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EL-15-1325 (2) fL 5 eon, Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756.8972 Inspection Number: INSP-250997 Permit Number: EL-6-15-1325 Scheduled Inspection Date:January 15,2016 Permit Type: Electrical- Residential Inspector. Devaney, Michael Inspection Type: Final Owner. CONTESSA, MICHELE Work Classification: Alteration Job Address:9220 NE 2 Avenue Miami Shores,FL Phone Number (305)761-5243 Parcel Number 1132060133060 Project: <NONE> Contractor. M&D ELECTRICAL SERVICE INC Phone: (305)318-7005 Building Department Comments ELECTRICAL WORK FOR NEW BATHROOM AND Infractlo Passed Comments KITCHEN. INSPECTOR COMMENTS False Inspector Comments Passed Failed Kfr Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid January 14,2016 For Inspections please call: (305)762-4949 Page 19 of 23 Miami Shores Village . m x 10050 N.E.2nd Avenue NE Miami Shores,FL 33138-0000 Phone: (305)795-2204 Expiration: 1210212015 Project Address Parcel Number Applicant 9220 NE 2 Avenue 1132060133060 MICHELE CONTESSA Miami Shores, FL Block: Lot: Owner Information Address Phone Cell MICHELE CONTESSA 9220 NE 2 Avenue (305)761-5243 MIAMI SHORES FL 33138- 9220 NE 2 Avenue MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation•_-_____ $ 3,500.00 M&D ELECTRICAL SERVICE INC (305)318-7005 _K_ v�.µ....x.�..,. ..,-..._._ w....._..�.e Total Sq Feet: Q Type of Work:ELECTRICAL WORK FOR NEW BATHROOM AN 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-6-15-55800 DBPR Fee $3.38 06/02/2015 Credit Card $50.00 $191.16 DCA Fee $3.38 Education Surcharge $0.80 06/05/2015 Credit Card $ 191.16 $0.00 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 = Ulrtin is pe I ssume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are requir for LECT L,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNE S AF IDA : I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constru 'on an zo ut ore,I authorize the above-named contractor to do the work stated. June 05,2015 A Sign re:Owner / Applicant / Contractor / Agent Date Buildincj Department Copy June 05,2015 1 Miami Shores Village Building Department JUN 0% 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 By INSPECTION LINE PHONE NUMBER:(305)762-4949 FBBC 20K4 BUILDING Master Permit No lAAal 5' 4q,7 PERMIT APPLICATION Sub Permit Nol�A 'j5—t32-5 ❑BUILDING 25-/ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL F-1 PLUMBING ❑ MECHANICAL F-1 PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: ^ G Gyi City: Miami Shores County: Miami Dade Zip: 33 1 Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): /"1 I e 4O Phone#:_?(0.57 4& �� 7 Address � AJN� City: 11-a- State: Zip: ., Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name:�.ef6awn2f� �� Phone#:CVO&&guor Address:21- _V"�) City: State: lope- Zip: 3 � f Qualifier Name: g5' Phone#: State Certification or Registration M tw ' Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: O© #0 0* Square/Linear Footage of Work: Value of Work for this Permit:$ S Type of Work: ❑ Addition ❑ 1Alteration ❑ NewRep�aiit/R�eepll�ace Demolition Description of Work: 14'pvv L-A t r I V-0 �vV Lam= Specify color of color thru tile: Submittal Fee$ to• IJLJ Permit Fee$ �j s ©o 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) 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 approved and a reinspection fee will be charged. Signature Signature V �'`"�� OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of r"f3�C-"-- ( ,20 VS ,by /2r day of o✓ 20 /1— ,by s k is personally known to 0661' ho is personally known to me or who has produced P(Z-J I.t?-- as me or who has pr duced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLI . Sign `\�p��t uh,��i Sign: : 11 Print: �\ �Sng�,; �� ' _ Print: L, i _Q��r� �S%T r�`9,.a •°e�2 LUIS FERPI�Q seal: ��7';`n Seal: MY COMMIMN#EEbkl80 y` �a�djp�_ � P ExPIRE9:1+lovember1,Z018 i Cd••.S 0Z/9O��D ��TFOF FLOP�� B rAw Th BUW NO S�YII�QB APPROVED BY ��S�Z 1`Zic�w- Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) M & D ELECTRICAL SERVICE. 21152 SW 128"' COURT, Miami, Florida. 33177 Ph: (305)318 7005 State of Florida County of Dade; Miami shores Village Building Department Before me this day personally 05/29/2015 who,being duly sworn,deposes and says That,Ihosvany Morrales is the only person working on the project located at 9220 ne 2"d ave Miami Shores FL 33138 Sworn to(or affirmed)and subscribed before this Ak4*"day of 20 6,-by 0's Personally know — OR Produced Identifications Type of identifications Produced < �°e'•. OANCENY REYES e+°• `�S Notary Public-State Of Florida .•_My Comm.Expires Oct 11.2015 E 106714 Bonded Through National � Notary Assn. Print,Type or stamp Nameof�o asRIP loss Miami Shores Village Building Department � R1DA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (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 recotds 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 IMLOW 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 1 day of Nl�� ,20 1 By �Al who is personally known to me or has produced as identification. Notary: SEAL: Notary Public State of Florida Sind fuz K 19 MY.Commiesim FF 156750 p�p Expires 09/0312016