EL-15-3174 7 �-
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-262362 Permit Number: EL-12-15-3174
Scheduled Inspection Date:July 05,2016 Permit Type: Electrical - Residential
Inspector: Devaney,Michael Inspection Type: Final
Owner: KING, ROGER&JUDITH Work Classification: Addition
Job Address: 137 NE 105 Street
Miami Shores, FL 33138- Phone Number
Parcel Number 1121360050120
Project <NONE>
Contractor. AP POWER ELECTRIC CORP Phone: (954)822-4496
Building Department Comments
INSTALL OUTLETS SWITCHES AS PER PLANS, INSTALL Infractlo Passed comments
22V FOR MINI SPLIT AC UNIT. INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
July 01,2016 For Inspections please call: (305)762-4949 Page 17 of 20
ie
lva
Miami Shores Village
10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000
Phone: (305)795-2204
Expiration:07/0612016
Project Address Parcel Number Applicant
137 NE 105 Street 1121360050120
Miami Shores, FL 33138- Block: Lot: ROGER$JUDITH KING
Owner Information Address Phone Cell
ROGER&JUDITH KING 137 NE 105 Street (305)_-
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 1,200.00
AP POWER ELECTRIC CORP (954)822-4496
Total Sq Feet: 0
Type of Work:INSTALL OUTLETS SWITCHES AS PER PLA Available Inspections:
Additional Info: Inspection Type:
Classification:Residential
Scanning:1 Review Electrical
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20 Invoice# EL-12-15-58151
DBPR Fee $2'25 01/07/2016 Credit Card $110.70 $50.00
DCA Fee $2.25
Education Surcharge $0.40 12/23/2015 Credit Card $50.00 $0.00
Permit Fee-Additions/Alterations $150.00
Scanning Fee $3.00
Technology Fee $1.80
Total: $160.70
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS DAVIT: I rtlfy that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
cons cf and z uthermore,I authorize the above-named contractor to do the work stated.
January 07,2016
Auth ignature:Owner / Applicant / Contractor / Agent ate
Buildin Department Copy
January 07,2016 1
Miami Shores Village
Building Department n 2.9 2 15
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 `
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION UNE PHONE NUMBER:(305)762-4949
FBC 20
BUILDING Master Permit No._R e-I jso-2-3.N
PERMIT APPLICATION Sub Permit No. a3 f:1
❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL
❑PLUMBING ❑MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
•-� CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade ZIP 1 3
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:!
OWNER:Name(Fee Simple Titleholder): =A )D t'TU Phone#
Address
City state: L Zip: 3 1 3�"
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name:,W %1t W4 1ELVCCLIC GA Phone#:
Address: '
City: State• Zip: C�,3
Qualifier Name: Phone#: '� 0- l'TCJ�
State Certification or Registration# 7— t 301 ('q Cerr�tificate of Competency
DESIGNER:Architect/E ineerc" (,,i[ c.P l . . e Phone#:30.r '? 6 —J V64
Address City: I UIJW�_State: Zip r '1
Value of Work for this Permit:$ i 9ngp Stivare/Unear Footage of Work:
Type of Work: ❑ Addition S4 Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:�iJ.� -u OUT(, 51;�w j4yhaj Pism- P(
t"-C&AA (r) 'A ✓Y - --o L u� -S'� ��� l� -C. c-10 3.
Specify color of color thru tile:
Submittal Fee$, Permit Fee$ jam CCF$ 1 . CO/CC$
Scanning Fee$ (Z) Radon Fee$ DBPR$ a• S Notary$ �> _
Technology Fee$ Gi3 Training/Education fee$ ®• 46 Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ °
(Revisedo2/24/2014)
e �
Banding 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 1 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 constnution and zoning.
HWARNING 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 Apprkant. As a condition to the issuance of a building permit with an estimated vahm exceeding$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction Am low brochure will be delivered to the person
whose property is subject to attachment Also,a certified copy of the recorded notice of cominenoement muA be posted at the job site
for the just Inspection which occurs seven (7)days after the building permit is issuedIn the absence Msuch posted notice, the
inspection wilt not be approved and a reinspection fee will be urged. JW
Signature Signature
O or AGENT
The foregoing Instru ent was ac nowledged before me this The foregoing instrument was acknowledged before me this
L _d of h-e-C.- 20 _ by day of (` 20 G �wh is rsonaliy known to `LO 1.. " who is rsonally kno�by
me or who has produced as me or who has produced as
identification and who I take an oath identification and who did take an oath.
NOTARY PUBLIC: k NOTARY PUBLIC:
Sign: '` = S.ign: K
Print: ' Sia Print; r t '
Seal: ' y" Gyro s Seal: H
e'wilt� Y�c'�i •?els
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(RWsed02/24/2014)
To:
Miami Shores Building Department
10050 NE 2nd Avenue
Miami shores FL 33138
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, that Roger King and Judith King,
jointly and severally (hereinafter referred to as "Principal') has made, constituted and
appointed, and by these presents does make, constitute and appoint Leonard Feldman
of Star Construction Company, Inc. (hereinafter referred to as "Agent"), true and lawful
attorney for Principal and in the name, place and stead of Principal.
This Power is given to enable the Agent to legally represent the Principals and to
take all actions necessary and to execute any and all documents, applications and
permits in connection with the issuance of Electrical, Mechanical and Plumbing Permits
under Master Permit No. RC-9-15-2395 regarding the property at 137 NE 10e Street,
Miami Shores FL 33138
The Principal exonerates the Agent from liability for all non-negligent acts of the
Agent. All acts done by Agent pursuant to the powers conferred herein, shall have the
same effect and inure to the benefit of and bind the Principal.
GIVING AND GRANTING unto said Agent full power and authority to do and
perform all and every act whatsoever requisite and necessary to be done, as fully to all
intents and purposes as the Principal might do, hereby ratifying and confirming all that
said Agent shall lawfully do or cause to be done by virtue of these presents until this
power is revoked or terminated by the Principal.
IN WITNESS WHEREOF, the hand and seal of the legal representative of the Principal
has hereunto been affixed this day of December 2015.
RPENJ ING
STATE OF FLORIDA
COUNTY OF MIAMI DADE
The forgoing Power or Attorney swo to and su before me this 1019
day of December byPv h d did not n oath.
Notary Pub c � ,�,9 • ,
STATE OF LORIDA
My Comm' ion Expires: a
6
GAB
' From: AP POWER ELECTRIC
Subject: No Subject
Date: Today at 9:49 AM
To: Starco@belsouth.net
._..sr CTQB
.kConstruction Trades QualifyIN ing Board
BUSINESS CERTIFICATE OF COMPETENCE'
10E000121
AP POWER ELECTRIC CORP
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ARZOLA HECTOR
is certified under the provisions of Chapter 10 of Miami-Dade County
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Sent from my Phone
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ACCiR&
CERTIFICATE OF LIABILITY INSURANCE 1
12I03/2015 !
.THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS
I 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 PRODUCM AND THE CERTIFICATE HOLDER.
IMPORTANT: N the CettiHcaft holder Is an ADDITIONAL INSURED.the poliey(IOS)must be erborsed. M SUBROGATION IS WANED,Subject to
the terms and conditions of the polity,certain policies may require an endorsement. A statemant an this cardio atla doss not canter rights to the
certificate holder In Bou of such endorsement(s).
PRODUCER 786-573-4485 786-573-4486 A Mavleen Blandon
Insurance NOW Agency :786-573-4485 __-.. tuc,nox.786-573-4486
12915 SW 132 Street suite 4-B mayleergnsUrancenowagency-cam
Miami,FL 33186 a
__..._...___.. ..._ _.___. _ _..... INSI )AQOVEFAtg wee
Zwer
V=RERA:Western Heritage insurance Co.
AP Electric Corp. INSURER s
3758 SW 16th Street PISURER C:
Fort Lauderdale,FL 33312 t"§URER D:
ahSURER E: i
I INSURER F. I
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REOUREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WENCH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAN)CLAIMS,
LYR I TYPE OF INSURANCE POSY NUAMM POLCY EFE POLICY EXf LOM i
tN?NERAL LIABILITY
EACH OCCURRENCE
j A --- t' •trAT,+A�E-Tz�rt�aTLro_..... ........ n
Cma=m GENERAL LIA1rIL1TY I 'PR�b1e9.S_LE@ PP. b.1.00,s/0�._-...._..
CLAmaS•01AM :.f.;Ocam MED EXP IAni ow pow ._..$1..0.00..
SCP1509617-01 03116/2015;03!1612016:PERSONAL&ADV INJURY :.3 1,(!0.0.,000 ;
_GENERALW.KGATE .s.2,000,000
r GE_N'L AGGREGATE LIMIT APPLIES PER PRODUCTS--_Coww AGG S 1�Qo,000
POLICY LOC s 1
AUTONOBILELWSILITY COMMWO SINGLE LIMIT $ i
IEn acckwu i
ANY AUTO ;BODILY WJURY(Per pa ro S
( 1 ALL OYiNED AUTOS ; BODILY INJURY(Pay'accdot) $
SCHEDULED AUTOS PROPERTY D4AAtN 5.._. ...
HIREDAUTOS IPW Q
NON•OMMED AUTO$ S I
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UaIBRELLA LIAR OCCUR EACH OCCURRENCE S
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I AND UNIPWYOW LIABILITY Y t N,
ANY PROPRIETOR MTNERtE)LECU EE.L EACH ACCIDENT S
OFFICERINIENISEREXCLUOED* �:NJA . . . i . . .---•----..--. . . i
okmdatary in NH) E L DISEASE-EA EMPLOYE _S
a yeti.delCftbe un0er
1>E RATIONS baba E.L.DISEASE-POLICY LIMIT`6
DESCRWfM OF OPERATIONS I LOCATIONS!VeHICLM(A#&Ob ACORD Ith,Ad*OWM R o 1*6 Schadtf,it more apace a mpured)
Electrical contractor.State Certification:ER-13014434
AP Power Electric Corp.
CC:IOE000121 I MIAMI-DADE COUNTY
CERTIFICATE HOLDER CANCELLATION
Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Building Department ACCORDANCE WITH THE POLICY PROVISIONS.
10050 NE 2nd Ave
Miami Shores Village,FL 33138 AUTHORIZED REPREBENTATM r
Mayleen Blandon
I
®1988-2009 ACORD CORPORATION. All rights reserved
ACORD 25(2009/0 The ACORD name and Iogo are registered marks of ACORD
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CUTOUTCARD BELOWAND RETAIN FOR RUMREREFERENCE
ftriuM to O y� ,�` f )'F 9.,n ofd of a
who
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RUCTION WDUS't"W EXEMPTI � �'i�,,� F MoO"W� moo.be
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AP POWER ELECTRICAL CORP.
3758 S.W. 16l". ST.
FT. LAUDERDALE, FL. 33312
TEL: 954-823-4496
12/15/2015
State of Florida
Dade County,Florida
Before me this day personally appeared: Hector Arzola,who being sworn,deposes and
says:
That he will be the only person working on the project located at:
137 N E. 105m. ST.
Miami Shores,FL33138
Sworn to(or affirmed and subscribed before me this 15*`Day of December,2015 by:
Personallykao
OR Produced Identification
Type of Identification Produced
..�.
. ,�
rups Miami shores Village
Building Department
tpR11 ► 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to Owner — Workers' Compensation Insurance Exem tion
Y„
oma.'
z
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:
OWU60
State of Florida
County of Miami-Dade
i
The fo oing was acknowledge before me this da ,20J_sr
Y
B 1 D Co 0 ho is personally kno to me or has produced
as identification.
Notary: —
SEAL:
�pp�6er�
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