge $0.40 03/02/2016 Credit Card $121.70 $0.00
Notary Fee $5.00
Permit Fee-Additions/Alterations $150.00
Scanning Fee $9.00
Technology Fee $1.60
Total: $171.70
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 uthorize th above-named contractor to do the work stated.
March 02,2016
Authorized Signature er / Ajoldfit / Contractor / Agent Date
Building Department Copy
March 02,2016 1
Miami Shores Village A
FE 26 16_
Building Department BY:
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC6 20(14
BUILDING Master Permit No t� ` ��-•-�
PERMIT APPLICATION Sub Permit No.
F-1 BUILDING 2_16LECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
F-1 PLUMBING ❑MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 17&4 )VW la'l Sf
city:X - rami Shores County: Miami Dade zip: 331 Se,
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name Fee Simple Titleholder): / -c5 y05_
( p ) /1�av 1'� L. �011�� Phone#: 7�l•G'z�
Address: 17`'I A(W IO'f V
City: AA;oLm 5'Aegne1� State: Flor;d®► zip: 33ISo
Tenant/Lessee Name: Phone#: 766 2,51- $'�°D S"
Email:
CONTRACTOR:Company Name: G;4y14$,4g: Hee f-rrc Phone#:
Address: 16136 $"w 66 ferr
City: M;O r%I State: FL zip: 3 51111
Qualifier Name: Te r je 6"r ero- Phone#: 786 Z81 $VC057
State Certification or Registration#: C 1300 7060 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: El Addition ❑ Alteration F-1New [B/Repair/Replace ❑ Demolition
Description of Work: SCr`V►=e F-e-I�Ejr'r" - 15o A evi D
Specify color of color thru tile:
Submittal Fee$ 'w` Permit Fee$ CCF$ i CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ 8 -GiD Training/Education Fee$ (U- ® Double Fee$ J6
Structural Reviews$ Bond$ 0
TOTAL FEE NOW DUE$_ •��
(Revised02/24/2014)
J
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 absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature a�Z 45� G �/�.;; Si re
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing Instrument was acknowledged before me this
4 day of 4? 20 16' by day of e 20�` .by
w o is f;personally known to /Q who is personally known to
d
me or who has produce ` L/ 04,1 C as me or 4o has produced �' ,tas
identification and who ke an oath. identification and o did ke an oath.
NOTARY P BLI NOTARY PU
J
Sig Sign:
in Pr t•
UTAr" MAGGIE MONTOYA
Se .°�: Notary Public-State o4 Florida Sear '2�° °ms's_ No4ar Public-State of Florida
N,6 Qo, My Comm.Expires Mar 97,2098 My Comm.Expires Mar 17,2018
'.;�soFj1oP� Commission#FF 102775Commission FF 102775
APPROVED BY 2S'��,8/6 Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
CITY LIGHTS ELECTRIC
EC13007060 (305)495-3697 16136 SW 66 Terr Miami,F133193
March 1,2016
Miami Shores Village
Building Department
10050 NE 2nd Ave
Miami Shores,FL 33138
State of Florida
Miami Shores Village
Before me this day personally appeared I Jorge Cabrera being duly sworn,deposes and
says:
That I and City Light Electric employees will be the only person working at the project
located at: 174 NW. 104th St.,Miami Shores,FL 33150.
Sworn before me this 1 st day of March 2016.
r
f.
Jorge Cabrera
Notary:
LEGRA ----�
MY COMMISSION#EE171037
EXPUM:Apd 04,2016
taoas3AD7atty 1RNaapDisamtAs=Co.
Miami shores Y
BuildingDepartment
050 N. Avenue
p R+�P► Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to Owner - Workers' Compensation Insurance Exem tion
� '� �r :��t:1?�r�,✓� r�,��v, rr , ?', r� ��^,`�, a �: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 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 BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:/
Z��gz
er
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me this 0& day of ,20
By_MLL`s, 1,N*)OQ�AA M6Uf441- who is personally known to me or has produced
l -b`t2. � L (�N� as identification.
Notary
:t4 SEAL: r Notary public State of Florida
Sindia A��pF,,6750
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