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EL-15-1651 Miami Shores Village 10050 N.E.2nd Avenue NW Miami Shores,FL 33138-0000 Phone: (305)795-2204V Expiration: 03102/2016 Project Address Parcel Number Applicant 70 NW 105 Street 1121360131210 TRUSTED HOME BUYERSLi MIAMI SHORES, FL 33150-1242 Block: Lot: Owner information Address Phone Celt TRUSTED HOME BUYERS LLC 12864 BISCAYNE Boulevard (305)793-0002 NORTH MIAMI FL 33181- Contractor(s) Phone Cell Phone Valuation: $ 3,500.00 SOUTH FLORIDA ELECTRICAL ENGIP (786)523-8879 Total.Sq Feet: 0 Type of Work:KITCHEN REMODELING,NEW LIGHTS FIXT 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-7-15-56194 DCA Fee $3.38 09/04/2015 Check#:1226 $241.16 $0.00 DCA Fee $3.38 Education Surcharge $0.80 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 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 construR,tic,n-an z� F hermore,I authorize the above-named contractor to do the work stated. September 04,2015 Aulhorized S re:Owner / Applicant / Contractor / Agent Date Building Department Copy September 04,2015 1 f 1 P O Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax:(305)7564972 Inspection Number: INSP-252238 Permit Number: EL-7-15-1651 Scheduled Inspection Date: February 05,2016 Permit Type: Electrical- Residential Inspector: Devaney,Michael Inspection Type: Final Owner: , Work Classification: Alteration Job Address:70 NW 105 Street MIAMI SHORES,FL 33150-1242 Phone Number (305)793-0002 Parcel Number 1121360131210 Project: <NONE> Contractor. SOUTH FLORIDA ELECTRICAL ENGINEERING INC Phone:(786)523-8879 Building Department Comments KITCHEN REMODELING, NEW LIGHTS FIXTURES AND I ctio Passed Comments REPLACE SWITCH AND RECEPTACLES INSPECTOR COMMENTS False Inspector Comments Passed 4 Failed �- Lo�16 Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-Inspection fee Is paid February 04,2016 For Inspections please call:(305)7624949 Page 29 of 36 Miami Shores VillageRE =z Building Department 'S 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 ny; INSPECTION UNE PHONE NUMBER:(305)762-4949 FBC 20I� BUILDING (waster Permit No.v_�s " PERMIT APPLICATION Sub Permit No. F--LI 5--1i6st ❑BUILDING ©ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL []PLUMBING ❑MECHANICAL F-1 PUBLIC WORKS [] CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS.• 70 NW 105 ST City: Miami Shores County: Miami Dade zip: ;11-21-36-013-1210 Is the Building Historically Designated:Yes NO Occupancy Type: Res - Load: Construction Type: CBS Flood Zone: X BFE: FFE: OWNER:Name(Fee Simple'ntleholder):Trusted Home Buyers, LLC Phone#:305-793-0002 Address:12864 Biscayne BL,#271 qty. North Miami State: FL 230. 33150 Tenant/Lessee Name: NIA Phone#: Email: CONTRACTOR:Company Name: SOUTH FLORIDA ELECTRICAL ENG INC Phone#: 7865238879 Address: 979 NE 36 AV City: HOMESTEADState: FL Zip: 33033 Qualifier Name: JORGE A RODRIGUEZ Phone#: State Certification or Registration M 14E000085 Certificate of Competency#: DESIGNER:Architect/Engineer: Fermin A. Martinez Phone#: 305-298-3216 Address:8340 SW 65 AVE, Unit 3city: Miami state: FL Zip: 33143 Value of Work for this Permit:$3500 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New © Repair/Replace ❑ Demolition DesaWon of Work: KITCHEN REOMODELING, NEW MASTER BAI'N AND BEDROOM, NEW LIGHTS FIXTURES AND REPLACE SWITCH AND RECEPTACLES Specify color of color thru We: Submittal Fee$ Permit Fee$ yyvv'P CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) Boridin npany's Name(if applicable) Bond" ipany'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. OWARNING 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 Applkant. 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. M the absence of such pasted notice, the Inspection will not be approved and a reinspection fee will be charged. Signature Signatur OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing Instrument was acknowledged before me this —Gt(P day of ��'��--- ,20 1 by gA day of I"t 20 1E by tA"(11U-V4 who is personally known to U66AL who is personally known to me or who has produced �� L� — as me or who has produced as Identification and who did take an oath. identification and who did take an oath. NOTARY PUBUQ NOTARY PUBLIC: Sign: • ". '•fid�f Sign: cza Print: ,in Print: �1"I C) Seal: ,� ou Seal: .o°' YPO''-iGloria Giorgi :P~� :14' COMMISSI0N#FF041387 /mob' •� EXPIRES:JULY 31 2017 �'h°„Ne www.MRONNoTARymm ***********r*rr*rssr* rr*rrrrssrs�W+�raWO*r*r*rrrr*srrrs*r**ssssrsssss*ssss**s**rsr*sssssss*r****rsrrsss Al�ci6- APPROVED BY Plans Examiner Zoning Structural Review Clerk (ReviseW2/24/2014) e�� � .•�-,. use= ' a DRNER LICENSE CLASS E R 36 2-421-78-29 -01 J0f;GE.ALE.WV4DRt3 s sn, u �7l1fG o--.rtan+.ne<...eP�vtr.ea+eersx..-..-mRaaca aew�sobrwtyease saq�s�at p�b� o ^� 4 CTQB Cor�nxfiOn Trades QuaNvkq Board BUSINESS CERTIFICATE OF COMPETENCY 14E000085 SOUTH FUNMA UZCTMCAL OMMEMMM MC D.B.A.: RO RtB GUEZ JORGE A. 1s ceMed rurder the p of Chapter 10 of Komi-Dade Courdy RICK SCOTT,GOVERNOR KEN LNAISON,SECRETARY STATE OF FLEA ©61�ARTINEIILT OF AND PROFESS�NALREGULATION EI:ECTRPMAL CONTRACTORS UCnisme soARD ER13014M The ELECTRICAL'CONTRACTOR _ NaMW bM w MS RESTERED U ifs PrOVkdDM of Chop ter 48.9 FS. Exkatbn doW AUG 31,2016 �INDMi3UAL MKiST MI MT..ALL.1MALUCENSING ENTS PRIOR 710-0 1 IN ANY AREA) RODRIGUEZ,JORGE AWi SOM FLORIDA ELE ;4 0EE INt INC 9fi9 WEHOMESTEAD ..36 A� VE �' ■ 'FL 33M ■ w j�� ■ MUM 07117M4 DISPLAY AS REQUIRED BY LAW SEQ# LUM70M431 �i 1. t ` r��z��"4°y-s•4 k F^at.}�..��h Q �"'✓w.�v .':�+1ta� y�C� 6 t t•� �r4� "� °". a _ � res -t 1 x. s «'+'F•'n ,E�q c Zi��y;� i .� n �.,�� '.,. ,f'' .T F r �.�v '��. ~'" •�+ ",�'�`y.�{'� �9. ° �•���k'''���'�M`F �� � 'fit � K.Bi a �1•... 8 M',' Y1 i 7"�''L:_SCioi. .".'2-ri�. � 4�„'{"L. _ � '�•e.. 1. .t • - ..x�'�`n �-v..4*S�+t,�'="r,.>^s x�i'x!"�y�'.•.3�'�T "�3 I , -+n. $�,_.,. VIllmit ` 1 F SY T 14 ',�,■�� �ffiBL90n1 'f�.YdB �B� •. j H WYE■ �� � _µ.4r. Sae F, PAL •5T � ti;'�,- " •�°�; 73ts d '�T" i--,� •'�.rZ�t � :«r� :,ry`s- '"''^.,ksz '.: t x lF7•L. S i! fih Ta 'C A-61 3;. �� t a Y �E.. tPit•' f � t�ate-. .. �. .- "� }•� ��`d F.' ".. ,i' �"la+`""d ;CRC{ S• •. 3! '� y_,ydj t•�`�� � �x a r �'�Np +! ti iF 9���` � 'ia Y+a�'�`cr. Yjgi .. .� 'i c � ,£�, x�� ���'�`.,,.•�,.7 '��,-�+:d.o �y�rj4 �•e: ,i€Y�- e; ,.,.�' ,.!�.ri;s;t C+VYNER Typ���INESS -*' -+--�""',•` PAYMEti��iNED SEi fL E�CZR:Cfit E iE ERfi!G i tlC EifC�t7l I CAiTRF+G� L tx BV TAX 4 INCT. b.00 10 1i�y 7 o#f }tom : For more iuietmatiou,visit)Mhrmiamidado F t Jun. 26. 201510:36AM No. 6707 P. 1 `f CERTIFICATE OF LIABILITY INSURANCE X13 THIS CERTIFICATE I$ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIOHT$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 DOW NOT CONSWWTE A CONTRACT BM WEEN THE ISSUING INBURLR(SL AUTWRWW REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER 111I1PORT : Irthe is an ADDITIONAL INSURED,the must be endouset ISUMMATION M WAIYBD, to theterm VA commmm ofthe POW.certain pedlobs may require an emturaoment a slmmamer�a,this et�tiea68 tloas Prot corder A®hm to the teres huff hoWer N Dom of sure►mdommsrvt(s� Cr 2A MARTAALONSO FWWa Battlers Imursnce 93 - 7278 SW S Stmt cam Miarni,FL 33144 mm"o Phone POSMS.4m Fax powsmn RER A: PEDERAT'ED NATIONAL.INSURANCE CO i oiswtw sute3R to SOUTH FLORIDA ELECTRICAL ENGINEERING INC ; 878 NE 38 A>ets JNSUMM HOMFSTEAD,Fl.33033- as >N COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: TR ISM CERTIFYTHATTME POLfCIES OF INSURANCE USTED BELJ31At HAVE BEEN ISSUED TO THE INSURED NAMI=D VE FoR THE PO4JC•Y PERIOD INDICATED. NOTWITHSTANDING ANY REQUIRImENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT Tp W WH DW CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE MUCIN DESCRIBED HEREIN M SUBJECT TO ALL Tt1E TERM, I EXCWSIONS AND CONDITIONS OF SUCH POUCIES.UMIM SHOWN MAY HAVE BEEN RFWUCBD 8Y PAID CLA@IAS, LI R rfm OP OWRANCE A=SUN t OR ! ueara i®tLLl.Wfi6d1'P s 300,000.OQ • ® Cmawmik.emm.UMLM s 100,OfX1.� A '❑ ❑ MANOWDt;.® OCCUR GL-COM11758-01 0212=15 02=018 vm torr+ 4m pw wn} is 5,000.00 ❑ P8t60M&ADVwjuw .s 3KO,00 1 d i } 99e3KAbORMTE a 300,00.00 } Q WLAGGRE"TEUWAPP=PETt PROtWCrs- �AOti a 30.00.0 AWONOWI.tw ❑ ANYAM ttOp�,YpVtU1tY(twpgreen) a ❑ ty ❑ ss.Y Wulff WarmwerA a C3 HRW AUTOa ❑ ; f a a UM8R11iAUM ❑ CCU OR I emm occump" a mmm um 11smummi AooREWTE s Wvmm TwR a AN1;EWIJ7f UA8Lr1Y Yin ANYMIA PttOPtO�fORiPAinlaER1�CUTI7R 9.1,tpAgMAWDW Y QFFI R FX1�uppp�INIQ ❑ VSLm n FL .sAt3s .0Y s bNow • E.L.Dpou"umml s npAIOPOPIMfATtIJ7CATlONMtYSIgCd,1� AL'OItlIt01.A�r�IS gry�sP��,�� 114E000085 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE OSSORMW POLICES W_CAIS BEFORE MIAMI SHORES VILLAGE '1118 EXPIRATION DATE TFIRNOP,NOTICE WLI.BE 02INM IN BUILDING DEPARTMENT , ACCORDANC11 WITH THE POLICY PROYMMAIS. 1050 NE 2nd AVE AUTROF W ATM FAX:306.848-0758 i 4 j t 01089.2x10 ACORO CORPORAMON. An d"reserved. ACORD 25(2010MS)1F The ACORD name and log*are nehftmd malice of ACORD Adk JEFFA1MM STA3E OF FLOFADA c D�/lf�lf IEI�T ter . OF Aim *•CERTNI M OF ELEMM TO SE EX FRMTimet LAW:• CONSTRfCI OURISTWOMMON ' Tills Gw&vmkWhkW Mad below haseistdadlt bs tSan Fbdft%%tdmW Compa tae ew=7111E Wo 36mm EXPOtA71�i!t#A'LL =kwls JORGE A FlEft 484997 UMMANDAUDIOM SOMMORMAELECTOM 878 HE 3SAVENUE HOMESTEAD FL 330.93 ELECTVXALVJNt= EIECTIC LIGHT CNt VATMOM POYIER L8E C pm=tlot hwAr ►FA..imdK 4ffQ Iowaon.�aoe�atseemm@Yea �tsd+epoerbp+�ag�ae�oMeatt aaana se�eaata�r rotwooear0 �raamp�eQaa peuesasaRtal:�eple� .p8.t�iw�asder�Boutsbe�amempl.-a�►adhr.�dn�e saoae b[ffie�u9TRess�fYae9Q�lBAonB�eAo�Oa�f�lsl�r+alobaeo�f.pa�tfo�epl� F.�..Naiaeaa►�leo�aato0e�aadaoi eteW9globe�oen�t�/09sd�jeottaie�oeaiORAatenYa�9�e�a/q�eaoN0aa1'6�s4sauepCBat�Bae�oa�r.fhBPer�aaaa�adas�sao�eor oa►i8ea0apoion®erre!®iradWsaeKliaRtotdaola.7AeAtei�tawnPoaeom5liox[eate�►�astor�aiaaatS�a petaoatm�aedaoiheae�Ba�la�etM�equiwdffis�eo. FG+ !WC-=LER7WA'MOFEus=M To OE OMMM MUM 4742 13f809 South Florida Electrical Engineering,Inc. 979 NE 36 AVE Homestead,FL 33033 May 21,2015 State of Florida County of Miami-Dade Before me this day personally appeared, who, being duly sworn,deposes and says: The he will be the only person working on the electrical project located at 70 NW 105 ST,Miami Shores, FL 33150. Affirmed and subscribed before me this 2V day of May,2015,by Personally know / OR Produced Indentification Type of Identification Produced Ft.D1. �� Yp4+i Gloria Giorgi s• t1,4..p . V .=COMMISSION#FF041387 GtA l fl(PIRES:JULY 31,2017 NOTAR%c= Print,Type or Stamp Name of Notary �.. .� Miami Shores Village Building Department 1t1R1� 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. v COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B.� OPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contraclor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES,FL 33138 Cerdit to must spedfy the demon of operations or contractor license number. ■■rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr■ BUSINESS NAME: SOUTH FLORIDA ELECTRICAL ENGINEERING INC BUSINESS ADDRESS: 979 NE 36 AV CITY HOMESTEAD STATE FL Zip 33033 BUSINESS PHONE:[ 5 l 9108320 FAX NUMBER 3( 05 ? 9108320 CELLPHONE 7( 86 ) 5238879 QUALIFIER'S NAME: FORGE A RODRIGUEZ QUALIFIER'S LIC NUMBER: 14E000085 0 .... a� Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 Notice to Owner— Workers' Compensation Insurance Exemption w 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 (LLQ 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: \ er State of Florida County of Miami-Dade + The foregoing was acknowledge before me this ?7 day of S�- --- ,201 who is personally known to me or has produced --+N 2ct_ ``ttttn111as 1.49ration. . oi�y� Notary: a: �� SEAL: :�' }_ �•; •........