EL-15-45 (2). .a
Inspection Worksheet
Miami Shores VillageRC
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-258282 Permit Number: EL-1-15-45
Scheduled Inspection Date: May 06,2016 Permit Type: Electrical- Residential
Inspector: Devaney, Michael
Inspection Type: Final
Owner: , Work Classification: Alteration
Job Address.1032 NE 98 Street
Miami Shores,FL 33138- Phone Number
Parcel Number 1132050180320
Project: <NONE>
Contractor. VOLT ELECTRIC CORP Phone: (305)200-7967
Building Department Comments
ADD RECESSED LIGHTING THROUGHOUT&REMODEL Infractio Passed Comments
PER PLAN. INSPECTOR COMMENTS False
Inspector Comments
Passed 1Z
Failed
Correction
Needed ❑
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
May 05,2016 For Inspections please call:(305)762-4949 Page 28 of 28
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Miami Shores Village
10050 N.E.2nd Avenue NE77
Miami Shores,FL 33138-0000
3
Phone: (305)795-2204
3..
Expiration: 1011312015
Project Address Parcel Number Applicant
1032 NE 98 Street 1132050180320 1032 NE 98TH HOLDINGS LLC
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
1032 NE 98TH HOLDINGS LLC 800 CORPORATE Drive
FT.LAUDERDALE FL 33334-
800 CORPORATE Drive
FT.LAUDERDALE FL 33334-
Contractor(s) Phone Cell Phone $ 21,400.00
Valuation:
LEWDI ELECTRIC 954/782-0006
- -- Total Sq Feet: 0
Type of Work:ADD RECESSED LIGHTING THROUGHOUT& Available Inspections:
Additional Info: Inspection Type:
Classification:Residential
Scanning:1
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $13.20 Invoice# EL-1-16-54101
DBPR Fee $11.24 04/16/2015 Check*2625 $759.68 $60.00
DCA Fee $11.24
Education Surcharge $4.40 01/09/2015 Credit Card $50.00 $0.00
Permit Fee-Additions/Alterations $749.00
Scanning Fee $3.00
Technology Fee $17.60
Total: $809.68
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 Futh ore I authorize the above-named contractor to do the work stated.
April 16,2015
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
April 16,2015 1
4
Miami Shores Village JAN 09 2015
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 2016
BUILDING Master Permit No.T& ( 1[ 4'y2 I
PERMIT APPLICATION Sub Permit No.-f-(--15- y'!a
BUILDING ®.ELECTRIC ❑ ROOFING ❑ REVISION [:]EXTENSION ❑RENEWAL
❑PLUMBING [:]MECHANICAL PUBLIC WORKS ❑ CHANGE OF [::]CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 10:3.9- N E. Q.8 ni
Miami Shres a� Con Miami Da i 3.9 13.E
Folio/Parcel#: I t" J a 0 T C'10 A 6 —as X0 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: YFlood Zone: BFE: ffE:
OWNER:Name(Fee Simple Titleholder): 10!3 ,;l N& 9 9rK -Ok-J.w�UCPhone#:
Address: 8(Xv,' 65-2J CrV-A re— 2•.'.e0 'i' *,26,A,
City: fi. Lorsa d eac-LIle— State: k-1.-.
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: C-E' l^ /�6IG - Phone#:
Address: JQ611-11, 3
City; 0kf State: pit Zip•
Qualifier Name: kg z Phone#:
State Certification or Registration#: gr- (3r-:2d /S1�_Certificate of Competency#: 11
DESIGNE Architect/Engineer: w Phone#: \� �-���
�
Address: vvT! intCity: CQ �► State:�cZip:
Value of Work for this Permit:$ t 0® Square/Linear Footage of Work:
Type of Work: ❑ AddXy
Alteration ❑ New ❑ Repair/Replace ❑ Demolition
AA Description of Work: �' / 1-
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ ® 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
it" --
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$250D,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 reinspection fee will be charged.
1032 NE937A �#�io �J LLC.
✓ Signature g Signature
gy; IM t eN� OWNER o-AGtNT Pwc#*it *4At4Ae� COACTOR
The fore oing Instrument was acknowledged before me this The fo—r-e7going Instrument,was acknowledged before me this
day of to"AL .20 i q .by ! day of J j y ,20� ,by
M iC 14"rL A S 1A W 4 .who is personally known to ���.✓ SNo�s ems- who is personally known to
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:
Si Sign:
Print: lLtr i(�t �• I[�I UL� Print: �s
Seal: lmnac a[Ntw�git Seal: 9° °? ROBERT CALOELL
Natal�rPdit-4 Ms N '
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Mh►ileaan.>E � � EXPIRES MW41 clic 201"
#iii##iiliiil#i#illli#ililii#lliiiil••+fi#liiiii#iiiiiii#lliiliM� itiii� '�� 9Riifiii##illiiii
APPROVED BY 7 Plans Examiner Zoning
Structural Review Clerk
(ReOwc[02124n014)
i .
uu Miami shores Village
may` Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
CONTRACTORS' REGISTRATION FORM Fax: (305) 756.8972
ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS
SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A$30.00 FEE PER YEAR.
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY OF QUALIFIER'S STATE LIC CARD
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF LIABILITY INSURANCE(CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT)
D. COPY OF WORKERS COMPENSATION(EITHER CERTIFICATE OR EXEMPTION)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER
B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT
C. COPY OF LIABILITY INSURACE(CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT)
D. COPY OF WORKER COMP INSURANCE(EITHER CERTIFICATE OR EXEMPTION)
YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES,FL 33138
COMPLETE CONTRACTOR'S INFORMATION
BUSINESS NAME:--48-k'/b-1-
BUSINESS
AME: b-1 sem/
BUSINESS ADDRESS: 7 �SS� �S'� f'CRy Ao "/ / 0-
STATE ZIP CODE �3C-2 b 2-
BUSINESS PHONE: L!�A_ 10-1- NUMBER(
CELL PHONE L---j QUALIFIER'S NAME: L pis
QUALIFIER'S LIC NUMBER: e7e"' 13caj'38T-
E-MAIL ADDRESS OF APPLICABLE):
Created on 31191N BY MWV I RV MM MLDV
RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY i
DSTATE Of FLORIDA
EPARTMENT O
F BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CIITRACTORS LICENSING 130ARD
4
Ect3001386
The ELECTRICAL CONTRACTOR
Named below IS CERTIFIED. ;
Under the provisions of Gr 481
*p ES.
Ea6on mate: AUG 31,, !Q"iS
yr
M3 M
PAStANO,:LEiS •
'LEWDt ELEC )L=
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ISSUED: W1112014 DISPLAY AS REQUIRED BY LAW SEQ'# L1408110001619
DCOUN' '" LOCAL IN111AS 'SAX R l l dEI
115 S.AMM"Ave., Rm-A400. Ft. Uwd4rda , FL. 33311-1895—954831-M
VALID OCT013FA 1,2014 THROUGH SEPTEMBER 30,1015
01
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Busk*n Typ9.(=X4MCAL R)Qwni ®'
'Nww.-tmis SPASIM/QUAL+ N ®Im8dn o/0l/1988
L*AdlOn:.2585 SIS 6 ST
R4g:BC13001388
rompiwo SFAC R EAMption Code:
PhQ11®:X54-'?82-4046
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TaxAunt Tran Fe0 t4 Fee 'pt Ye tb C� 'r4Wi
27.0 0.0q 0,00 0.00 0.00 q.00 27.00
'PHIS RECEIPT MUST 135 POSTOD CON �
t�AUSLY IN YOUR PLACE 4� BUSINESS
Tits COMES A TAX REMPT "tis Vc IS for th oto bL*kwn vWft$wwgrd con*OW is
ron-rogtdoxY h ru".You mudt meet a#CwWwWo r Mum pwmho
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bu*ww M This MCW dwo not fkkx to that ow Wpkwn k Wo or t
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8 1 N S57 ST O jQQg�, R*asipt $308-13-0000366.7
8 1 57 ST Poid 09/23�2Q14 27.00
'� ��t1R13AI.S, 3'L 3330
2014 » 2015
�o CERTIFICATE OF LIABILITY INSURANCEDAIS
116f2015
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER TN
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S). AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT:B the cert8cate holder Is an ADDITIONAL SIRED,the policy(ias)aharet be endorsed.If SUBROGATION IS WAIVED,subject to
the tf M WMI condition of the policy,ewtdn pomades may m**o an anderaemont.A etabement on this certllo to does not confer rW is to the
owls tate holder In lieu of such s
PRODUCER Phones (561)995-9577 CONTACT Renee Small
Fax: (561)"5-9677 (5611995-9577 (561)995-9677
Van Anmringen's Irwrance and FhhmhX W Sertwes
902 Clint Moore Rd Manenw
evananvefinscuLcom
Suite 132 IIISURERIN AFFOR011013 GOVERAM "Ao#
Boca Raton.Florida 33487 01Bf1RERA: ScoasdaleInsurance 41297
HAD 91SUV9R e:
LEWDI ELECTRIC,INC. BSC:
2149 NE 63RD CT. WSURER D:
FORT LAUDERDALE,FL 33308 nourm
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1 DORM P:
COVERAGES CERTIFICATE NUMBER:125 REVISION NUMBER:-
THIS
UMBER:THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERF
INDICATED NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,Tl-M 94SURANCE AFFORDED BY THE POLIOS DESCRIBED HEREIN IS SMECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
TYPE OF POLWYMUMPSR Lente
,/ C0110118RCIALGEMBRALUABUTY CPS1906064 1tMO15 11312016 EAcNO a 11000,000
A � Q O=M PROMS10Socavral"i a 100.000
MED EXP VM one a
PERBOIALaADYe1JURY a 1+0001000
GM AGGREGATE Ln fTAPPUEB PER: GENERALAGGREGATE a 2,000,000
J m=Q T& ❑Lac PRODUCTS-COMP00PAGG a 2,000,OOD
OTHM S
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T1001OFOPERATrDN81LOCATNiNB/VE VWWRD101.Adder Rammis aohadul%maybe aff dwd8mmespaceMnqukeM
REFERENCING LICENSE # MC13001388
CERTIFICATE HOLDER CANCELLATION
Hogs Nature of Interest:Ceadriicatc Holder SHOULD ANY OF THE ABOVE DESCRIBED POLKA BE CANCELLED BEFORE
VQ.LAt OF MIAMI SHORES THE EXPIRATION DATE TH EREO=, NOTICE WCL BE DELIVERED It
ACCORDANCE WRH TIS POLICY PROVISIONL
10050 NE 2ND AVE
MAW SHORES.FL 33138 AUTHORMATaB
®1> 14 ACORD CORPORATION.All rights reserved.
ACORD 25(201487) The ACORD awn and logo we regiatirecl meft of ACORD
,IES A11�►'T�It
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.... �. Miami shores Village.
Building Department
�OR1DA 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 officersin 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.
f: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.In these circumstances,Miami Shores Village
• does not require verification of workers'compensation insurance coverage from the contractor's company. Therefore,you may be
personally liable for the worker compensation injuries of my person allowed to work under this permit. Please check with your
insurance carrier since most property insurance policies DO NOT cover this type of liability.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Owner Contractor
Print Name: AS H I lN/ Print Name: 46a-i is
Signature Signature:
State of UUWa.)4W Y&K State of Florida)
County of64Aaibaka do)9MW County of Miami-Dade)
Sworn to d su scribed before me 1s 16) Sworn to and subscribed before me this
day of ,20 1 . day of 5�4- ,20j LL.
By By Q ea
(SEAL) AL) IL EV
Type of Identification produced e g ,:
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